Issues Following Biceps Tenodesis: A Request for Guidance on Seeking a Second Opinion
As a 27-year-old male, I underwent right shoulder arthroscopy in July 2024, which included a subpectoral biceps tenodesis, subscapularis debridement, and posterior labral debridement. This procedure was conducted as a precaution after experiencing a rupture of my left biceps, which had been successfully repaired later on. **Before the Surgery:** At the time, I was fully functional. I was able to bench press, sleep on my arm without discomfort, and enjoyed complete mobility, interrupted only occasionally by mild pain in the biceps tendon that would alleviate with rest. **Problems Following Surgery (7 Months Later):** - I’m unable to perform a “thumbs down” gesture when my arm is lifted forward; it feels as if it becomes stuck midway. - There is a pronounced crackling sound at the top of my shoulder during movements that involve external rotation. - Bench pressing is now impossible, due to pain and new restrictions. - Engaging in horizontal adduction produces noticeable crackling sounds as well. **MRI Results (Pre-op vs. 7 Months Post-op):** - There is new bone marrow edema at the tenodesis anchor site. - The biceps anchor and superior labrum show new signs of attenuation, despite previous scans indicating they were intact. - A new 2mm chondral flap has developed in the inferior humeral head. - Partial thickness wear in the superomedial humeral head has been noted as new damage. - There is further progression of attenuation in the posterior labrum. - New fissuring has appeared at the insertion site of the rotator cuff tendons. My surgeon claims these developments are due to the “progression of glenohumeral arthritis” instead of complications from the surgical procedure, and has suggested a conservative treatment approach along with a follow-up in 6 to 12 months. My concerns are as follows: 1. The symptoms started immediately after the surgery. 2. I had no limitations in function prior to the operation. 3. The new bone marrow edema aligns directly with the tenodesis site. 4. Previously healthy anatomical structures are now damaged. **I have several inquiries:** 1. What is the best way to pursue a second opinion without straining my relationship with my current surgeon? 2. Which type of specialist would be the most fitting for my situation? 3. Would dynamic ultrasound or a diagnostic injection yield beneficial insights? 4. Is it common for a 27-year-old to experience quick arthritis progression just months after surgery, particularly considering that I refrained from training or any activities for 4 to 5 months following the surgery, yet still encountered symptoms when I resumed training? 5. During a second opinion appointment, what key questions should I ask to ensure I receive a thorough evaluation? Additionally, I’ve conducted some research on the differences between tenodesis tightness and positional tenodesis impingement. I suspect I may be experiencing positional impingement linked to the tenodesis, but I'm struggling to fully grasp the implications of this and where to seek further information.
Answers (1)
3/18/2025, 11:30:47 PM
OpenHealth AI
It sounds like you're experiencing significant concerns following your biceps tenodesis surgery, particularly in relation to new symptoms and MRI findings. Getting a second opinion can be a wise step to ensure you have a clear understanding of your situation and potential treatment options. Here’s how to navigate your queries:
Summary of Key Issues
- You have developed new symptoms and MRI findings that could indicate complications following surgery.
- You're interested in pursuing a second opinion while maintaining a respectful relationship with your current surgeon.
- You have specific questions about the nature of your complications and how to evaluate them properly.
Explanation
Post-surgical issues can arise, and while some changes may be attributed to natural progression in joint conditions, it’s important to ensure that your current symptoms and imaging results are being interpreted fully and effectively. Given your active lifestyle before surgery, the rapid onset of these new issues is understandably concerning.
Actionable Steps
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Pursue a Second Opinion Respectfully:
- Communication: When you decide to seek a second opinion, you can explain that you are looking to gather more information for peace of mind or surgical clarity. Most surgeons understand the importance of patient education and the need for a broader view.
- Documentation: Compile your medical records, including MRI reports and any notes on your symptoms. This will help the new specialist understand your history.
-
Choose the Right Specialist:
- Orthopedic Surgeon: Look for a specialist focused on shoulder surgeries or a sports medicine orthopedic surgeon, as they will have a better grasp of post-operative complications and recovery.
- Physical Medicine and Rehabilitation (PM&R) Specialist: This can also be helpful if you are looking for more conservative management options.
-
Consider Diagnostic Tests:
- Dynamic Ultrasound: This imaging can be more functional and might show how your shoulder behaves in motion, providing insights into impingement or instability.
- Diagnostic Injection: This could help differentiate between the causes of pain (e.g., adhesive capsulitis vs. arthritis) and see if the injection relieves symptoms.
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Understand Arthritis Progression:
- It is somewhat uncommon for someone as young as 27 to develop rapid arthritis after surgery without prior symptoms, especially after a period of inactivity. Discuss this concern with your new specialist to better understand the underlying causes.
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Prepare Questions for the Second Opinion:
- Ask about the significance of the MRI findings and how they relate to your symptoms.
- Inquire about the potential for reverse surgical procedures if complications are related to the tenodesis.
- Discuss what conservative treatments are advisable and their expected outcomes.
- Seek clarification on whether there are alternative diagnostic options that might better explain your symptoms.
- Explore the likelihood of future interventions or therapies based on the findings.
Additional Considerations
While awaiting your appointment, continue to track your symptoms and any changes, such as pain levels or mobility. It can be helpful for your new specialist to have this information. Lastly, stay active in gentle movements that feel comfortable to you to prevent stiffness, but avoid any activities that exacerbate your pain.
Feel free to return with any new questions or updates on your situation. Your health and well-being are the priority!
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