Getting Athletes Back in the Game Sooner Following Shoulder Injuries

Northwestern Medicine
Orthopaedics October 04, 2012
Athletes who make repetitive overhead actions, such as baseball pitchers or swimmers, are prone to shoulder injuries because of the enormous stress those activities place on the joint. One common type of athletic shoulder injury is called a SLAP (superior labrum anterior and posterior) tear, an injury that often requires surgery and rehabilitation. Traditionally this type of injury could leave an athlete sidelined for up to four months, but there is now an alternative minimally-invasive surgery called biceps tenodesis that has the potential to cut rehab time in half.  

Michael Terry, MDBiceps tenodesis is a relatively new way to treat superior labral tears, but it’s quickly gaining popularity for treating these tears because it allows athletes to return to play much sooner than other surgical options. Most patients who undergo this procedure find that they are able to return to activity in six to 10 weeks; other options may require double that time for recovery and rehabilitation.

A SLAP tear occurs in a part of the shoulder called the labrum, which is a cuff of cartilage that forms a cup for the arm bone (humerus) to move within. This type of tear often specifically affects the biceps tendon, a cord-like structure connecting the biceps muscles to the bone at the shoulder as it travels toward the elbow. The shoulder is similar to a hip in the sense that it’s a ball and socket joint, but the shoulder is very shallow making it potentially unstable and prone to overuse injuries. SLAP tears can also result from a fall on an outstretched arm or lifting a heavy object. Patients who have this type of labrum tear will experience pain, as well as other symptoms including decreased range of motion, popping and clicking in the joint and a feeling of instability in the shoulder.

While conservative treatment such as rest, icing, anti-inflammatory medications and physical therapy may be the first approach to managing a SLAP tear, many patients are unable to return to full athletic capability without surgery. Biceps tenodesis is an outpatient arthroscopic procedure during which the surgeon approaches the tear through two small incisions to cut the normal attachment of the biceps tendon then reattaches it to a position that is out of the way of the shoulder joint, limiting the distracting force that the biceps places on the labrum.

By removing tension on the injured area, this procedure alleviates pain and discomfort and allows the restoration of mobility and strength in the arm. Often performed as part of a larger shoulder surgery such as rotator cuff or SLAP repair, biceps tenodesis is becoming more common as the primary means for treating this type of injury. Patients go home the same day as surgery and do not require a hospital stay. As more surgeons become trained in this technique, it will likely eclipse other surgical options to fix these types of shoulder injuries in many cases. Not only are these patients rehabbing quicker, but they are also returning to their pre-injury level of performance. With athletic patients, the goal shouldn’t be to just fix the injury, but to do so in a way that allows them to return to sport quickly and as close as possible to their pre-injury performance level, if not better. Biceps tenodesis is a treatment that allows these patients to get back to what they love doing with little reminder of being hurt.

To learn more about biceps tenodesis and to read about one patient’s experience, check out the full press release.
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