About two weeks ago I had a proximal bicep tear on my dominant arm training for a contest (posted about it in your FB group while I was waiting for ultrasound imaging). Still pending an MRI (tomorrow morning) and follow up with my ortho (the 14th) but at the moment it’s likely a long tendon head rupture, although not sure of the severity or detail. For the time being I’ve been training as normal (for the most part) on my non-dominant side, with no real interruption of day to day function on my injured side (though I’m obviously taking care to avoid activity that could potentially make it worse or aggravate the injury).
Originally I was expecting to be told I needed surgery, and had pre-decided that was the route I needed to take, but the conversations I’ve had so far and research I’ve done waiting on the MRI seem to have put me on the fence as to whether the surgery/recovery time would be ‘worth it’. My ortho’s PA says that with proximal tears, even in athletes, they tend to lean towards just letting it heal naturally with rehab versus surgery because it’s largely cosmetic and there isn’t a great deal of strength loss. With surgery they say I’m looking at around 6-9 months before I return to ‘normal’ training versus a much shorter window without. So far the ‘major’ downside I’ve heard about those who don’t repair the tear is that it becomes prone to cramping, but I’m not sure how much that would effect me going forward, or if I’d experience it at all.
Really I’m just wondering if either or you have some insight or experience with these tears and what the average outcomes are with/without surgical intervention that you wouldn’t mind sharing. I’ll be having this whole conversation with my ortho at the MRI follow up, including whether or not surgery would still be an option down the road should there be any complications should I decided to just let it heal. However while I wait, anything either of you might be able to add (being lifters as well as doctors) would be incredibly valuable and appreciated.
While my ortho and his team work with athletes and understand I’m an active strongman competitor, I think you both ‘get it’ just a little more hahaha…
Unfortunately I don’t have a ton of direct experience rehabilitating these sorts of things in athletes, as more of my patient population tends to fall on the geriatric side in whom the risk/benefit considerations are much different. I suspect that our rehab guys would have more valuable input here, though, so I’ll see what they think.
I have seen quite a few of these injuries and can honestly make a case either way. Proximal injuries do tend to have good surgical outcomes but it is a slow rehab in the beginning. I believe I saw your original post as well and you referenced some athletes who underwent a surgical tenotomy for shoulder issues (Favre being the typical citation). I am going to answer your question from a “if this were me” perspective.
If it were me, I would go the conservative route. You can most certainly get back to training sooner and there are no established long term limitations. There is no good evidence that surgical intervention beats conservative. You are probably still looking at 6-10 weeks of modified training as you heal but overall that is much faster than likely being in a sling for 6 weeks before being able to start and 6 mo before returning to any significant training. Once you are past the initial healing phase, I would likely take the same approach that we mentioned in the limb symmetry article and use that for your biceps. I obviously do not think that you need to shoot for 100% symmetry but I would also be willing to bet that some of the subjective reports you mention are as much related to not getting back to close to full strength on the injured side.
This was incredibly helpful and I appreciate it Derek. MRI was done this morning so I just have to meet with the surgeon but this definitely helps tip me toward the side of just taking the conservative route for the next couple months… thanks again for the response.
On the upside of all this I guess my left side won’t feel so awkward for circus dumbbell by the time I’m done healing up hahaha
Derek, don’t know if any of this info would effect your previous opinion, but my MRI results/impression got posted:
The majority the supraspinatus tendon fibers are torn and retracted to the distal acromion. There is calcific deposits in the tendon stump at the greater tuberosity. Moderate infraspinatus tendinopathy with undersurface partial-thickness tear distally.
Mild calcific tendinopathy of the subscapularis. High riding humeral head.
The long head biceps tendon is torn and retracted distally into the bicipital groove. The labrum is torn along its superior and anterior portions.
Moderate glenohumeral joint effusion that communicates with fluid in the subacromial/subdeltoid bursa and subscapularis recess.
None of this really comes as a shock, only thing weird on the findings was a note about my AC joint that says “Downsloping distal lateral acromion with decreased subacromial space.” but I doubt that was related to the injury…
At least it will be a lively conversation on Monday…
I went through this ordeal last year and had surgery to reattach the biceps tendon 8 weeks post injury. I’m about 80% back to normal with regards to strength and aesthetics, so not where I expected to be 13 months later, but definitely better than choosing to leave it go without surgery. Had I known my biceps was torn sooner like yourself I may have had a better outcome. On that note, I’d choose to have the surgery and get it done ASAP, you have a short window of opportunity to get the best results from the surgery if it’s done sooner than later. For what it’s worth, I’m a former competitive bodybuilder and provincial title holder so strength and aesthetics were very important factors in my decision, and I’m glad I had the procedure because I’ve seen guys who chose not to have it done and they wished they had. Good luck with your decision !
EDIT just realized you said proximal tear, where mine was distal. I believe your injury may be a bit more involved to repair, but Jay Cutler former Mr O had his done and he recovered well.
Another update for you guys or anyone interested, the bicep tendon will be staying unattached and I’ll deal with that through rehab/training… however rotator cuff repair is on the menu for July. Kind of sucks waiting that long but it is what it is and the surgeon seems optimistic about the outcomes. Sounds like it will be about 3 months and then back to what might resemble some normal training…
At the risk of excluding information, here’s everything I’ve got…
And in terms of why surgery was recommended, he basically made the case that long term it would heal better with surgery than without it. Given that I’m reasonably confident I had this tear last year benching (which I rehabbed myself, crap insurance at the time) I’m more inclined to agree the surgery/rehab time is worth it.
MRI Findings:
Supraspinatus Tendon: The majority the fibers are retracted to the distal acromion. A few anterior most fibers may remain intact. A tendon stump at the supraspinatus footplate demonstrates globular low signal intensity on all sequences, likely
representing the calcific density seen on the prior radiographs.
Infraspinatus Tendon: Moderate tendinopathy and partial-thickness undersurface tearing distally.
Subscapularis Tendon: Mild calcific tendinopathy, similar to the prior radiographs.
Teres Minor Tendon: Intact.
Long Head Biceps Tendon: The long head biceps tendon is torn and retracted distally into the bicipital groove, with the distal tendon stump likely seen on series 4 image 21.
Rotator Cuff Muscles: No atrophy.
Labrum: The labrum is torn along its superior and anterior portions.
Bones: High riding humeral head. No acute osseous abnormalities.
Fluid: Moderate glenohumeral joint effusion that communicates with fluid in the subacromial/subdeltoid bursa. Fluid is seen within the subscapularis recess and around the distal long head biceps tendon.
Thanks for that. Ultimately it is your decision to elect surgery or not in this context. Perhaps check out this article before making a decision: Shoulder, Part IV: The Rotator Cuff Teardown
We’d also be happy to consult with you to provide individual advice and recommendations.
I realized I haven’t included a (somewhat important in this context) piece of the puzzle here. Multiple threads in multiple spots I thought I added it in here somewhere. Anyway, in light of this experience I’m highly inclined to believe I tore this rotator cuff last year during the 2020 shutdowns while I was chasing a 405 bench. At the time I just adjusted training and worked around it for a while until it ‘cleared up’ (lousy insurance kept me from getting checked out). Eventually most of the immediate painful symptoms went away but I’ve had some lingering difficulties with the right side throughout the rest of the year. Some stability issues on that side, along with lots of (for the most part painless) popping and stuff.
With this in mind, considering it may be freshly damaged with the bicep tear I’m leaning in to thinking surgery will be worth a shot. Rehab is in my future regardless and I may as well use the time and resources to try and get it right.
I appreciate all your effort so far and won’t hesitate to reach out for a consult if I start getting a different vibe than I’ve gotten so far…
Mouse, did you go ahead and have the surgery for the proximal bicep tendon rupture? I would really appreciate hearing how things are with you. I ruptured mine a few weeks back. I’ve already spoken to 1 consultant who advised against surgery, I will be speaking to another this coming week. Anyways, hope to hear back from you.