Low grade partial biceps tendon tear

[Eship]

So after 6 years of on and off nagging pain in my left shoulder, I finally made the time to get to the VA and have an MRI done to see what the culprit is. I had tried to have it done a couple years back, but at the time covid was still affecting their process and would only sparingly give MRIs. Everytime I decided to get it checked, it seemed to clear up and I’d forget about it until it came back up.

Anyway, the MRI showed a slightly attenuated proximal biceps tendon of the long head indicating a low grade partial tear. I have an Otho appointment scheduled in July (soonest VA had) to see what they recommend. I’m assuming it’ll just be PT to start, and I am very much a surgery as a last resort type of person as I work in a rehab as a therapist and see all of the bad outcomes.

I’m wondering if anyone else has had a similar injury and how you managed it. I am very active and love lifting, so I am aware that I need to modify my workouts. I’ve gotten pretty good at that over the years when a flare up occurs. Regardless, I will do whatever it takes to get my shoulder back to 100% after having dealt with it holding me back in some way or another for the last 6 years. To be honest, the pain is never that bad (3/10 when lifting) and if it weren’t for the fact that I’m smart enough to not keep pushing it a complete tear, I easily would keep working out with it. What are your thoughts and experiences?

 

[Eship]

I’d also add that I have used BPC157 orally for a 1 month cycle earlier this year and did not notice any effect at 1400mcg/day, but I just purchased 60 days worth of BPC157 and TB500 that will be in later this month to give it another try and see if that combo for a longer period is beneficial.

 

[Bubblehide]

You should keep in mind that tears atrophy. As such, complete tears, and some partial tears have a limited amount of time to be a le to repair them, via surgery. Once atrophy reaches a certian point, surgical repair provides limited benefit. It will be important to ask your ortho the right question, so you can truely make informed decisions about your care.

With that said, yours is a partial tear, so the specifics and extent of your tear, should drive your decision making process.

 

[Eship]

You should keep in mind that tears atrophy. As such, complete tears, and some partial tears have a limited amount of time to be a le to repair them, via surgery. Once atrophy reaches a certian point, surgical repair provides limited benefit. It will be important to ask your ortho the right question, so you can truely make informed decisions about your care.

With that said, yours is a partial tear, so the specifics and extent of your tear, should drive your decision making process.Good news is the MRI showed

Good point. I believe there has been no muscular atrophy, but possibly some of the tendon. The MRI report is as follows:

Minimal acromial undersurface spurring. No suspicious focal bone lesion. Acromion is flat without significant downsloping. Acromioclavicular ligament is intact. No significant joint effusion. Inferior glenohumeral ligament is intact. Muscles demonstrate no fatty atrophy.

Minimal signal near the supraspinatus myotendinous junction could represent low-grade strain. Otherwise the supraspinatus, infraspinatus, teres minor and subscapularis tendons demonstrate no tear. Minimal tendinosis. Labrum is intact. No para labral cysts. Slightly attenuated appearance of the extra-articular long head biceps tendon with adjacent focal fluid signal.

Impression: 1. Slightly attenuated extra-articular long head biceps tendon with adjacent fluid could represent low-grade partial tear. 2. No labral tear..

 

[Bubblehide]

From my limited perspective (this is not my area of expertise) it sounds like it is likely minor, and as you suggest, PT will be prescribed. Obviously you can strengthen muscles around it, and increase their endurance, to help compensate. But that will not fix the issue. Healing is possible, but to what degree is unknown. You do not want to continue to injure it, re-injure it, or expand the injury. You may want to discuss an anti-inflammatory, steroid, and mild muscle relaxor possibilities as you start rehab, as a short term treatment. But, as I'm sure you're aware, they can make it easy to over do it, and potentially exacerbate the injury. But, if you're cautious, the combination treatment can assist PT.

 

[Eship]

From my limited perspective (this is not my area of expertise) it sounds like it is likely minor, and as you suggest, PT will be prescribed. Obviously you can strengthen muscles around it, and increase their endurance, to help compensate. But that will not fix the issue. Healing is possible, but to what degree is unknown. You do not want to continue to injure it, re-injure it, or expand the injury. You may want to discuss an anti-inflammatory, steroid, and mild muscle relaxor possibilities as you start rehab, as a short term treatment. But, as I'm sure you're aware, they can make it easy to over do it, and potentially exacerbate the injury. But, if you're cautious, the combination treatment can assist PT.

Yeah, I’m willing to do almost anything to improve the actual health of the tendon. I want long term recovery. With that in mind, I am not concerned with the pain as it isn’t bad, and I know some injections can weaken the tendon more. Where I work, we generally only recommend people receive injections if they’re very old and at a significant risk of remaining bed ridden if they do not get up and start walking immediately. I also know that, like you mentioned, if I don’t have any pain, I will definitely overdo it in training

 

[Montucky]

I currently have a very similar injury in exact area you are. I started 8wks of physical therapy last week to see any improvement before doing an MRI…Please look into Red Light Therapy as I have seen significant results in 2 weeks of treatment at home, I was skeptical but it’s working for me…..Here’s a few articles on RLT & the Redtonic I have been using

What Is Red Light Therapy?

Red light therapy is used for dental pain, hair loss, and skin damage. But does it work? Learn more about this treatment and its risks here.

www.webmd.com

RedTonic Red Light Therapy Device Review - Pain Relief for Joints and Muscles: Is This the Solution You Need? - Health Spot

Are you suffering from chronic joint and muscle pain? Are you tired of trying various treatments and therapies to find relief? Consider trying out the

healthspot.net

 

[Eship]

I currently have a very similar injury in exact area you are. I started 8wks of physical therapy last week to see any improvement before doing an MRI…Please look into Red Light Therapy as I have seen significant results in 2 weeks of treatment at home, I was skeptical but it’s working for me…..Here’s a few articles on RLT & the Redtonic I have been using

What Is Red Light Therapy?

Red light therapy is used for dental pain, hair loss, and skin damage. But does it work? Learn more about this treatment and its risks here.

www.webmd.com

RedTonic Red Light Therapy Device Review - Pain Relief for Joints and Muscles: Is This the Solution You Need? - Health Spot

Are you suffering from chronic joint and muscle pain? Are you tired of trying various treatments and therapies to find relief? Consider trying out the

healthspot.net

I’ve heard good things about red light therapy for general health stuff, and I’m willing to try anything non invasive initially. I’ll definitely check it out

 

[Mcribs]

I know you’re looking for non-surgical which makes sense. But if tenodesis is the proposed surgical fix, I’ve had both long heads reattached with shoulder surgery. Very common for surgeons to clip it and reattach, even just to clear space along with other procedures. This part of my shoulder surgery has had positive outcomes.

 

[Montucky]

I’ve heard good things about red light therapy for general health stuff, and I’m willing to try anything non invasive initially. I’ll definitely check it out

My Physical Therapist is like…..WTF have you been doing?….she’s fresh outta school & there’s not enough data & research, could be years bro

 

[Montucky]

Either way….I’m doing 5 pushups next week under her discretion, a month ago no FKN way

 

[Eship]

I know you’re looking for non-surgical which makes sense. But if tenodesis is the proposed surgical fix, I’ve had both long heads reattached with shoulder surgery. Very common for surgeons to clip it and reattach, even just to clear space along with other procedures. This part of my shoulder surgery has had positive outcomes.

That’s good to hear. Did you notice any initial or lasting loss of shoulder flexion strength or do you feel like they’re basically 100%. For me, my left shoulder has always been a bit weaker than the right side anyway, so it may not even be much of an issue and maybe I’d finally be able to rebuild to to be nearly as strong as the right.

 

[Eship]

I would definitely prefer to avoid surgery, but I’m also only 27, and I know that at my age, surgery is often far more successful than if I were to put it off and need surgery when I’m older.

 

[Eship]

My Physical Therapist is like…..WTF have you been doing?….she’s fresh outta school & there’s not enough data & research, could be years bro

Yeah, they tend to stick to the basics in school even if some of that stuff is now outdated or disproven. But that’s how everything in medicine is. That’s why so many people still recommend the RICE method despite it being counterproductive to stop the inflammation response in most cases.

 

[Mcribs]

That’s good to hear. Did you notice any initial or lasting loss of shoulder flexion strength or do you feel like they’re basically 100%. For me, my left shoulder has always been a bit weaker than the right side anyway, so it may not even be much of an issue and maybe I’d finally be able to rebuild to to be nearly as strong as the right.

I’ve definitely lost range of motion more than strength. But I had pretty major surgery on both of them. I just know the biceps repair is solid and they essentially reattach it lower in your arm with a screw. If it’s just that they are doing, I’d take a strong look at getting it done. If they plan on doing a bunch more, I would be hesitant, as shoulder surgery is no joke.

 

[Eship]

I’ve definitely lost range of motion more than strength. But I had pretty major surgery on both of them. I just know the biceps repair is solid and they essentially reattach it lower in your arm with a screw. If it’s just that they are doing, I’d take a strong look at getting it done. If they plan on doing a bunch more, I would be hesitant, as shoulder surgery is no joke.

I can’t imagine they’d want to do anything else because fortunately, my entire rotator cuff as well as the cartilage within the joint is healthy. Just really the biceps tendon

 

[Yoder]

I tore mine about 25 years ago. I never knew what happened, only that it was bad and I felt something tear. It always bothered me, but I was able to walk it off until two years ago. The pain got progressively worse, and my range of motion was pretty limited. I got an MRI and they found the bicep tendon was torn at the shoulder, not sure which one, bone spurs and bursitis. They re-attached the tendon, ground down the bone spurs and cleaned up the joint. I'm almost 4 months out of surgery and my shoulder is already better than before surgery. Range of motion is almost normal, hardly any pain and I'm able to lift about 75% of what I can with my good arm. PT was a little painful and it was really tough sleeping for about a month, but it really wasn't that bad. I recommend saving your pain medication until you start PT, instead of using it right after the surgery. At night, it aches just enough to keep you awake all night. So far, I'm really happy with the results. I'm pretty confident I'll be able to shoot my bow again for the first time in two years.

 

[Eship]

I tore mine about 25 years ago. I never knew what happened, only that it was bad and I felt something tear. It always bothered me, but I was able to walk it off until two years ago. The pain got progressively worse, and my range of motion was pretty limited. I got an MRI and they found the bicep tendon was torn at the shoulder, not sure which one, bone spurs and bursitis. They re-attached the tendon, ground down the bone spurs and cleaned up the joint. I'm almost 4 months out of surgery and my shoulder is already better than before surgery. Range of motion is almost normal, hardly any pain and I'm able to lift about 75% of what I can with my good arm. PT was a little painful and it was really tough sleeping for about a month, but it really wasn't that bad. I recommend saving your pain medication until you start PT, instead of using it right after the surgery. At night, it aches just enough to keep you awake all night. So far, I'm really happy with the results. I'm pretty confident I'll be able to shoot my bow again for the first time in two years.

That is great to hear and makes me not do worries about surgery. Obviously I’d prefer healing the tendon without surgery but I’ll remain open to options upon speaking with the ortho

 

[Eship]

An update: still waiting for my orthopedic appt with the VA on July 1st. In the meantime I’ve stopped all pressing and pulling work, so basically nothing for chest or lats. I’m also only doing light eccentrics for shoulders. I’m and continuing to do arms while just being particular about exercise selection to keep from irritating it. One thing I want to avoid is complete rest and then having all of my tendons getting weaker as I’ve heard that beyond a brand new, reactive tendinosis, complete rest does more harm than good. The pain in the front of my shoulder has subsided, however it seems that my supraspinatus tendon has gotten aggravated in the process so now I’m concurrently trying to manage that, which seems to be causing me more trouble that the biceps tendon.

 

[WyoWild]

Ask your Ortho Doc at the VA if they do Platelet Rich Plasma Injections. Get a PRP injection adjacent to the tendon and then rest in a shoulder sling for one week and then start with PT. I have been doing a lot of PRP treatments and have had great results in treating chronic tendinopathy, partial tendon tears and early joint osteoarthritis. In a young guy like you PRP could really boost healing and help your tendon repair.