Thursday, July 13, 2017

Complete evulsion of right proximal outer bicep tendon head, bug or feature?

Dear Doc,

I wanted to let you know what I decided to do regarding my right proximal outer bicep tendon tear. First of all, I want to thank you for making the time to see me, and for your excellent consultation and advice. Having watched a couple youtube videos now, I am very impressed with the the surgical tools now available to re-attach tendons, and also the skill with which surgeons like yourself can wield them. I have no doubt you are among the best, and would have every confidence in your abilities if you did surgery on my arm.

When I saw you a couple weeks ago I had fairly severe cramping in the bicep, which I hoped would soon subside, and also had  real concerns it was still in the process of some further tearing throughout the muscle because of the way it felt. For the most part the cramping is gone now. Although I have not had any MRI, mainly because I do not like being stuffed in the tunnel (particularly without any chance to do any kind a quick ‘dry run’ ahead of time to get acclimatized and relieve anxiety), I am sure you were right that the proximal tendon tore completely.

Looking back, I think the tendon must have been pretty much gone for some time and was merely hanging on uselessly by a thread that served to do nothing for me save keep the bicep from crumpling up like it is now, and causing me intense pain for two years. I think that because when it finally went, there was absolutely no blood or bruising (like both of us expected) in the arm at large afterwards, and also because for the last two years that I had the shoulder pain, and also mid bicep cramping (like when I took long jogs), I could notice the slightest little droop in the right bicep relative to left.

I must say I am elated that I can now throw footballs, shoot hoops, and lift weights without the pain I had grown accustomed to and that going through a surgery and the associated recovery time is the furthest thing from my mind right now. My expectation now for surgical reattachment to the humerus somewhere at this point would really only be to serve a cosmetic purpose, and that alone cannot justify surgery given my personal aversion to what I see as the endemic and unavoidable risks to general anesthesia (and intubation). I am not an expert in upper arm anatomy but my impression is that the ideal attachment point to give the muscle any actual purpose for generating additional supination force would be high up in an area where real estate is already expensive -- in other words, I  imagine you would have to make space by taking it from somewhere else.

Yes the bicep still looks a little strange, but having tested things now, the arm as a whole somehow seems to have full strength. I know the conventional wisdom is the tendon does not sprout and reattach, but as I mentioned, my experience with other injured parts of my body and eventual recovery suggests I should give natural healing processes a shot and see what my own rehabilitation efforts might accomplish. I must agree with Leonardo Da Vinci who apparently was the first to say that the biceps is only a minor playing in elbow flexion and really acts primarily to assist in supination. My baseline test for that is that I used to do 10 pullups with a 60lb weight vest on; if I can do that again eventually I will be content. As far as supination, I have not tested things yet by trying to torque down a bolt or open a big bottle of tightly corked Belgian beer, but soon will.

I was curious that in your experience the preferred method of reattachment was a titanium screw as opposed to something that would eventually degrade away, but understand that surgery is not an a-la-carte affair where the patient picks what they imagine might work and the surgeon complies. One last comment. In looking at the curious structure of the tendon and the way it winds around to eventually form the labrum, it is not surprising to me that this thing eventually frays in many men who do evolutionarily odd things like throw balls. If I had to guess I would imagine this kind of structure formerly was a good way to stabilize and provide feedback for walking on four limbs, something of little use to me now, and that my own self pruning has essentially acted more as a feature than a bug.

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