Friday, July 22, 2016: Jack's Surgery

Weight:  151.8

Unless something unexpected happens, I will have time to put up a longer post this morning.  I am unexpectedly home on a Friday morning because Jack had surgery on his arm last night to fix a ruptured tendon in his right bicep.  I guess I'll talk about that, first.

Did I mention, previously, that Jack ruptured a tendon in his right bicep?  I don't recall.  When I was out of town last weekend Jack hit the ground in exactly the wrong position when he was trying to catch a line drive during a kickball game.  He was playing short stop, which is a position he does not normally play.  When his arm hit the ground in one direction with him reaching in the opposite direction, it caused the tendon to tear off his bone just below the elbow.  Yesterday's surgery reattached the tendon to the bone.  In case you're wondering, that surgery was kind of a big deal. Here is some information that I found on the website http://orthoinfo.aaos.org/:

"The biceps muscle is located in the front of your upper arm. It is attached to the bones of the shoulder and elbow by tendons — strong cords of fibrous tissue that attach muscles to bones.

"Tears of the biceps tendon at the elbow are uncommon. They are most often caused by a sudden injury and tend to result in greater arm weakness than injuries to the biceps tendon at the shoulder.

"Once torn, the biceps tendon at the elbow will not grow back to the bone and heal. Other arm muscles make it possible to bend the elbow fairly well without the biceps tendon. However, they cannot fulfill all the functions of the elbow, especially the motion of rotating the forearm from palm down to palm up. This motion is called supination.

"To return arm strength to near normal levels, surgery to repair the torn tendon is usually recommended. However, nonsurgical treatment is a reasonable option for patients who may not require full arm function.

"The biceps muscle has two tendons that attach the muscle to the shoulder and one tendon that attaches at the elbow. The tendon at the elbow is called the distal biceps tendon. It attaches to a part of the radius bone called the radial tuberosity, a small bump on the bone near your elbow joint.

The biceps muscle helps you bend and rotate your arm. It attaches at the elbow to a small bump on the radius bone called the radial tuberosity.

"Biceps tendon tears can be either partial or complete.

"Partial tears. These tears damage the soft tissue but do not completely sever the tendon.

"Complete tears. A complete tear will detach the tendon completely from its attachment point at the bone.

"In most cases, tears of the distal biceps tendon are complete. This means that the entire muscle is detached from the bone and pulled toward the shoulder."  Jack had a complete tear.

A complete tear of the distal biceps tendon. The tendon has pulled away from where it attached at the radial tuberosity.

"Other arm muscles can substitute for the injured tendon, usually resulting in full motion and reasonable function. Left without surgical repair, however, the injured arm will have a 30% to 40% decrease in strength, mainly in twisting the forearm (supination).

"Rupture of the biceps tendon at the elbow is uncommon. It occurs in only three to five people per 100,000 each year, and rarely in women."  Lucky Jack!  He is so special.

Not Jack, but this is exactly what his arm looked like before surgery - hair and all.  Ha ha.

"Surgery to reattach the tendon to the bone is necessary to regain full arm strength and function.

"Nonsurgical treatment may be considered if you are older and less active, or if the injury occurred in your nondominant arm and you can tolerate not having full arm function. Nonsurgical treatment may also be an option for people who have medical problems that put them at higher risk for complications during surgery.

"Surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten, and restoring arm function with surgery may not be possible. While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.

"Procedure. There are several different procedures to reattach the distal biceps tendon to the forearm bone. Some doctors prefer to use one incision at the front of the elbow, while others use small incisions at both the front and back of the elbow.

One method for reattaching the tendon is through a single incision at the inside of the elbow.  This is the treatment Jack received.

(Left) A suture and suture anchor. (Right) This x-ray taken from the side shows where the suture anchors are placed in the radius bone.

"A common surgical option is to attach the tendon with stitches through holes drilled in the radius bone. Another method is to attach the tendon to the bone using small metal implants (called suture anchors).

"Complications. Surgical complications are generally rare and temporary.

• Numbness and/or weakness in the forearm can occur and usually goes away.
• New bone may develop around the site where the tendon is attached to the forearm bone. While this usually causes little limitation of movement, sometimes it can reduce the ability to twist the forearm. This may require additional surgery.
• Although uncommon, the tendon may re-rupture after full healing of the repair 

"Rehabilitation. Right after surgery, your arm may be immobilized in a cast or splint.

• Your doctor will soon begin having you move your arm, often with the protection of a brace. He or she may prescribe physical therapy to help you regain range of motion and strength.
• Resistance exercises, such as lightly contracting the biceps or using elastic bands, may be gradually added to your rehabilitation plan.
• Be sure to follow your doctor's treatment plan. Since the biceps tendon takes over 3 months to fully heal, it is important to protect the repair by restricting your activities.
• Light work activities can begin soon after surgery. But heavy lifting and vigorous activity should be avoided for several months.
• Although it is a slow process, your commitment to your rehabilitation plan is the most important factor in returning to all the activities you enjoy.

"Surgical Outcome. Almost all patients have full range of motion and strength at the final follow-up doctor visit.

• After time, return to heavy activities and jobs involving manual labor is a reasonable expectation."

The way Jack's surgeon described the surgery is this:

He made an incision in Jack's forearm.  The he drilled a small hole through the radius bone. He sewed one end of the anchor to the tendon.  He threaded the other end of the anchor through the hole in the bone (top to bottom).  He drilled a larger hole in the top side of the bone.  He installed a button on the end of the anchor that was threaded through the hole in the bone.  He wrapped the anchor around the bone and settled the button into the larger hole.  He secured all of this with a screw and then sewed him back up.

After Jack woke up from surgery and he demonstrated that he could move all of his fingers, they injected a nerve block in at Jack's shoulder.  This made the arm completely number for 18 - 24 hours, which allowed time for the trip home and a decent night's sleep.  Jack is just now starting to get a little feeling back into his fingers.  We started the pain medication, as the doctor said to make sure we started it no later than this morning.  We are waiting for the nerve block to wear off to see how much pain he will have.

Jack's arm is in a splint and is heavily wrapped in bandages; effectively, it's a cast.  It is also in a sling.  It will stay like that for two weeks, until he sees the surgeon again.  After two weeks the splint will be removed and he'll be able to bend his elbow, again.  No lifting, no pulling, no exertion, just bending.  At six weeks he will start physical therapy.  At three months he can start lifting light weights.  At six months he can start lifting heavier weights and should be fully recovered.

My oh my.  As Jack would say, "It's quite the deal!"

I'm going to end this post here, since this is kind of long.  I'll start another post about other things.