Post-Operative Instructions Shoulder Arthroscopy, Decompression, and Biceps Tenodesis

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1 Laith M Jazrawi, MD Prfessr f Orthpedic Surgery Chief, Divisin f Sprts Medicine T Day f Surgery Pst-Operative Instructins Shulder Arthrscpy, Decmpressin, and Biceps Tendesis A. Relax. Diet as tlerated. B. Icing is imprtant fr the first 5-7 days pst-p. While the pst-p dressing is in place, icing shuld be dne cntinuusly. Once the dressing is remved n the first r secnd day, ice is applied fr 20-minute perids 3-4 times per day. Care must be taken with icing t avid frstbite. Alternatively, Crycuff r Game-ready ice cuff can be used as per instructins. Yu will be cntacted by East Cast Orthtics regarding an ice cmpressin unit t be used after surgery. This helps with pain and swelling but typically is nt cvered by insurance. The cst is $ fr a 2-week rental. Alternatively, ice gel packs with a shulder r knee sleeve can be prvided by the hspital fr a minimal charge. C. Pain medicatin as needed every 6 hurs (refer t pain medicatin sheet) First and Secnd Pst-Operative Day A. Cntinue Icing. B. Pain medicatins as needed Third Pst-Operative Day A. Yu may remve surgical bandage and shwer this evening. Apply 4 x4 (r similar size) waterprf bandages t these wunds prir t shwering and when shwering is cmplete apply fresh nes. Yu will need t fllw this rutine fr 2 weeks after surgery. Physical Therapy A. Physical Therapy shuld begin within the first 10 days after surgery. Please call yur preferred facility t make an appintment. *Nte: Yur shulder will be very swllen. It may take a week r lnger fr this t g away. It is als cmmn t ntice burning arund the shulder as the swelling reslves. If excessive bleeding ccurs, please ntify Dr. Jazrawi. Call ur ptin 4, ptin 2 t cnfirm yur first pstperative visit, which is usually abut 1-2 weeks after surgery. If yu are experiencing any prblems, please call ur ffice r cntact us via the internet at NYU Langne Orthpedic Center 333 E 38th St, New Yrk, NY T F

2 Dr. Laith M. Jazrawi Chief, Divisin f Sprts Medicine Assciate Prfessr Department f Orthpaedic Surgery Rehabilitatin Guidelines fr Biceps Tendesis The shulder has tw primary jints. One part f the shulder blade, called the glenid fssa frms a flat, shallw surface. This is cupled with the humerus (shaped like a glf ball) t make up the jint. The glenid labrum is a ring f car@lage that turns the flat surface f the glenid int a slightly deeper scket, which is similar t res@ng a glf ball n a glf tee instead f a table tp, prviding mre shulder stability. Anther part f the scapula, called the acrmium, ar@culates with the clavicle (cllar bne) t make the acrmiclavicular (AC) jint. The rtatr cuff is a grup f fur muscles: the supraspinatus, infraspinatus, teres minr, and subscapularis. The rtatr cuff tendns afach arund the humeral head (ball) and cnnect the humerus t the scapula. The lng head f the biceps riginates frm the tp f the glenid fssa and labrum (tp f the glf tee). It then runs thrugh a grve in the humerus (upper arm bne) t jin the shrt head f the biceps and inserts n a bne in the frearm1 (See Figure 1). Because f its psi@n, the lng head f the biceps is als cnsidered t be a secndary stabilizer f the shulder jint. The lng head f the biceps is at risk f injury and degenera@ve changes due t its prximity t the rtatr cuff and the acrmium. Since the lng head f the biceps can act as a secndary stabilizer f the shulder, it is als subject t injury during high speed verhead mvements; repe@@ve verhead mvements; r frceful shulder ac@vi@es when the elbw is straight. Specific injuries may include inflamma@n and irrita@n f the bicep tendn itself; a prblem with the bicep tendn in cnjunc@n with ne f the rtatr cuff tendns; r detachment f part f the tendn frm the afachment pint (SLAP tear).1 Bicep tendn degenera@n and/r tearing can cause significant shulder discmfrt and dysfunc@n (See Figure 2). A biceps tendesis is a surgical prcedure which may be perfrmed fr treatment f severe symptms invlving the biceps tendn, including inflamma@n r par@al tears. It may be perfrmed in isla@n r as part f a larger shulder surgery, including surgery invlving the rtatr cuff. During the biceps tendesis, the nrmal afachment f the biceps tendn n the shulder scket (glenid fssa) is cut and reafachment f the tendn is made n the humerus (upper arm bne). This takes the pressure ff the biceps afachment and places the afachment belw the actual shulder jint.2 The gal is t eliminate the shulder pain cming frm the bicep tendn. Different techniques are used t perfrm a biceps tendesis. The surgical techniques can be brken dwn in t tw categries: techniques and hardware fixa@n techniques. Bth techniques are effec@ve and chsen based n surgen preference and pa@ent indica@ns. Figure 1 Shulder anatmy th St. New Yrk, NY (646) newyrkrth.cm!

3 Rehabilitatin Prtcl After Biceps Tendesis The primary technique is the pen key hle prcedure. An pen keyhle technique relcates the tendn within the grve in the humerus bne aver cuxng it frm its riginal in the shulder.1 The prcedure invlves the prximal end (the clsest t the it frm its riginal lca@n in the shulder.) f the biceps tendn being rlled int a ball and then sutured tgether as a mass. A keyhle is made in the grve f the humerus, the tendn mass is then inserted int the keyhle and pulled dwnward s that the tendn mass is lcked in place.3 The PiF technique uses tw needles t pierce the bicep tendn in ppsite direc@ns. Sutures are then threaded thrugh the needles t make a suture. This prcedure is repeated with the needle placement reversed t create a lcking pafern f the sutures. A knt is used t secure the sutures t the transverse ligament in the shulder instead f t the bne.4 The hardware fixa@n techniques include screw fixa@n r endbufn fixa@n. In the screw fixa@n the tendn is detached and then place in a hle made at the tp f the bicipital grve. Then an interference screw is placed ver the tendn, in t the bne, t hld it in place. In the endbufn technique the released tendn is secured t a bufn, the bufn is then secured behind the bne by sliding it in t a smaller hle at the tp f the bicipital grve. Imagine a drywall type anchr where the pressure is applied frm the inside ut. Apprpriate rehabilita@n is vital t p@mizing yur utcme aver surgery. The rehabilita@n guidelines are tailred t the type f prcedure perfrmed, therefre belw yu will find rehabilita@n guidelines fr fixa@n techniques and rehabilita@n guidelines fr hardware fixa@n techniques. The rehabilita@n guidelines are presented in a criterin based prgressin. frames are given fr reference t the average, but individual pa@ents will prgress at different rates depending n their age, assciated injuries, pre-injury health status, rehabilita@n cmpliance and injury severity. frames, restric@ns and precau@ns may als be given t prtect and the surgical repair/recnstruc@n. Figure 2a Nrmal lng head f bicep. The muscle has a smth arc frm the shulder t the elbw Figure 2b and Figure 2c Trn lng head f bicep. The muscle has retracted tward the elbw th St. New Yrk, NY (646) newyrkrth.cm!

4 Rehabilitatin Prtcl After Biceps Tendesis Phase I (Surgery t 4 weeks after surgery) Gal Sling immbilizatin t be wrn at all times fr shwering and rehab under guidance f PT Gals: full passive flexin/extensin at elbw and full shulder AROM Range f Mtin PROMàAAROMàAROM f elbw as tlerated withut resistance (allws biceps tendn t heal int new insertin n the humerus withut being stressed), AROM f shulder (n restrictin ) Encurage prnatin/supinatin withut resistance Therapeutic Grip strengthening Heat/Ice befre and after PT sessins Phase III (4 t 12 weeks fllwing surgery) Gals Discntinue sling immbilizatin Range f Mtin Therapeutic Being AROM f elbw with passive stretching at end ranges t maintain/ increase elbw/biceps flexibility Begin light ismetrics with arm at side fr rtatr cuff and deltid can advance t bands as tlerated Begin light resistive biceps strengthening at 8 weeks Range f Mtin Therapeutic Prgress t full AROM f elbw withut discmfrt Cntinue and prgress with Phase II exercises Begin UE ergmeter Begin sprt-specific rehabilitatin Return t thrwing at 3 mnths Thrwing frm a mund at 4.5 mnths Return t sprts at 6 mnths if apprved th St. New Yrk, NY (646) newyrkrth.cm!

5 Rehabilitatin Prtcl After Biceps Tendesis References 1. Krupp RJ, Kevern MA, Gaines MD, Ktara S, Singletn SB. Lng Head f the Biceps Tendn Pain: Differen@al Diagnsis and Treatment. Jur Orth & Sprts PT. Feb 2009; 39(2): Rme AA, Mazzcca AD, Taur JC. Arthrscpic Biceps Tendesis. Arthrscpy. Feb 2004; 20(2): Ozalay M, et al. Mechanical Strength f Fur Different Biceps Tendesis Techniques. Arthrscpy: Jur Arthr & Related Surg. Aug 2005; 21(8): Lpez-Vidrier E, Cs@c RS, Fu FH, Rdsky MW. Bimechanical Evalua@n f 2 Arthrscpic Biceps Tendesis: Duble-Anchr Versus Percutaneus Intra-Ar@cular Transtendn (PITT) Techniques. Am Jur Sprts Med. 2010; 38(1): Slenker NR, Lawsn K, CiccX MG, Ddsn CC, Chen SB. Biceps tentmy versus tendesis: clinical utcmes. Arthrscpy Apr;28(4): di: /j.arthr Epub 2012 Jan Burns JP, Bahk M, Snyder SJ. Superir labral tears: repair versus biceps tendesis. J Shulder Elbw Surg Mar; 20(2 Suppl):S2-8. di: /j. jse th St. New Yrk, NY (646) newyrkrth.cm!

6 Laith M Jazrawi, MD Prfessr f Orthpedic Surgery Chief, Divisin f Sprts Medicine T Rehabilitatin Prtcl: Biceps Tendesis Name: Diagnsis: Date: Date f Surgery: Phase I (Weeks 0-4) Sling immbilizatin t be wrn at all times except fr shwering and rehab under guidance f PT Range f Mtin PROM à AAROM à AROM f elbw as tlerated withut resistance (allws biceps tendn t heal int new insertin n the humerus withut being stressed), AROM f shulder (n restrictin) Gals: full passive flexin/extensin at elbw and full shulder AROM Encurage prnatin/supinatin withut resistance Grip strengthening Heat/Ice befre and after PT sessins Phase II (Weeks 4-12) Discntinue sling immbilizatin Range f Mtin Begin AROM f elbw with passive stretching at end ranges t maintain/increase elbw/biceps flexibility Therapeutic Exercise Begin light ismetrics with arm at side fr rtatr cuff and deltid can advance t bands as tlerated Begin light resistive biceps strengthening at 8 weeks Mdalities per PT discretin Phase III (Mnths 3-6) Range f Mtin Prgress t full AROM f elbw withut discmfrt Therapeutic Exercise Cntinue and prgress with Phase II exercises Begin UE ergmeter Begin sprt-specific rehabilitatin Return t thrwing at 3 mnths Thrwing frm a mund at 4.5 mnths Return t sprts at 6 mnths if apprved Mdalities per PT discretin Cmments: Frequency: times per week Duratin: weeks Signature: Date: NYU Langne Orthpedic Center 333 E 38th St, New Yrk, NY T F