Author Topic: Healing bicep distal tendon partial tear?  (Read 4979 times)

Offline tothemax

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Healing bicep distal tendon partial tear?
« on: April 07, 2010, 09:48:50 PM »

Was just diagnosed with a Distal Tendon Partial Tear - Injury occurred 3 weeks ago. Stupidly did 55 lbs dumbbell curls. MRI confirmed a partial tear but the Dr. cannot tell how much it's torn. Tendon is still partially attached and I can see the bicep and tendon at the correct location. I have decent strength, discoloration is gone and still some pain in the tendon and bicep  maybe 3/10... nothing that some Aleve can't fix.  Am taking off from lifting weights and riding road and mountain bikes.

Surgeon 1 recommended immediate surgery to completely detach it and reattach it properly. he says it will not heal because it does not get blood flow and will never be as strong. He says the only way to properly fix to get full strength is to operate is now and re-attach it.

I got a second opinion from another surgeon 2 who is a very well respected sports medicine surgeon. He is the team doctor for the USA Rugby team and also the Hurricanes professional soccer team. I really respect him and he has already fixed my torn ACL from a previous injury. He says no need to operate right now. He says physio for 6 weeks and re-evaluate then. He says if and when it completely tears in the future, we can always fix it then but no need to do this now. He says it will partially heal over time and may heal to be almost as strong as my other arm. I have opted to wait six weeks and do physio.

My question are:

Has anybody experienced the same injury?

How much luck have you had in healing the partially torn tendon on it's own?

What can I do to help heal in addition to physiotherapy ? Supplements? massage? treatments?

Any and all comments or suggestions welcome

thank you for your help

Offline Brian J

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Re: Healing bicep distal tendon partial tear?
« Reply #1 on: April 07, 2010, 11:07:59 PM »
tothemax -- Greetings from just down the road a little ways.

Youíve encountered the perpetual dilemma of the partial tear:

On the one hand, I think that surgeon 2 has a good point.  With only a partial tear, the tendon is prevented from retracting, and so this buys you time to decide whether or not you want surgery.  Why not just worry about it if and when it finally lets loose?  On the other hand, youíll need to treat that arm with extreme caution over the next several weeks at least, and, as surgeon 1 has pointed out, you never know what result youíll end up with -- you may just be prolonging your misery as you watch the arm atrophy, only to suffer a rupture a few months from now once you start strengthening it again.  I donít think there are too many of us here who are satisfied with just sitting there and watching an arm shrink, especially if the outcome is uncertain.  As for me, it took me a whole five days to turn my partial tear into a full rupture, and so I made it easy on myself (well, sort of).

I donít mean to make light of your situation, but I donít think there are any really good answers here, especially if the extent of the tear is undetermined.  Estimates of tear % from MRIís are notoriously unreliable.  Often the recommendation is to go for surgery if the tear is >50% of the thickness of the tendon.  See this reference.  Some people have done well in rehabbing a more minor partial tear.  Perhaps the best example is a guy named Mike in NYC from the old topix.com forum.  In the end, I think the decision rests with you and you alone, but maybe give it a couple weeks of thought.  (Now, in re-reading your post, I see you've already decided on this.)

By the way, what sorts of curls were you doing?  Quite a few people on the forum -- including myself -- did the damage on the preacher bench.

Also, here is a recommendation for a tendon-healing supplement recipe (to be taken "several" times a day -- I'm just quoting it essentially verbatim).  It comes from a poster ("pumbertot") on the pec tendon rupture forum at topix.com.  Some people here and elsewhere swear by cissus quadrangularis as a miracle supplement of sorts:

1/2 tsp vit C powder
1 tsp cissus quadrangularis
1 tsp edible gelatine (same amino acid profile as in joints)
1 tsp AAKG (nitric oxide has been shown to improve tendon/ligament healing)
1 tsp glucosamine powder
1 tsp MSM powder
1/4 tsp beta alanine (has also shown promise in tendon healing)
« Last Edit: April 07, 2010, 11:42:38 PM by Brian J »
  • Hospital: Specialized Orthopedic Surgeons, Davis, California
  • Repair Method: two incisions/transosseous sutures
  • Surgeon: Drs. Metheny and Smith-Hoefer
  • Surgery Date: 28 May 2008
Brian Joy
Kingston, Ontario

Offline tothemax

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Re: Healing bicep distal tendon partial tear?
« Reply #2 on: April 08, 2010, 09:23:48 AM »
Hey Brian,

Thank you sooo much for response and your great insight....

I am very happy to see you are in Davis as  you most likely know the experienced  surgeons in the area for this type of repair.  I actually work at the Sac Airport and travel though Davis daily.

Injured it doing regular standing dumbels curls (not the preacher bench) started  w/ 55's, then 50's, then 45's and so on down the rack all the way to 30's.... very stupid since my normal weight is 35's.  I have two teenagers boys (17 & 19) who are now getting much stronger than me and I was trying to hang on for another year.... 

I have a couple  follow up questions for you.  I really want to buy the products you mention to assist the healing process,  Do you know where these are available, either locally or on line?   

Also, who are the experienced surgeons here in Norcal?  My Dr is a top notch ACL Dr but I am not sure of his experience in distal tendon repair.  The other Dr I have in Sac (Dr. Poppens) is a hand specialist and he has performed some repairs but he admits this is not something he does a lot of.   I am obviously considering the surgery but I want someone who has done and does a lot of these repairs.  Also, I would love to get someone who can do the repair without having to  cut off what's left of the tendon  to reattach it.   Is that even possible?  Who do you know in Norcal who has a lot of experience repairing distal tendons ?

I have read so many threads and forum and journals and sites.. .it get confusing and I feel great being part of this community of informed folks who have done this same walk before me... I really appreciate all the information and the support ... Thank you

I am going to press for another MRI or another means of finding out the extent of my  tear to give me more information on which to make the decision.  i.e. more or less than 50% torn. 

also, I want to do all I can in the next five weeks to heal what I have left of the tendon and also research the most experienced surgeon I can find in Norcal.  If/ when I get the surgery, I really do not want to end up with some of the side effects some of the others have had... paralysis, pain , loss of ROM  etc etc.. 

Maybe the repair is inevitable and the best course of action but I need more information to get a higher comfort level with this decision.


 
« Last Edit: April 08, 2010, 01:56:14 PM by tothemax »

Offline Brian J

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Re: Healing bicep distal tendon partial tear?
« Reply #3 on: April 08, 2010, 12:16:55 PM »
Actually, I havenít been able to figure out who the most experienced distal biceps surgeons in norCal are.  There is a more distinct concentration of them in the L.A. area.  The hand/arm surgeon who repaired mine (Jeffry Metheny from Specialized Orthopedic Surgeons here in Davis) does not specialize in distal biceps repairs, but he is a highly skilled surgeon who has been practicing for more than 30 years.  At the time he did my repair, he told me he had done about 30 of them; he sticks with the traditional two-incision method.  He is definitely a ďno b.s.Ē kind of guy, and I would certainly recommend him if youíre looking for an honest and competent third opinion; his phone# is 530-771-4000.  I know that he takes Anthem/Blue Cross insurance, but Iím not sure what other plans he accepts.

In most cases, surgical repair of a partial tear involves cutting the tendon and then reattaching it.  I think only one poster (wtkob) has reported dealing with a surgeon who did not intend to cut the remaining tendon.

I donít buy a whole lot of supplements, but, when I do buy them, I usually get them from musclesurf.com (located in Massachusetts).  They have a large selection, often have very low prices, and process orders quickly.  I think they have most or all of the items on that list.  It appears that Primaforce Cissus contains the most concentrated extract of cissus quadrangularis (somebody correct me if Iím wrong).  Bodybuilding.com also sells cissus for cheap, but it is a less concentrated form.
  • Hospital: Specialized Orthopedic Surgeons, Davis, California
  • Repair Method: two incisions/transosseous sutures
  • Surgeon: Drs. Metheny and Smith-Hoefer
  • Surgery Date: 28 May 2008
Brian Joy
Kingston, Ontario

Offline Bill C

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Re: Healing bicep distal tendon partial tear?
« Reply #4 on: April 08, 2010, 06:50:31 PM »
Hi tothemax,
 Sorry that you had to find this great forum, It means you have had bad experience like everyone else here. I am a partial tear guy with a greater than 90% (MRI confirmed).I tore mine on 10/17/2009 and had surgery on 12/21/2009 and do not regret having the surgery. Most docís donít know what to do with us, there isnít a lot of info out there on recovery by rehab vs. surgery. My ortho doc was one of them also; we went the conservative route to start, PT, out of work and put in a ROM brace to stop me from rotating my arm.

 One month later went back for an eval, I had no improvement and pain wise It was getting worse not better.I decided for surgery and am greatfull for it. A lot depends on your age, what you do for a living and how active you are, and seeing how you injured your arm I would say go with the first docís opinion. The second doc was right about having time to decide because with a partial tear the bicep doesnít retract as bad or not at all. This is good because we can have a faster recovery.

I had the toggle loc with zip loop surgery which looks a lot like the tension slide technique talked about on this forum. Personally I would recommend the surgery, but this is just my experience with this injury. The final choice is yours and you do have time to decide, just be careful and take it easy, you donít want a complete tear if you can help it. My doc has done three partial tear surgeries recently with the same outcome as me,which has been fantastic, and now will recommend surgery for partial tears.

Good luck with this, and take a good look at as many posts here to help you decide.   Bill Czaja
  • Hospital: UMMC Batavia,NY
  • Repair Method: Toggle Loc with Zip Loop
  • Surgeon: Dr. Landfrield
  • Surgery Date: Right12/22/09 Left 3/19/11

Offline tothemax

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Re: Healing bicep distal tendon partial tear?
« Reply #5 on: April 09, 2010, 09:08:12 AM »
Guys,  thank you for your information and insight.

On the supplements, I ended up finding everything on list here http://www.vitacost.com/  except for the Primaforce Cissus

EDIT - On the Cissus, I ended up buying this product at your recommendation and after seeing that it contains  Cissus Quadrangularis standardized for 40% total Ketosterones and 20% 3-ketosterone ... more than anything else out there http://www.amazon.com/Cissus-Primaforce-Ketosterone-Health-Formula-Vegitarian/dp/B00112MABS   I asked for overnight shipping so I can start the regime ASAP.  I will return the previous stuff I had purchased. 

I am really needing to get more information as to the extent of the tare before I can make a decision.  I am going back to Surgeon 1 this afternoon as 3 PM and  will press for another MRI of some other test to determine the % of the tare.

Also, one more question pls,  does anybody have  any idea on where and how to research surgeons who specialize in this repair ?  Stanford medical center is close by and there is also UCSF and Davis which are all close.  How does one go about finding the most experienced surgeon in the Norcal?
« Last Edit: April 10, 2010, 10:37:08 PM by tothemax »

Offline tothemax

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Re: Healing bicep distal tendon partial tear?
« Reply #6 on: April 10, 2010, 08:24:14 AM »
Update:

Went to Surgeon 1 and reviewed the MRI report and also the films.  He said best guess it's about a 50% tear but very hard to tell.

 

He said the part that is torn,  will most definitely not reattach or heal on it's own and will need to be reattached via the medical procedure if it is to regain 100% of it's strength.   He said he will use the "single Posterior Incision" method and it has less risks than the method used to repair a complete tear because he does not have to go through the center of the forearm where all the nerves and the blood vessels are.  He said risks of damaging  nerves using that method is next to nil.

On the other hand, I recall my other Dr. said  "it may heal on it's own, but it's will take a long time, however you risk a complete tear in the meantime" .

Coming to the conclusion that I may want to do operation and started researching who the best and most experienced  surgeons for this specific procedure are in Norcal.

Not easy to find someone specializing in this procedure

Contacted Dr Emelie Cheung at Stanford Medical Center http://med.stanford.edu/profiles/handsurgery/researcher/Emilie_Cheung/

and also Dr Lisa Lanttanza at UCSF  http://www.ucsfhealth.org/adult/cgi-bin/prd.cgi?action=DISPLAYDOCTOR&doctorid=1419

to ask for their level of experience with this procedure.  Have not yet heard back from them.



Offline Jeff

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Re: Healing bicep distal tendon partial tear?
« Reply #7 on: April 11, 2010, 11:26:54 PM »
what do you do for your living?...Do you need a high degree of dexterity?..or a lot of stregnth?

Offline tothemax

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Re: Healing bicep distal tendon partial tear?
« Reply #8 on: April 12, 2010, 11:14:08 PM »
Tnx for asking - I work in an office for a living but I do lots of work with my hands on cars and around the house.  I also ride bikes, swim  and lift weights.  I would really like to gain most of the function and strength  back.  Do not necessary want to win any body building contests but I would like to return to a somewhat normal looking arm/ bicep with normal strength. 

Also... interesting I found a link  between Lipitor use and tendon damage... I also just developed a sprain finger and pulled calf doing simple work on my car....  I have decided to stop Lipitor and am going to try more the natural / holistic  route to try to maintain low cholesterol... Niacin, Red yeast Rice,  Policosanol... etc.  I think I may have weakened my tendons using Lipitor for so many years ... 

I'll see how it works out. I am taking a baseline cholesterol test this weekend and one in 3 months.  Sorry about the Off topic but this link may be of interest to others who are also on lipitor.

Offline Brian J

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Re: Healing bicep distal tendon partial tear?
« Reply #9 on: April 12, 2010, 11:51:01 PM »
tothemax -- I don't know that there is really any systematic way to find the surgeons who specialize in this repair.  They are generally pretty few and far between.  On websites, they may only be referred to as "hand" or "elbow" specialists, which is sort of vague as far as people with distal biceps tendon injuries are concerned.  Sometimes you can get a little extra information if the surgeon has a link to his/her CV with publications and presentations listed.  Probably the best way to approach it is to do what you have started doing and just contact surgeons at major and/or university hospitals and then ask who they would recommend.  It's a little strange that no prominent names have appeared so far in the Bay area or Sac'to.  If you can identify one, then it would be a great help to the forum.
  • Hospital: Specialized Orthopedic Surgeons, Davis, California
  • Repair Method: two incisions/transosseous sutures
  • Surgeon: Drs. Metheny and Smith-Hoefer
  • Surgery Date: 28 May 2008
Brian Joy
Kingston, Ontario

Offline tothemax

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Re: Healing bicep distal tendon partial tear?
« Reply #10 on: April 14, 2010, 04:38:22 PM »
Yes Brian,

I will absolutely share any relevant findings I come up with.  So far, it appears I have not had much success in getting anything back from either Dr or Ortho  Dept.  They are mostly interested in me making an appointment with the Dr , which I will gladly do once I find their level of experience in the procedure, and not much interested in providing me the information I want.

Stanford and USCF is a little far to drive to just ask the surgeon how much experience they have in distal tendon tear repairs.   I am however still pursuing..

Onwards... 

Offline tothemax

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Re: Healing bicep distal tendon partial tear?
« Reply #11 on: April 22, 2010, 10:45:40 AM »
Update week five after my partial tear.

Have not yet found a surgeon with extensive partial tear repair.  Have not yet received satisfactory response from either UCSF or Stanford,  but continuing search.

On the nutritional supplements, I received my  full order of all supplements listed above but discontinued and sent back the:
-AAKG (nitric oxide has been shown to improve tendon/ligament healing)
-beta alanine (has also shown promise in tendon healing)
This stuff is very intense and made me feel all flushed and way too jacked up.  It kindda felt like I was on some major steroids and I was a little concerned about any side effects on my health with the use of these products.  I think if one is going for a muscle building contest, and needs to work super heavy weights, these products would help. 

I am continuing with the
-vit C
-cissus quadrangularis
-edible gelatine (same amino acid profile as in joints)
-glucosamine & MSM

I am also continuing the Physio Therapy twice per week, (currently on Week 3) and found an excellent clinic in Walnut Creek called Pacer Physical Therapy on Ignacio Blvd.  The PT Danny is absolutely top notch.  He starts off the treatments with an assessment followed by a deep massage of the injured area, electrical Stim,   ROM exercises and strength exercises with super  low loads with focus on eccentric loading and ends with Ultrasound.

Results:
So far, I am noticing most of the pain having gone away except when I rotate the forearm in a 90 degree position from palm facing up to palm facing down.  I also have a little pain left (mostly a slight burning sensation) right at the inner crease of the elbow.  Note that I have not yet done any normal loading on my arm.  No pull ups, curls, carrying loads, or any kind of heavy duty work using my left arm.   The bicep muscle is slightly smaller than the right arm but not too much.  The distal tendon is fully apparent under load. The muscle is not deformed or start any higher up the arm.  It pretty much looks the same as the other one except it's a slight bit smaller and not as hard. 

Lipitor Concern:
Since the injury, I have done a lot of reading on trying to identify why my tendon was damaged and found that extensive anecdotal records of tendon damage in people who use Lipitor.  I now think that maybe my tendon was weakened by Lipitor and that it's use may have contributed to the damage.   Also, I tore hurt my finger and my calf by doing some simple work (not heavy loads) and I am concerned that all my tendons may be weakened and prone to being damaged.   I stopped Lipitor and replaced it by a regime of Niaspan (prescription slow release Niacin)  and Red Rice Yeast a natural substance with statin  like cholesterol lowering effects.   We'll see in three months if the cholesterol in sufficiently under control without Lipitor. 


Next steps:
1-Continue my search for an experienced surgeon.
2-Continue the nutritional supplements regime  above.
3- Continue the PT twice per week and progress to higher loading on exercises
4- Continue to stay away from heavy loads on my left arm (being super careful with it)
5- Re-assess surgery or no surgery with my sports Ortho in approx 4 weeks when I see him.


 



Offline tothemax

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Re: Healing bicep distal tendon partial tear?
« Reply #12 on: May 18, 2010, 09:09:09 PM »
Update;

Tomorrow 05.19.10 is my last PT appointment.  I go back to see my ortho in another week.  Pain is 99.99% gone but my arm still feels weak.  I have not done any serious weight lifting in at least 2 months. Just started very light curls and a bunch of girly exercises with rubber bands for he last 6 weeks.  My injured bicep is much smaller and softer than my other arm.  I have been released by the PT to do heavier curls (max 25 lbs).  I am starting these heavier curls daily.  I also do muscle electro. stim unit daily.  Hoping to build up the bicep a little more than what it is right now.