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Old 11-28-2010, 10:57 AM   #21
Paul Richards
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Re: Choosing a Surgeon for SLAP repair

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Originally Posted by Steven Low View Post
I would suggest in addition to the compound movements you'll likely be doing (as long as they don't hurt) that you add in 2-3 sets of 20-30 reps of each of the rotator cuff exercises and scapular mobility work as well.
The PT had me do shoulder internal/external rotation, flexion and extension with bands (currently 2 sets of 20 daily) and 10x10sec isometric holds in scapular retraction and depression (cf. http://exrx.net/Articulations/Shoulder.html and http://exrx.net/Articulations/Scapula.html WFS). Oh yeah, unstable support on Bosu/Med/Swiss ball on both arms in a plank, pushing and retracting the shoulders. Anything to add to those?
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Additionally, work on your grip strength as much as possible too because the downstream effects of nervous activation to the arm will help up at the shoulder as well.
Hadn't thought of that -- just work with extended BW hangs from pullup bar and DL-type lifts? Or more active stuff such as fingertip pushup, wrist pushup, etc?

-Paul

Last edited by Paul Richards : 11-28-2010 at 11:01 AM.
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Old 11-28-2010, 03:41 PM   #22
Steven Low
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Re: Choosing a Surgeon for SLAP repair

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The PT had me do shoulder internal/external rotation, flexion and extension with bands (currently 2 sets of 20 daily) and 10x10sec isometric holds in scapular retraction and depression (cf. http://exrx.net/Articulations/Shoulder.html and http://exrx.net/Articulations/Scapula.html WFS). Oh yeah, unstable support on Bosu/Med/Swiss ball on both arms in a plank, pushing and retracting the shoulders. Anything to add to those?

Hadn't thought of that -- just work with extended BW hangs from pullup bar and DL-type lifts? Or more active stuff such as fingertip pushup, wrist pushup, etc?

-Paul
1. Do something that challenges you. Make sure teh bands and the stuff are challenging your strength so you can increase it

2. Grippers would be ideal.... but I guess that stuff works. Rice bucket works too.
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Old 12-06-2010, 02:48 PM   #23
Paul Richards
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Unhappy Re: Choosing a Surgeon for SLAP repair

Uggh... I was able to get in to see the Ortho early due to a cancellation, and the news (I think) is not so good. I'm going to continue this thread with my experience in the hopes it will be useful to others facing this choice in the future.

His recommendation is not only for an arthroscopic SLAP repair, but feels that the bicep tendon will never settle back into the groove in the humerus properly on it's own. He's recommending a bicipital tenodesis, which is detachment of the bicep long head tendon from the labrum, shortening it, and anchoring it to the humeral head with an anchor. This procedure will have to be done through a non-arthroscopic anterior incision between the deltoid and the bicep.

Needless to say I'm nervous about a procedure that removes something I only have one set of!

So, for the general community -- have any of you had a tenodesis performed? If so what has your post-surgery experience been, both recovery and resuming weight-bearing activity afterward? The Ortho is asserting that he's done a lot of these and I should be able to resume the activities I told him I was doing currently as well as what I was hoping to continue doing (Crossfit related, etc).

First thoughts? Tenatively they've scheduled surgery for 12/15 (9 days from now).

-Paul
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Old 12-07-2010, 11:56 AM   #24
Steven Low
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Re: Choosing a Surgeon for SLAP repair

Did your transverse humeral ligament tear or something?

Usually biceps doesn't go "out of place" unless there's some damage to the anterior shoulder ligament that holds it in the humeral groove there.

That seems pretty odd to do something like that unless your ligaments and tendons are pretty lax and actually do go out of place.

I don't want to accuse people of anything without knowing the facts
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Old 12-07-2010, 02:06 PM   #25
Paul Richards
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Re: Choosing a Surgeon for SLAP repair

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Did your transverse humeral ligament tear or something?

Usually biceps doesn't go "out of place" unless there's some damage to the anterior shoulder ligament that holds it in the humeral groove there.

That seems pretty odd to do something like that unless your ligaments and tendons are pretty lax and actually do go out of place.
Good question, and the answer is yes... I'm not a physiology expert so I don't always remember the precise terms.

I believe the proper term is "subluxation" of the bicep tendon out of the bicipital groove. I have the MRI scan series on my computer, if I can figure how to upload the particular image that shows this clearly I'll do so. Looking down axially on the humerus (head down to elbow) shows the tendon out of the groove and much closer to the junction of the humeral head and glenoid ... cavity? Again not really clear on the terminology. The exact quote from the radiologist's report was "Tear of the articular surface fibers of the subscapularis tendon with resultant dislocation of the long head biceps tendon. The tendon itself shows signs of tendinopathy and proximal intrasubstance tear."

So the ligament that retains the bicep tendon in the groove has torn or detached from the humerus at some location to allow the tendon to displace. Sometimes I've seen it referred to as the coraco-humeral ligament, by others it seems to be considered part of the subscapularis tendon.

However it's called, I asked the Dr if the retaining ligament(tendon?) could be repaired enough to again confine the bicep tendon into the bicipital groove. He says that his experience indicates that if such a repair is attempted, it always is followed by continued tendonitis of the bicep tendon. And since the tendon is attached to the superior part of the labrum, it will be tugging on any repair work to reanchor the SLAP lesion. Which is why he's recommending the tenodesis.

I spent last night looking for resources around tenodesis, and while it should be considered after all other conservative measures have been tried, there are a number of papers that (especially recently with interference screw anchors) indicate mostly favorable outcomes. I didn't get into enough detail with the Dr to ask things like "where will the tendon be anchored?" or "is there a name for your preferred technique?" Because the Dr mentioned an incision close to the pectoral attachment I think he will be doing the attachment to the humerus below the groove.

Steven, thanks for continued input here, and I still would like to hear other's experiences (I did find one here http://board.crossfit.com/showthread.php?t=14714 (wfs) but Roger never posted whether he elected for surgery or not. He does echo some concerns I have about the change in leverage that shortening the tendon would seem to produce.)

-Paul
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Old 12-07-2010, 03:11 PM   #26
Jamie Crichton
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Re: Choosing a Surgeon for SLAP repair

You may find this website useful: http:www.shoulderdoc.co.uk (WFS). It's the website of one of the best shoulder surgeons in the UK, Prof Len Funk. I have done research with him in the past and am currently and he knows his stuff, treats many of the professional athletes here, particularly rugby players. The website has lots of information on all shoulder pathologies. Worth a look.
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Old 12-07-2010, 05:26 PM   #27
Darla Powell
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Re: Choosing a Surgeon for SLAP repair

I'm getting my surgery next week.
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Old 12-07-2010, 07:37 PM   #28
Paul Richards
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Re: Choosing a Surgeon for SLAP repair

Jamie, thanks for the reference. I retrieved a couple of specific articles from Prof Funk's site that popped up in searches, but I'll wander around the rest of the site tonight.

Darla, good luck with your surgery. It will be interesting to compare progress as time goes on.

-Paul
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Old 12-08-2010, 11:56 AM   #29
Steven Low
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Re: Choosing a Surgeon for SLAP repair

I'd probably defer to your doc on that one. If most of the people who don't get it get chronic tendonitis then that's probably something you're going to want to avoid.

You could ask him the pros and cons of each that mgiht give you a better idea
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Old 12-10-2010, 07:54 PM   #30
Darla Powell
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Re: Choosing a Surgeon for SLAP repair

I'll be chronicling my shoulder surgery and recovery in my blog I anyone wants to follow along - among other things.
The Primordial Wingnut wfs

Last edited by Darla Powell : 12-10-2010 at 07:57 PM.
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