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Forum Name: Miscellaneous Orthopedic Topics

Question: Bicept Tendon Surgery

MrMech - Thu Dec 21, 2006 3:57 pm

Has anyone lost motor function of thumb and finger extension after surgery for a bicept tendon. I am 3 weeks post op and cannot move fingers up at knuckle. Any advice would help. Doctor thinks it's nerve trauma? I am not sure if I can trust his diagnosis. I am terrified as I am the lone bread winner with 2 kids and my wife is on disability, I fix jets for a living. I am a43 year old male. Thanks

Dr. Safaa Mahmoud - Fri Dec 22, 2006 12:07 am

Hello, This could be Posterior interosseous nerve (PIN) palsy. This is due to injury of a branch of the radial nerve that supply muscles of the hand on the dorsal surface that result in motor dysfunction. It is uncommon but seen after trauma or iatrogenic during fixation of fractures ordeep traumatic injuries ( nearby the tendon of the biceps). Traumatic PIN palsy have three types: of them Type I complete PIN palsy affects extension of the wrist ,at the metacarpo-phalangeal joints of all the fingers and the thumb, and weak abduction of the thumb. Type II the xtension of the little and ring fingers are lost sparing the index, thumb and middle fingers. Type III the index and the thumb extension is lost and loss of abduction of the thumb sparing the other fingers. (as in your case) Radiographs to detect forearm fractures, dislocations or instabilities and EMGs (3 weeks after damage may become abnormal) are helpful in the diagnosis. A 6- to 12-week waiting period is followed by some doctors, if there is no recover of function, exploration of the nerve is indicated. Exploration and primary or delayed primary repair or nerve grafting is performed if complete nerve damage occur. The results depend on the nature of the wound and the extent of nerve injury. Keep us updated. Best regards.

MrMech - Fri Dec 22, 2006 12:31 am

Ironically I read about (PIN) while doing hour upon hour of research. To hear it from you will prompt me to ask about it. I won't mention this forum. I know(pray) I'll recover and I will keep you posted. I can't thank you enough for your help. It's honest and caring people like you that make a difference in this world. Happy Holidays Mike

MrMech - Fri Dec 22, 2006 12:37 am

FYI he did use the single incision suture anchor technique.

Dr. Safaa Mahmoud - Fri Dec 22, 2006 1:30 am

Hello, In fact, distal rupture of the biceps tendon may be disabling (the traumatic injury or the surgical trauma). Successful surgery mandates an attention for possible complications like nerve injury and ectopic bone formation. Single-incision technique is one of the approaches aiming to avoid as possible fixation damage, avoids PIN injury, and minimal ectopic bone formation although injury of the radial nerve is still of consideration. I hope, it is just a mild injury and you will recover soon. Keep us updated. Best regards.

MrMech - Fri Dec 22, 2006 1:38 am

I will update as I progress. I wish my Surgeon was more understanding Thanks again. Mike

MrMech - Wed Jan 03, 2007 5:58 pm

Hi, my arm strength is improving but my nerves for my knuckle and thumb are still non responsive. However following some muscle stim this AM I felt some tingling in my fingers for the first time. I think I am healing, and it feels great. Well one day at a time. FYI my employer is Southwest Airlines and if you think they have great service. They treat us fallen workers just as good. They are wonderful. Regards, Mike

MrMech - Sat Jan 20, 2007 12:49 pm

Hi, in the case of healing nerves, do you recover function from the injury outward or from your extremety "fingers" inward. 7 weeks post op and still no movement at the mcp joints. I have an appt with Neurologist Monday. Thanks, Mike

Dr. Safaa Mahmoud - Sun Jan 21, 2007 10:57 pm

Hello, Nerve axonal regeneration takes place in 4 phases. Only in the third phase, the axons elongate beyond the site of injury till the distal peripheral target with restoration of function. Thus direction of regeneration goes from site of injury to periphery till complete recovery of conduction. The duration ranges from 6-18 months, according to the nerve length as well as the site of the lesion. Keep us updated. Best regards.

MrMech - Wed Mar 14, 2007 3:27 pm

Hi again, well it's been 3 1/2 months since the surgery. I am not seeing "visual" progress yet. The last nerve conduction exams were not too promising. Yet my second Doctor seems to think it's very unlikely that the nerve is entrapped. He thinks it's a compression injury. Another surgery is an option but could set me back further. I am not sure what I should do? I wish I knew which function I will regain first. I read about an ultrasound machine that can detect nerve lesions. I just want to make the right choice, Also for what it's worth, he damaged the sensory branch of the Radial nerve too as I am numb on the inside of my forarm. My arm is atrophied badly below the elbow. Here is the link to the ultrasound equipment. . http://www. medical. philips. com/us/news/publications/articles/ultrasound/AdvancingPeripheralSonography. asp It's getting very difficult to remain positive. I wish I were more patient. if I only knew for sure that I will improve it would make this so much easier. Thanks, Mike

MrMech - Tue Mar 20, 2007 3:12 pm

I can now move my fingers at the MCP joint, a little on the thumb, and I am starting to gain other functions slowly. Well I think this means I should have a good prognosis. I noticed very small movement at the MCP at 3months +1 week post surgery, for what it's worth, I was uncertain. I recorded it so I could track the progress this way I knew for sure, well it's much better. I will keep updating as progress is made. Now 3 months 20 days post op. Target return to work is June or better. I found a very good second Doctor who told me to wait on surgery for the nerve. He said it was literally impossible to entrap the nerve doing single incision bicep tendon repair. However he stressed the importance of being very careful with retractors as they can compress the PIN nerve as it appears happened in my case. Mike

Dr. Chan Lowe - Tue Mar 20, 2007 10:15 pm

It's good to hear you are beginning to recover. Thanks for the update. Nerve damage can be a very slow recovery. If your nerve was compressed during surgery it may very well take months to recover. Best wishes.

MrMech - Wed Apr 11, 2007 12:35 am

Hi just an update. Every muscle that was not working is firing to some extent. Incredible progress in the last month. Full finger extension, thumb is progressing very well. The only lagging problem is my index finger when moving it alone. I understand it's one of the last muscles to be innervated. Considering that 1 month ago I was in poor shape and moving nothing, I am thankful. Taking vitamin b-12 methylcobalamin, and a B-100 complex. Target return to work is June 15th, I am working hard to beat that estimate by my Doctor. Speedy recovery to all. Mike

MrMech - Sat May 26, 2007 11:15 am

Hi, 6 months later the PIN nerve palsy has almost fully resolved. My strength is near normal. The sensory nerve is still not right "numbness on inside of forearm and base of thumb"and I have swelling on the back of my hand which the Doctor injected with medicine. I could not tilt my wrist with fingers extended because of this swelling and pain. It's much better since the injection. I still feel a little stiff and sore but I am scheduled to return to work soon. Anyway this should be the end of my ordeal. I strongly believe that I will be 100% recovered soon. Thanks for your help. Mike

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