SAD with bicep repair PROM

[Hayden123]

I need some advice. I have a patient that is 7 week post op Acromioplasty, subacromial decompression and bicep tenodesis. MD wanted him to be PROM for elbow flexion and supination secondary to repair. At 2-3 week after surgery patient without thinking grabbed for object that was falling and had severe pain and heared a pop. He returned to MD and MD thought tore bicep loose but pt./MD declined surgery. MD put him on PROM after this incident x 6 weeks. I have been performing PROM on the shoulder at 130 degrees flexion pt pain and abduction approximately 115, ER 45 degrees. Recently when performing PROM he had a snap with ER causing pain in shoulder. Also with flexion at times his shoulder will perform a strong jerk that will roll his shoulder into IR and extension. He has severe pain when it initially happens and 30-60 min after. Contacted MD office and Nurse called back to hold PT x 1 week (I was unable to speak with nurse so I am not sure what MDs thoughts are on the snap and jerk)Has anyone experienced this happening to a patient? Any tips on how to resolve. I thought it might be spasm in bicep or mechanics of AC jt but unclear secondary to MD thought possible tear of bicep repair. Pt also has had mod/severe tenderness to bicep belly since the incident 2-3 week following reinjury. Any suggestion would be helpful.

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[Hunter_PT]

My only reply would be for the patient to allow MD to go back into shoulder. Possibly a labral tear along with biceps tendon tear.

Should've been in his sling to begin with though!

[Hayden123]

Thank you for the reply. You are correct about the sling. He should not have been without the sling. The MD did not decide to repair bicep secondary to this would be the 3rd surgery and was not real positive if the bicep had been completely torn. If it was torn the patient had opted to not have another surgery secondary to he was just 2 week from surgery and patient mainly wanted bicep repair secondary to cosmetic concerns. He did not want a buldge and MD reported he would still have the strength in arm without another repair but would consider surgery at later time. The patient went for a follow up 1 week ago but he went into MD office without sling which MD said PROM until he returned to him. MD did not have much to say secondary to his noncompliance and told patient to get it moving (no restrictions).