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Torn Labrum, Torn rotator cuff

BR1217

BR1217

Member
May 29, 2014
63
3
I tore my labrum and rotator cuff back in 2012. I decided to have surgery this summer as the pain is no longer manageable with painkillers. My surgeon wants to reattach my long bicep tendon. He says it it fraying and by reattaching it will help the labrum heal. Apparently that bicep tendon pulls on the part of the labrum that is being repaired. Anyone have this done? Is this common with labrum surgery? I have read that the tendon reattachment takes longer to heal than the labrum, why mess with something that isn't injured yet? Thanks.
 
dr jim

dr jim

MuscleHead
Apr 7, 2014
785
168
I tore my labrum and rotator cuff back in 2012. I decided to have surgery this summer as the pain is no longer manageable with painkillers. My surgeon wants to reattach my long bicep tendon. He says it it fraying and by reattaching it will help the labrum heal. Apparently that bicep tendon pulls on the part of the labrum that is being repaired. Anyone have this done? Is this common with labrum surgery? I have read that the tendon reattachment takes longer to heal than the labrum, why mess with something that isn't injured yet? Thanks.

------------------------------------

A few questions for you first OP, and they are important mate!

1st - Is the involved rotator cuff muscle the SUPRASPINATUS?

2nd - Did you have impingement syndrome prior to tearing the cuff?

3rd - it sounds like you have what's referred to as a "SLAP" lesion, if so what is it's grade (I-IV)

4th- Did your surgeon complete a sports medicine fellowship? (Don't know ask, by phone or in person)

5th- Does your surgeon intend to perform the surgeries arthroscopically or using an open technique? (If it's to be performed on an arthroscopic basis your doctor is very likely SM trained)

I can say one thing already as food for thought. The fixation of the biceps onto the upper humeral region below the bicipital groove reduces it's lever arm. (It's often placed there to prevent the fraying.

The latter generally occurs because of a narrowed acromial-humoral outlet from impingement syndrome. A decreased lever arm lowers the distance the muscle must travel to achieve full ROM.

The net effect adversely alters one's strength, however some are troubled by the difference more or les than others.

How much of your strength will change depends upon a few factors such as; your height, how much distance was "lost" because of the transfer and your need or desire for "strength"

What the latter means is unfortunately most studies on bicipital transfers were done on relatively sedentary patients who wouldn't notice or care about an alteration of their strength!

If you can provide the additional info I should be able to answer your questions and concerns in a more direct fashion mate.

Regs
Jim
 
Last edited:
BR1217

BR1217

Member
May 29, 2014
63
3
------------------------------------

A few questions for you first OP, and they are important mate!

1st - Is the involved rotator cuff muscle the SUPRASPINATUS? Yes

2nd - Did you have impingement syndrome prior to tearing the cuff? Yes

3rd - it sounds like you have what's referred to as a "SLAP" lesion, if so what is it's grade (I-IV) Not sure, I will call the office

4th- Did your surgeon complete a sports medicine fellowship? (Don't know ask, by phone or in person) Yes, he was the surgeon for the St. Louis Blues and Rams for a bit.

5th- Does your surgeon intend to perform the surgeries arthroscopically or using an open technique? (If it's to be performed on an arthroscopic basis your doctor is very likely SM trained) Yes, arthro

I can say one thing already as food for thought. The fixation of the biceps onto the upper humeral region below the bicipital groove reduces it's lever arm. (It's often placed there to prevent the fraying.

The latter generally occurs because of a narrowed acromial-humoral outlet from impingement syndrome. A decreased lever arm lowers the distance the muscle must travel to achieve full ROM.

The net effect adversely alters one's strength, however some are troubled by the difference more or les than others.

How much of your strength will change depends upon a few factors such as; your height, how much distance was "lost" because of the transfer and your need or desire for "strength"

What the latter means is unfortunately most studies on bicipital transfers were done on relatively sedentary patients who wouldn't notice or care about an alteration of their strength!

If you can provide the additional info I should be able to answer your questions and concerns in a more direct fashion mate.

Regs
Jim

Thanks Doc!
 
dr jim

dr jim

MuscleHead
Apr 7, 2014
785
168
Thanks Doc!


Understand just because he was the surgeon for a pro team does NOT mean they are SM trained. It's important IMO.

FYI Bret Farve had a BT transfer performed because of "fraying" but since he had a "shallow" Bicipital Groove the tendon was subluxing or moving in and out of that groove AND any throwing motion encouraged that fraying.

The net effect was pain which preventing him from throwing and if left untreated could have ruptured!

(However the most common cause of BC tendonopathy in otherwise young healthy mates is IMPINGEMENT, which is the undoubted reason for the Supraspinatus tear and a very likely cause for your labral tear.)

Nonetheless recall BF returned and played for one more year AFTER his "shoulder surgery" and they almost went to the S Bowl.

What is your age, approximate at least ?

Do you ACTIVELY lift or BB?

How was the bicipital tendon "fraying" diagnosed? (Exam, MRI, Local anesthetic injection) ?

Have you had PRIOR shoulder surgery?

Reg
Jim
 
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dr jim

dr jim

MuscleHead
Apr 7, 2014
785
168
OP, Ive located a couple Internet pics which may help you understand the functional anatomy.
I also posted a abstract on BCT transfer with a "ten year" follow up. (Unfortunately this is the form of literature being cited as proof of an "excellent functional recovery")

The "ease with which a patient could curl a TEN POUND WEIGHT" was the benchmark used in this study to determine "loss of strength" occurred, COL how absurd. I doubt ANYONE on this forum would agree with that assessment

Also I forgot to mention the primary indication for this surgery is PAIN, which is usually due to compression of one type or another.

So it's really important to determine if this fraying is causing significant pain, which it likely is, AND whether it can be effectively treated without a tendon transfer.

(If you choose to provide answers to my questions I should be able to provide you with a more informed analysis)

Indeed many younger patients with BCT pain develop remarkable pain relief after ACROMIAL-HUMERAL outlet decompression.

Regs
jim
 
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dr jim

dr jim

MuscleHead
Apr 7, 2014
785
168
View attachment Biceps transfer for "PAIN".pdfView attachment Biceps transfer for "PAIN".pdf
OP, Ive located a couple Internet pics which may help you understand the functional anatomy.
I also posted abstract with TEN YEAR follow up. (Unfortunately this is the form of literature being cited as proof of "excellent functional recovery")

Importantly, the "ease with which a patient could curl a TEN POUND WEIGHT was the benchmark used in this study for a "loss of strength"!

Also I forgot to mention the primary indication for this surgery is PAIN, which is usually due to compression of one type or another.

So it's really important to determine if this fraying is causing significant pain AND whether it can be effectively treated without the tendon transfer.

Indeed many younger patients with BCT pain develop remarkable pain relief once the ACROMIAL-HUMERAL outlet is decompressed.

Regs
jim


View attachment Biceps transfer for "PAIN".pdf GH -1.jpgshoulder-anatomy.jpgView attachment Biceps transfer for "PAIN".pdfGH -1.jpgshoulder-anatomy.jpg


OP the abstract is at the TOP OF THE PAGE
 
Last edited:
BR1217

BR1217

Member
May 29, 2014
63
3
Understand just because he was the surgeon for a pro team does NOT mean they are SM trained. It's important IMO.

FYI Bret Farve had a BT transfer performed because of "fraying" but since he had a "shallow" Bicipital Groove the tendon was subluxing or moving in and out of that groove AND any throwing motion encouraged that fraying.

The net effect was pain which preventing him from throwing and if left untreated could have ruptured!

(However the most common cause of BC tendonopathy in otherwise young healthy mates is IMPINGEMENT, which is the undoubted reason for the Supraspinatus tear and a very likely cause for your labral tear.)

Nonetheless recall BF returned and played for one more year AFTER his "shoulder surgery" and they almost went to the S Bowl.

What is your age, approximate at least ? 39 YO

Do you ACTIVELY lift or BB? Yes, BB

How was the bicipital tendon "fraying" diagnosed? (Exam, MRI, Local anesthetic injection) ? Arthrogram

Have you had PRIOR shoulder surgery? No, but the left shoulder is was also diagnosed with fraying and impingement syndrome, not as painful though.

Reg
Jim

Thanks again Doc.
 
B

bucky321

New Member
Apr 27, 2014
1
0
I had "slap" tear to my labrum and surgery done by a sports med physician in 2006. I've had zero problems with lifting heavy weights since. Recovery was approximately 5 months before I could lift heavy, but it was worth it. Good luck!
 
dr jim

dr jim

MuscleHead
Apr 7, 2014
785
168
Thanks again Doc.


An Arthrogram? Interesting because the information obtained does NOT reveal WHY the fraying is occurring.

Whatever!

This is what I would suggest you consider AND ask your surgeon about.

Have the Acromio-Humeral outlet decompressed and what is probably a SLAP lesion repaired.

If A-H impingement is the etiology of your fraying, which it likely is, then the fraying and pain will be effectively treated. However if an abnormality of the BC grove is causative then only partial relief would be noted.

Why partial relief? Because the primary cause of impingement pain is the humerus scraping underneath the A-H which frays the Supraspinatus tendon AND the Biceps tendon in some folk.

Personally based on the info you have provided (Thx) I believe the tendon transfer should be delayed pending the outcome of your decompression. The disadvantage of course is you COULD need two surgeries but I think that's a small price to pay considering risk of reduced strength, ESPECIALLY in BB where the literature is fully inadequate, IME.

Understand what and WHY of my suggestion mate?

Regs
Jim
 
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kjetil1234

kjetil1234

Senior Member
Jul 6, 2014
114
9
Doc, do they not rebuild the attackment in BCgroove during slap-surgery?
 
dr jim

dr jim

MuscleHead
Apr 7, 2014
785
168
Doc, do they not rebuild the attackment in BCgroove during slap-surgery?


No, SLAP surgery involves a reattachment of the torn labrum ligaments. The abbreviation literally means "Superior Labrum Anterior Posterior". Take a look at the PICs I posted and note a significant portion of the labrum is actually formed by a continuation of the BICEPS TENDON. So once the tear begins it's actually an avulsion of the biceps tendon which begins SUPERIORLY and extends POSTERIORLY. This is what is being reattached.

Repairing the BT "groove" has been attempted many times, usually thru "decortication", which involves removing bone to deepen the groove. However it's just not effective since bone eventually overgrows the initial site, causing a worsening of symptoms and the tendonitis itself. The most reliable means of treating this condition, (biceps tendonitis) especially to relieve PAIN, is indeed a "tendon transfer" which the OP mentioned.

regs
jim
 
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kjetil1234

kjetil1234

Senior Member
Jul 6, 2014
114
9
Thanks for that doc. In my experience, chronic tightness in the subscap can make the biceps really sore.

Some anatomy pics show the subscap as covering the BC groove, others show them as separate. I don't know what to take from that, but surely tight subscap makes my ( and my clients') brachii hurt!
 
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