[russ]

Originally Posted by chickdiver

Quick anatomy lesson:
Shoulder Anatomy - Orthogate - Improving orthopedic care, education and research with Internet technologies

My injury:
I am 99% sure I injured my biceps tendon by doing db snatches (I can trace the beginning of the pain and almost immediate decline in strength to when I first started doing this exercise) back in late June. At first I thought the pain was simply muscle soreness, but by mid-July I figured out there was something else going on and sw my ortho. I had an MRI 2 days before leaving to go on a 2 week SCUBA diving vacation. By the time I returned from vacation my shoulder was in such bad shape that I couldn't lift a glass to take a drink without severe pain. I saw the doc the day after I returned to get the MRI results- frayed biceps tendon. Initially he treated with oral steroids and rest- which didn't make any real improvement. Next step was a steroid injection into the tendon sheath- this bought me about 48 hours of relief. I was supposed to have a 3 week followup on this procedure, but since the pain came back so fast I was back in the office in 10 days- that was yesterday. The next step is surgical repair of the biceps tendon and a suspected labral tear (which will be confirmed when he gets in there).

How does a biceps tendon fray? The biceps tendon sits in a groove. As it moves, it can slip out of the groove and rub on the edges, causing fraying. In my case I suspect that this occured because I am hypermobile in every joint I can identify (my normal range of motion is hyperextension). I think that when doing the db snatch my shoulder was hyperextending enough to allow a fair amount of unnatural movement in the joint, causing the biceps tendon to slip out of the groove and rub. (FYI- I exhibited symtoms bilaterally- the right shoulder responded to oral steroids and rest- I had MRI's on both shoulders). Some individuals also have congenitally shallow grooves, which sort of "pre-disposes" them to biceps tendon fraying. The repair: I am having an arthroscopic repair. They will dissect the long head of the biceps tendon from it's attachment point, and move it to a new attachment point, thus removing it from the groove. This will not impact either the functionality or the cosmetics of the bicep. To re-attach the long head of the biceps tendon they will abrade the bone and insert suture anchors (they look like drywall anchors with sutures attached) and suture the tendon down. The shoulder will have to remain mostly immobile for 6 weeks in a sling. After that I will start physical therapy. No real lifting (or diving) for 3-4 months post op. I was a little surprised by that- I had an ACL reconstruction (allograft) 7 years ago, and was back in the water in 6 weeks. The difference here is that they want to make sure the new attachment point has healed and is solid before allowing any over head motions- if the repair detaches, the whole procedure has to be repeated. What I likely have is a SLAP tear
http://orthopedics.about.com/c s/generalshoulder/a/slap.htm In either case the biceps tenodesis will repair the problem. Becuase the SLAP tear doesn't show up well on an MRI, my surgeon won't know about Labrum involvement until he gets in there. Regardless- the biceps tenodesis procedure is indicated and has the best success rate.

My injury mechanism was different than the deadlift injury under discussion, but the repair procedure is the same regardless. My surgery is scheduled for next Wednesday, and if you guys are interested I can give updates afterwards on the recovery process.

Sorry for writing a book!
Heather

Your injury is a bit different, I believe. Biceps tears from deadlifting usually involve the distal biceps tendon at its radial (below the elbow)attachment. What you're describing sounds more like a "SLAP" (superior labrum, anterior to posterior) injury, which involves the junction of the long head of the biceps tendon and the superior aspect of the glenoid labrum.