Biceps rupture - proximal long head tendon

[lxc]

Good morning,

I would like to ask about your experience and results with biceps tendon rupture - in my case proximal long head tendon.
It seems to be common injury, but unfortunately I was not able to find too much informtion about the treatments comparison (from the pacient's perspective).

Specific information areas of interest:

- what would be the typical situation requiring/recommending surgery versus conservative treatment

- what are usually most important (subjective) aspects of the positive/negative outcomes for the patients by type of treatment and short/long-term time horizon

- what could be the decisive moments/facts to change the type of treatment (before the final decision is made)

- anything else what comes to your mind which would help me with the decision - statistics, observations, stories related to functionality and strength of affected hand with respect to type of the treatment.

I would appreciate if you could find few moments of your time to address my questions/share your experience.

Thank you.

[mtomaino]

Thank you for your questions-----sorry for my delay in responding. First---visit this link for some information on this website:
http://www.rearmyourself.com/article/biceps-tendon%20as%20a%20pain%20mediator-tenotomy-versus-tenodesis

Regarding your questions, I will respond in the order that you asked them:

1. What would be the typical situation requiring/recommending surgery versus conservative treatment?

If you are not concerned about the potential that you may develop a "popeye" deformity in the muscle, or possibly experience fatigue in the biceps with strenuous activity, nonoperative treatment will likely result in near normal--if not normal function.

2. What are usually most important (subjective) aspects of the positive/negative outcomes for the patients by type of treatment and short/long-term time horizon?

Nonoperative treatment is overwhelmingly okay, but in 30%, patients may complain of occasional fatigue or cramping. It is my experience, however, that this usually resolves. The only way to obviate that risk is to perform a tenodesis, which would be performed through a small open incision---differently than what the videos on the link above show.

3. What could be the decisive moments/facts to change the type of treatment (before the final decision is made)?

One might be the development of deformity in the muscle which you might clearly want addressed. Other than a preference for "being normal"---there are no specific decision points, in my opinion.

4. Anything else what comes to your mind which would help me with the decision - statistics, observations, stories related to functionality and strength of affected hand with respect to type of the treatment?

It has been my experience that both tenotomy and tenodesis provide satisfactory outcome when I think the long head of the biceps is a pain mediator during rotator cuff surgery---so the desision here is really based on the patient's preference. I typically recommend tenodesis in younger patients and tenotomy in older patients, but it has more to do with avoiding the appearance of a mis-shapen biceps in a patient with a thin arm, than concern about poor function.

Thanks for your post!!

[lxc]

Dear Dr. Tomaino:

Thank you very much for the information.

I did read the article and with the input you shared, I conclude that the surgical approach would have cosmetic effect only. My arms are not long and thin (more toward the opposite), so I hope that 'popeye' effect will not be that visible.

With respect to mentioned deformity, I do have a questions - you stated that there is a chance of popeye 'developing' - and I am wondering what did you mean by 'developing':
Will the deformity more likely get bigger as I'll go through physical therapy and the muscle goes through atrophy/alignment/'normal' use, or, will it stay about the same as now (about three weeks after the accident), or, will it get smaller? Are there any activity/physical therapy factors which may influence the outcome?

Thank you.

[mtomaino]

It's unlikely to change after the first couple of weeks----and once your discomfort settles, you can essentially resume normal activity.

[markmark]

@IXC If you are able to could you let the forum know how your recovery has been? I'm of the same mindset to not do the surgery.

@Dr. Tomaino
I'm 36 and enjoy training a lot, i'm not a body builder, but I simply enjoy excercise ALOT and enjoy MMA as well. I'm not a big fan of surgery so I"m likely to opt for not doing it unless there was some significant reason to have it done. My work insurance will cover the entire surgery so money is not an issue...mainly I can't imagine being cut open and rehab if it's primarily for cosmetic purposes. My proximal bicep tendon ruptured on Tuesday. Still can enjoy full ROM, no bruising or swelling, no pain, a little tenderness in suprispinatus area but like I said...full ROM. Aside from cosmetics is there any long term benefits to having the surgery done? Long term consequences for not having it done that you are aware of?

[mtomaino]

If you have no appreciable weakness now, it is possible that "endurance strength could be an issue, but in my experience, this is not common. So, absent a compelling functional problem, or dissatisfaction with a change in shape in the biceps, there is no mandate that a tenodesis be performed in most cases.