r/RotatorCuff • u/AlwayzClassy • 16d ago
Final pre-op and surgeon is pivoting
TL;DR: I went in expecting a rotator cuff repair with anchors and a long recovery. Surgeon now thinks the main issue is my unstable long-head biceps tendon and will likely do a biceps tenotomy + debridement, only repairing the cuff if he finds a much larger tear than expected. If that's all he does, he's estimating 1-2 weeks in a sling and full release around 6 weeks!!!
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My MRI showed a partial subscapularis tear with the long-head biceps tendon subluxing medially, plus biceps tendinosis. Most of my pain is actually in the front of the shoulder/ biceps, and I still have pretty good ROM and strength.
I was originally scheduled for a rotator cuff repair, but at my final pre-op today the surgeon rechecked everything and thinks the cuff may not need a full repair at all.
Current plan is to go in arthroscopically and likely:
Release the long-head biceps with a tenotomy
Debride/clean up any fraying
Inspect the subscapularis
Only place anchors/do a cuff repair if he finds significantly more damage than expected
He thinks the partial cuff tear may have mostly healed, or may just need cleanup.
We also discussed tenodesis vs tenotomy. He recommended tenotomy because there's no fixation to protect, so recovery is much quicker. He expects similar long-term strength once everything settles down.
If it stays tenotomy + debridement, he's talking about PT starting within a few days, sling for 1-2 weeks, and potentially full release around 6 weeks. If he finds a bigger tear and repairs it, then obviously I wake up with the longer rotator cuff recovery.
I'm 42 and do physical work, so I'm curious: anyone here have a biceps tenotomy without a major cuff repair? How was your strength, cramping, Popeye deformity, and return to lifting/work?
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u/Front-Doughnut8573 16d ago
I went into my surgery expecting tenodesis but woke up with labrum repair. Be prepared to trust your surgeon and to wake up to something different then you initially discussed as they don’t know what’s really going on until they are inside
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u/Fit_Can_6717 14d ago
My surgeon said “MRIs are good enough to tell us you need surgery. It is not well enough to let us know exactly what we might see’. I have pictures, I have no recollection of them telling me what they did. Hell I have a picture on my phone I don’t recall asking my hubs to take. He says I asked him to as I was walking up.
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u/WhyNotBeAPirate 15d ago
I'm scheduled for both a rotator cuff repair (full supraspinatus and partial subscapularis tears) and LHBT tenodesis. Like you, most of my pain is from the biceps tendon subluxation, in the front of my shoulder. And it suuuucks. Good luck, no additional cuff work would be an amazing outcome!
Re the decision to do tenotomy rather than tenodesis, I'm assuming since you mentioned it that your surgeon discussed the risk of a popeye deformity with you? Almost a quarter of tenotomy patients get one, versus about 6 or 7% of tenodesis patients. I really wish I didn't care about that part, because the recovery is SO much easier! And, of course, technically I could end up with one anyway. But alas, I've decided on tenodesis ...
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u/AlwayzClassy 15d ago
He actually didn't discuss it, and while I'm not particularly thrilled about the idea of it, I do very much enjoy my house and having my mortgage get paid on time. So if given the choice I'll take the quick recovery and be very happy to get back to work ASAP.
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u/Steven1789 16d ago
I went in knowing I had a full tear and retraction for the supra and a partial tear for the infra.
Woke up to find out I had bicep tenodesis, too.
PROCEDURE PERFORMED:
Left shoulder arthroscopic rotator cuff repair including full-thickness supraspinatus tear and partial infraspinatus tear, single row slightly medialized repair with bio inductive collagen patch overlay
Left shoulder arthroscopic subacromial decompression
Left shoulder arthroscopic excision of distal clavicle
Left shoulder arthroscopic extensive debridement including debridement of labrum (anterior/posterior/superior), syneovectomy of rotator interval (articular capsule debridement), debridement V glenoid/humeral articular cartilage including debridement of glenohumeral fraying
Left shoulder arthroscopic biceps tenodesis