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Old 09-12-2011, 12:25 PM
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mtomaino mtomaino is offline
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Default Treatment of Long Head Biceps Ruptures

Thank you for your questions-----sorry for my delay in responding. First---visit this link for some information on this website:

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!!
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