Blown Biceps
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This article appeared in Rock and Ice issue 249 (April 2018).
While desperately manteling a highball 10 years back (I am now 46), I felt my shoulder shift and heard alarming noises. Although I recovered, my shoulder has recently become painful. I had an MRI and saw a surgeon. I damaged the labrum and the bicep, which is cutting through the subscapularis tendon. The surgeon wanted to cut the bicep tendon free at the shoulder and leave it. I have heard it is normal procedure to reattach it. When I saw him a second time and asked about this, he said, “I’m not going into detail until you’ve studied six years of medicine.” I called him a bad name and left. What do you think?
——Anonymous
Good on you. Once upon a time doctors, in particular specialists, got away with an expedient “This is very complex and beyond your tiny mind” attitude. Nonsense.
Yours was a very pertinent question and one easily answered. See a more socially adept and communicative practitioner, one that you like and trust. Perhaps Google “stable genius surgeon” and see who you find.
At the top of the arm the bicep tendon runs in a short groove. A small ligament bridging the groove locks the tendon in place. In your case, this ligament has ruptured, and the dislocated tendon is abrading the subscapularis tendon. Imagine a rope running across another rope. The surgeon needs to repair labral damage, stop further delamination of the subscapularis tendon, and release the bicep tendon.
The topic of tenotomy (cutting the tendon) versus a tenodesis (reattachment farther down the shaft of the humorus) is a contentious one among surgeons. Peer reviewed data indicates that there is little difference in terms of functional outcome —strength, coordination, range of motion—but it is difficult to compare individual studies due to the methodology variables between them, namely surgical techniques. In the instance of a tenotomy, the muscle, once released from the shoulder, bunches above the elbow creating a “Popeye” look. I use several shoulder specialists and they have always opted for a tenodesis.
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