Arm Swelling After Biceps Tenodesis

Abstract

HISTORY: A 40-year-old, right-hand dominant male presented initially for right shoulder pain which began when he slipped on a waterpark slide, injuring his arm. Prior to injury, he was active in baseball. His past medical history was complicated by a history of right AC separation which was treated non-operatively as well as bilateral neurogenic thoracic outlet syndrome (TOS) for which he underwent surgery on both sides. He recovered from the procedures with no complications and complete symptom resolution. The pain, following his fall, was unlike past extremity pains, and he reported difficulty throwing a baseball. After failing 2 months of non-operative treatment, he obtained an MRI suggesting a superior labrum lesion (SLAP). He underwent a shoulder arthroscopy with an open biceps tenodesis. He was placed in a shoulder immobilizer. In the recovery room, he was neurologically intact with no arm swelling. He was placed on aspirin and discharged the same day. Nine days later, he returned for followup complaining of swelling and pain in his distal arm. He had no shortness of breath or angina. Physical Exam: Upon exam, the patient was in no acute distress and had no dyspnea. His vital signs were normal. His incisions were well healed, and he had no signs of sepsis. Distal to his incisions, he had swelling on the medial side of his arm, down to his elbow. His forearm did not have any swelling. He was entirely neurovascularly intact to sensation and motor for all dermatomes, myotomes and peripheral nerves. His capillary refill and pulse were equal bilaterally. He was tender in the area of swelling but no cord could be felt. His biceps tenodesis was intact. DIFFERENTIAL DIAGNOSIS:Postoperative dependent edema Exacerbation of thoracic outlet syndrome Deep vein thrombosis Superficial vein thrombosis Failure of biceps tenodesis TESTS AND RESULTS: Duplex ultrasound: occlusive thrombus in right basilic vein FINAL/WORKING DIAGNOSIS: Upper extremity superficial vein thrombosis TREATMENT AND OUTCOMES:Hematology consultation: no signs of deep venous extension so it was decided to treat with aspirin only with no further work up warranted Warm compress and elbow range of motion as tolerated Followed closely: four total in-office visits by orthopedist, PCP and TOS surgeon Resolution of symptoms at 3-month (latest) followup