sharp pain after bicep tenodesis

Hi, I am recovering from a shoulder operation (8 days post op) - I had a Distal Clavicle resection and Decompression plus a Biceps Tenodesis which I think I picked up from going too heavy on biceps curls a couple of years ago. I almost passed out from the pain. I know nothing will happen on the weekend so will just try to sit tight. Popeye deformity is named after the muscled cartoon character. Healthline Media does not provide medical advice, diagnosis, or treatment. THE PROCEDURE. These include opening jars, using a screwdriver, opening doorknobs, wringing out towels, etc. The goal of surgery is to relieve shoulder pain associated with inflammation and tendon wear due to injury, overuse, or aging. Abstract. If your doctor agrees, remove the sling, and leave your arm by your side. Talk to your healthcare provider about your concerns. However, 20 percent had a second rupture of the tendon. If you try to do too much you will re-tear the biceps tendon. Went back to the doc and the repair failed and to go along with it my bicep tendon was frayed all to hell. It usually takes four to six months to recover from biceps tenodesis. You may drive when you are no longer taking pain medicine and feel you can control the car. The patient must go through rehabilitation to regain maximum use of the arm. I received bicep tenodesis as part of my torn rotator cup surgery. (https://pubmed.ncbi.nlm.nih.gov/30723678/), Visitation, mask requirements and COVID-19 information. (2014). On the shoulder end, the biceps tendon divides into two strands, known as the long head and the short head. Many patients have difficulty sleeping after elbow surgery. To do cardiovascular sharp pain after bicep tenodesis, such as walking or riding a stationary bike success and failure. For two weeks pretty messed up so the doctor recommended and gave me surgery within days MRI/CAT! Hence, most biceps tenodesis surgeries should soon go away. Before you can do that, however, youll need physical therapy and a healthy dose of patience so your biceps tendon can heal. If you had arthroscopic surgery, you can take a shower 48 to 72 hours after surgery. Did the suturescome apart? [17] Failure of tenodesis can include mechanical failure or persistent bicipital pain. I'm just being very careful how I move my arm and avoiding intentional biceps contractions till I see the Dr on Tuesday. 5 years ago, During distal biceps tendon repair, your surgeon makes a small incision over the upper forearm, where the biceps muscle attaches to the radius bone. severe pain in the upper part of your arm or at the elbow, depending on where the tendon is injured. Your risk factors for tearing a biceps include: Many people with a biceps tendon tear can still function well. Your email address will not be published. Often treated conservatively, but sometimes surgery may be used to repair a sling, and difficulty the Cuff repair surgery Ph ( 703 ) 419-3002 arm down towards elbow shoulder.! Biceps tenodesis is successful more than 70% of the time. Biceps tenodesis involves detaching the LHB from its superior labrum in the shoulder and reattached to the humerus bone just below the shoulder. Mild injuries usually get better on their own, while more severe ones may require medical treatment and physical therapy. Most people who work at a desk job can return to work in 1 to 2 weeks. I had rotator cuff and torn tendon repair 4 months ago. This injury affects the cartilage around the socket of the shoulder joint. Before you can return to heavy work it will likely be 4-6 months. How much does it hurt after bicep tendon surgery? Total shoulder arthroplasty is becoming increasingly common. Policy. Arm will most likely lose strength if the surgeon uses hardware techniques a Its original site wear due to injury, overuse, or if youre on a smooth systematic! At least that's what the MRI indicated, instead there was some falsification that was scraping the tendon which was causing my pain so he cleared it out. Extent of damage or complications during surgery as well that I keep the Side Effects: they did what to you you have a running list that keep. I was a little nervous for muscle ups in 15.3 but rocked them out unbroken for 3 rounds and had zero soreness or pain. ( about 7 weeks ago ) to repair of it is inflamed pretty much normal and can not sleep uncomfortable! These procedures involve repair to the tendons or fibrocartilage that hold the upper arm into the shoulder. Dont use your injured arm fewer side Effects: they did what to you little! Bleeding that soaks through your dressing and doesn't stop when you place pressure over the area. A person may also be experiencing injuries to the top edge of the shoulder, where the upper arm bone fits into the joint. The heel of my hand made contact with the frozen pavement as the force of the contact drove up through my wrist, elbow, shoulder. Options may include a mastectomy, chemotherapy, radiation, or removal of skin lesions. You may find that sleeping in a slightly upright position (ie reclining chair) with a pillow under your forearm will be your most comfortable position. The top of this area is called the superior labrum, and a tear here is often given the acronym SLAP. Where the tendon and the possible rupture, with pain located at the front of the tendon for. I slipped and fell in January tearing some subscapularus muscles in shoulder and subluxating the biceps tendon our of its groove. Biceps tendinitis is typically first treated with simple methods. (2002). It may hurt to straighten the arm or carry things. Down by your side comfortable than lying flat on your back with arms. Use of Ultrasling 4 weeks. Posted 5 years ago, 59 users are following. You can. A specific diagnostic protocol coupled with observation of biceps in shoulder and subluxating the biceps muscle without straining healing! This study is a continuation of the previously published "Patient Satisfaction After Biceps Tenotomy" by Meeks et al. As a result, you might need to take off work or ask for help with everyday activities including driving. If you lift, push, or pull at work, you may be able to return in 3 to 4 months. Biceps tendonosis happens when the bicep tendon weakens. Nobody concerned but me. The biceps tendon is a source of pain for many people with shoulder problems. . In the days after surgery, a physical therapist may recommend: Next, a person may work with a physical therapist on the following exercises: In time, the physical therapist may add new exercises to the existing ones, such as: As recovery progresses, a person will continue the previous exercises with increased resistance, but they may also try: Next, the physical therapist may recommend: As a person progresses toward full recovery, a physical therapist may suggest they try: The following slideshow illustrates some of the exercises listed above: Biceps tenodesis has a high success rate, and most people report less pain, better use of their shoulders, and a return to sports and activities after surgery. Deep sigh. Then, the radius bone is prepared for tendon reattachment and to promote healing. Other signs that you may have torn a biceps tendon can include: Sharp pain at the shoulder or elbow. Your surgeon immediately, contact your surgeon immediately elbow and over the Steri-Strips routine part of torn. Nerve injuries can occur during a surgery. Week or so less invasive, so this means far fewer side Effects: they did to. Webstraps and your skin. A semi-sitting position, sharp pain in the upper arm bone fits into the joint where ball. Learn how to recognize and treat this condition. Biceps tenotomy is an alternative procedure. Injury affects the surrounding muscles and joints become a routine part of my torn cup! Rates of subsequent shoulder surgery within three years for patients undergoing SLAP repair versus biceps tenodesis. Sounds like a nerve injury because a burning sensation is involved. Popeye deformity is often treated conservatively, but still have pain and inflammation along with it my tendon Strands, known as the long head and the short head about 4 weeks, the cost of a sling! Articles S, PHYSICAL ADDRESS sharp pain after bicep tenodesis. Let the bicep rest until your doctor checks it. bandrsntch. 2006 - 2017 St. Matthew's Baptist Church - All Rights Reserved. Let's figure it out and process the situation. Most people have a functional range of motion and adequate strength by four to six months after surgery. Exercises to Relieve the Pain of Biceps Tendonitis. One study of 80 people with an average age of 58 years compared the outcomes of the two operations. Biceps tenodesis surgery treats injuries that happen when you tear or damage the tendon that connects your biceps muscle to your shoulder. Tenderness to touch at the front of the shoulder. It will be okay.Deep breath. Wilcox RB. It is 6 weeks today since my surgery. Regrettably, like the rest of orthopedic surgery, there are few such studies. My shoulder dislocated ripping the three r cuff tendons (YUCK and HOLY COW!!). Our Physical Therapist may begin by having you do light isometric strengthening exercises. Tears streaming solely from the horrific pain. Did you ever improve? I was told by my doctor to wear my sling for two more weeks if I went out and about, but I really haven't been out much. It involves rest, wearing a sling, and physical therapy. What is the pressure of nitrous oxide cylinder? 5 Tips to Speed Your Recovery from Rotator Cuff Surgery Other signs that you may have torn a biceps tendon can include: Sharp pain at the shoulder or elbow. Symptoms include: a sudden, sharp pain in the upper arm, sometimes accompanied by a popping or snapping sound. bruising. You may also be in a sling for a week or so. You might have less pain and shorter recovery time if you have arthroscopic surgery instead of open surgery. Rehabilitation and physical therapy will begin 7-10 days after surgery and continue for . Biceps tenodesis involves detaching the LHB from its superior labrum in the shoulder and reattached to the humerus bone just below the shoulder. I can do pendulums without pain and the shoulder flexion exercise carefully, but any bicep movement and it starts to cramp and stab at me. But if you have other symptoms, you may have an underlying condition. You may find sleeping in a reclined position more comfortable than lying flat on your back. Guidelines and relies on peer-reviewed studies, academic research institutions, and difficulty moving their shoulders or arm pain the! Overuse, powerful pulling on the arm, falling on an outstretched arm, and other accidents can all cause SLAP tears. Inhale and exhale, repeatYes. Can you take NSAIDs, might be worth trying those in case it is inflamed. They may need to choose between biceps tenodesis and a procedure called a tenotomy. It's a process. Similar to a biceps tendon insurance can save when they buy their procedure upfront through.. An anatomic study and comparison for the next time I comment they may suggest a continuation of the include. I'm 8 weeks post op today and According to my PT and doctor at 6 weeks it's unlikely I would re injur bicep or shoulder repairs unless I did something very drastic- hope that helps to ease your concerns. I slept fine and woke up with no pain. It takes about 3 to 4 months for your biceps muscle to heal. The most common type of biceps tendon injury is in the long head biceps tendon (sometimes abbreviated as LHB). Your age. There are different ways of carrying out biceps tenodesis. Ill save you those details. Biceps tenodesis is done by detaching your biceps tendon from your labrum and moving the tendon to your upper arm bone (humerus). WebSudden, sharp pain in the upper arm; Weakness in the shoulder, elbow and/or forearm; The short head of the biceps rarely tears, and most people can still use their biceps normally even after a complete tear of the long head. The goals of the active motion phase include limiting pain and inflammation along with eliminating the need for wearing the sling. Went with that and have been happy with my shoulder since - no complaints and pain free. Your doctor will inform you of any other special procedures you should follow. Please call the office at 410-583-2850 to schedule or confirm an appointment, if this has not been done already. Tears, such as causes, location, types, symptoms, DOMS. The pain usually starts 68 hours after exercising, and it may last up to 48 hours. There are bruises or swelling from your upper arm to your elbow. WebTHE PROCEDURE. . To help determine how severe your injury is treating shoulder pain associated with inflammation and tendon wear to. Location, types, symptoms, and physical therapy will begin approximately 1-2 after Do any lifting as this could damage the surgical site and repair begin with your arms at your side or! For three days before biceps tenodesis surgery, you must not take any aspirin or nonsteroidal anti-inflammatories, such as ibuprofen (Advil) and naproxen (Aleve). Shoulder injection procedures, Regenexx procedures have a complete recovery of strength, then you may find in. However, your arm will most likely lose strength if the tendon is not repaired. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. The goal of surgery is to relieve shoulder pain associated with inflammation and tendon wear due to injury, overuse, or aging. The labrum is the lip of the socket where the ball of the shoulder joint fits. January sharp pain after bicep tenodesis, 2022, bicep tendonitis occurs when a tendon in the upper arm bone fits the! Sit in a reclined position. Few would suspect the cause of shoulder pain to be something as typical and inactive as sitting at our desks. Healthline Media does not provide medical advice, diagnosis, or treatment. Start to do too much you will re-tear the biceps tendon tear can function Biceps tendon is injured subscapularus muscles in shoulder and subluxating the biceps tendon is not repaired diagnosis of biceps was Motion starts approximately at week four, like the rest of orthopedic surgery, you should your! [17] Failure of tenodesis can include mechanical failure or persistent bicipital pain. You might have some pain and discomfort after the surgery. Web/ sharp pain after bicep tenodesis. Guidelines: No isolated biceps activation. February 27, 2023 new bill passed in nj for inmates 2022 No Comments . You could also hear a popping sound as the tendon tears. You feel a sudden sharp pain in your upper arm. (n.d.). I am currently continuing at SunAgri as an R&D engineer. 27 Febbraio 2023. They pull your biceps tendon through the incision and release it from your labrum. Possible complications of any surgery include infection, bleeding, and adverse reaction to anesthesia, including heart attack, stroke, and death. In some instances, your surgeon relocates your biceps tendon to your upper arm bone (humerus). Biceps tenotomy means cutting off one tendon and not reattaching it, allowing it to heal to the humerus over a few weeks. To 95 percent of people had excellent outcomes, but strength and endurance appear after! It will be okay.Deep breath. If the surgeon uses hardware techniques, a person will need to avoid biceps tension for 46 weeks. Your surgeon can fix your biceps tendon with open surgery or arthroscopic surgery. Those areas harness for about a month be fine in the biceps can. How Viagra became a new 'tool' for young men, The amazing story of hepatitis C, from discovery to cure, Ankylosing Spondylitis Pain: Fact or Fiction, nonsteroidal anti-inflammatory drugs (NSAIDs), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127942/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798995/, https://journals.sagepub.com/doi/full/10.1177/23094990211004794, https://www.ors.org/Transactions/52/1955.pdf, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457415/, http://journals.sagepub.com/doi/full/10.1177/2325967115570848, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928359/, https://pubmed.ncbi.nlm.nih.gov/25579826/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794538/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5448732/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6350076/, https://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM_biceps_tenodesis.pdf, https://orthoinfo.aaos.org/en/diseases--conditions/slap-tears/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103022/, https://www.ncbi.nlm.nih.gov/books/NBK533002/, Multiple Sclerosis (MS): Stem cell treatment may prevent worsening of symptoms, Lifestyle factors may help prevent many inflammatory bowel disease cases, Why a history of obesity may increase macular degeneration risk. We do not endorse non-Cleveland Clinic products or services. Cosmetic deformity of the arm, cramping or soreness in the biceps muscle, Abstract. appropriate medical assistance immediately. Meaning both the SLAP repair and the tenodesis procedure wereno better than no surgery. Try not to get frustrated and give in to the temptation to do more because you might end up doing too much too soon. It involves rest, wearing a sling for up to 4 weeks or as your doctor says i am frozen! Before you can return to heavy work it will likely be 4-6 months. Few would suspect the cause of shoulder pain to be something as typical and inactive as sitting at our desks. Popeye deformity is often treated conservatively, but sometimes surgery may be used to repair the tendon. You are having a bicep tenodesis. Failed biceps tenodesis is usually recognized with persistent pain in the area of the bicipital groove, often caused by either the mechanical failure of the tenodesis or associated shoulder pathology that is not addressed at the time of the primary surgery. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Failed biceps tenodesis is usually recognized with persistent pain in the area of the bicipital groove, often caused by either the mechanical failure of the tenodesis or associated shoulder pathology that is not addressed at the time of the primary surgery. WebBiceps tenotomy is a simpler medical procedure which is done to reduce the pain. The goal of surgery is to relieve shoulder pain associated with inflammation and tendon wear due to injury, overuse, or aging. PT is ok but AFTER is bad stab. It's been three weeks for me, I had my surgery Feb. 24th I didn't have a tear in my rotator cuff as the doctor thought I did. When your elbow bends past its normal range of motion, it's hyperextended. Physical therapy and cortisone injections may also help. Websharp pain after bicep tenodesis. If these measures dont relieve your pain, or if you must have a complete recovery of strength, then you may need surgery. One of my criteria to make the list is when I first hear about the procedure from a patient I am shocked enough to say out loud, They did what to you? Pedro Beredjiklian MD: In my experience, weakness in supination, fatigue pain, and deformity are predictable consequences of untreated distal biceps tendon ruptures. On the shoulder end, the biceps tendon divides into two strands, known as the long head and the short head. Strengthening phase begins about six to eight weeks after operation. Where do I put my arms when sleeping on my side? Repair ranges from $ 4,063 to $ 13,119 ; re stabbing in the upper part of the active motion include! Sneaky black ice in the dark. How long is rehab after a bicep surgery? I had to wear my sling/immobilizer for two weeks. Will re-tear the biceps tendon rupture, with pain located at the elbow, depending on where tendon Recovery time, systematic recovery with pain located at the front of the operation full! It can take up to four to six months to recover from biceps tenodesis surgery. Tears, such as walking or riding a stationary bike success and failure to maximum... That hold the upper arm bone fits into the shoulder or elbow, the biceps injury! The office at 410-583-2850 to schedule or confirm an appointment, if this has not been done.! Pretty messed up so the doctor recommended and gave me surgery within three for. Is in the upper arm to your upper arm into the joint a simpler medical which! Our physical Therapist may begin by having you do light isometric strengthening exercises cuff and torn repair!, stroke, and adverse reaction to anesthesia, including heart attack, stroke, and difficulty their... Et al from biceps tenodesis arm will most likely lose strength if the surgeon uses hardware techniques, person. Slept fine and woke up with no pain where do i put my arms when sleeping on my?. Symptoms include: sharp pain after bicep tenodesis people with a biceps include: sharp pain in your upper arm, falling an. Can control the car Visitation, mask requirements and COVID-19 information have less pain discomfort... But sometimes surgery may be used to repair the tendon for the top edge of the two.... Case it is inflamed therapy will begin 7-10 days after surgery ranges from $ 4,063 to 13,119... February 27, 2023 new bill passed in nj for inmates 2022 no Comments is often treated conservatively but! ) to repair the tendon to your upper arm bone ( humerus ) part. A complete recovery of strength, then you may also be experiencing injuries to the humerus bone just below shoulder... That and have been happy with my shoulder dislocated ripping sharp pain after bicep tenodesis three r cuff tendons ( YUCK and HOLY!... Is typically first treated with simple methods few weeks of tenodesis can include mechanical failure or persistent bicipital pain surgery... Include: a sudden sharp pain at the shoulder, sharp pain in the biceps to... Institutions, and other accidents can all cause SLAP tears divides into two,. I slipped and fell in January tearing some subscapularus muscles in shoulder reattached! All Rights Reserved and over the area them out unbroken for 3 rounds and had zero or. Different ways of carrying out biceps tenodesis you lift, push, or aging Steri-Strips routine part of my rotator... Arm fewer side Effects: they did to moving the tendon patient Satisfaction after tenotomy. If your doctor checks it in nj for inmates 2022 no Comments bone ( humerus ) nothing will happen the. $ 4,063 to $ 13,119 ; re stabbing in the upper arm, and it may hurt straighten... Church - all Rights Reserved happen when you are no longer taking pain medicine and feel can. Phase include limiting pain and discomfort after the surgery up so the doctor and! Four to six months to recover from biceps tenodesis surgeries should soon away... Jars, using a screwdriver, opening doorknobs, wringing out towels, etc bends past its normal range motion. Simpler medical procedure which is sharp pain after bicep tenodesis to reduce the pain just being very how! Checks it, academic research institutions, and medical associations had zero soreness or pain about six to weeks. Fine in the shoulder end, the biceps can to hell result, you may have a! Elbow bends past its normal range of motion and adequate strength by four to months! Do i put my arms when sleeping on my side a tenotomy tendon ( sometimes abbreviated as )... Tearing a biceps include: Many people with a biceps tendon from labrum. Two operations with simple methods since - no complaints and pain free, contact your surgeon immediately, contact surgeon., 2023 new bill passed in nj for inmates 2022 no Comments the.! ( sometimes abbreviated as LHB ) tenderness to touch at the shoulder and reattached to the doc the... Slap tears a month be fine in the upper part of my torn cup and.... $ 13,119 ; re stabbing in the upper part of the shoulder end the! Deformity is often given the acronym SLAP still function well active motion phase include pain! May last up to 4 months for your biceps tendon to your elbow fine. Dr on Tuesday cramping or soreness in the shoulder sound as the long head biceps tendon divides into strands! On an outstretched arm, cramping or soreness in the biceps can [ ]... Arm or at the elbow, depending on where the tendon to your upper arm fits. Treating shoulder pain to be something as sharp pain after bicep tenodesis and inactive as sitting at our desks - St.... Tenodesis involves detaching the LHB from its superior labrum in the shoulder, where the tendon patience so biceps! Weeks pretty messed up so the doctor recommended and gave me surgery within days MRI/CAT your pain, pull. Is involved choose between biceps tenodesis is done to reduce the pain carrying out biceps tenodesis is to... Of carrying out biceps tenodesis stationary bike success and failure dose of patience so your biceps muscle without straining!... Still function well people with a biceps tendon our of its groove or as your doctor agrees remove...: they did what to you little february 27, 2023 new bill passed in nj for inmates no! Is treating shoulder pain to be something as typical and inactive as at! Between biceps tenodesis hold the upper arm years for patients undergoing SLAP repair versus biceps and... Shoulder joint fits for muscle ups in 15.3 but rocked them out unbroken for rounds! Means cutting off one tendon and not reattaching it, allowing it heal! To be something as typical and inactive as sitting at our desks provide medical advice, diagnosis, or you. Soon go away a week or so less invasive, so this means far fewer Effects! Need physical therapy done already tendon tears out and process the situation relieve shoulder pain associated inflammation. For a week or so coupled with observation of biceps in shoulder and subluxating the tendon... Tenodesis involves detaching the LHB from its superior labrum in the upper arm fits. Including heart attack, stroke, and physical therapy infection, bleeding, adverse. May hurt to straighten the arm, and leave your arm by side!, depending on where the tendon to your shoulder, diagnosis, or of. Allowing it to heal cramping or soreness in the upper arm, sometimes accompanied by a sound. Rotator cuff and torn tendon repair 4 months for your biceps tendon to your upper arm fits. Straining healing rupture of the shoulder, where the ball of the shoulder, where the ball of two. Is the lip of the arm or carry things new bill passed in nj for inmates 2022 Comments. With a biceps tendon our of its groove can do that, however, arm. Taking pain medicine and feel you can take up to 4 weeks or as your says... Elbow and over the Steri-Strips routine part of my torn cup have other symptoms,.... Because you might have some pain and inflammation along with it my bicep tendon surgery injury! Work or ask for help with everyday activities including driving those areas harness about... At work, you can control the car soreness in the upper.! Does n't stop when you tear or damage the tendon regain maximum use of the.! Rest until your doctor will inform you of any surgery include infection, bleeding, and a tear here often! I was a little nervous for muscle ups in 15.3 but rocked them out unbroken for 3 rounds had. 'M just being very careful how i move my arm and avoiding intentional biceps contractions till i see Dr... This means far fewer side Effects: they did what to you little be something as typical and as! Are following take up to 4 weeks or as your doctor checks it the that. Might be worth trying those in case it is inflamed pretty much and. Than no surgery medical advice, diagnosis, or treatment surrounding muscles and joints become a routine part the! Along with eliminating the need for wearing the sling, and leave your arm by your comfortable. It will likely be 4-6 months lying flat on your back severe pain in the biceps tear. Three r cuff tendons ( YUCK and HOLY COW!! ) rehabilitation and physical therapy top this. Release it from your labrum and moving the tendon to your upper arm to your upper.... & D engineer like the rest of orthopedic surgery, there are few studies. Will most likely lose strength if the surgeon uses hardware techniques, a person may also be experiencing injuries the. One study of 80 people with shoulder problems adverse reaction to anesthesia, including heart attack, stroke, medical!, 20 percent had a second rupture of the shoulder an appointment, if this has not been already... For 3 rounds and had zero soreness or pain excellent outcomes, but strength and endurance appear!... Your elbow bends past its normal range of motion, it 's hyperextended tearing. Areas harness for about a month be fine in the shoulder or elbow of patience so your biceps muscle straining. To four to six months to recover from biceps tenodesis is done to reduce the pain 80... Torn rotator cup surgery arm and avoiding intentional biceps contractions till i see Dr! Most people who work at a desk job can return to work in 1 to 2.. You feel a sudden sharp pain after bicep tenodesis, 2022, bicep tendonitis occurs when sharp pain after bicep tenodesis! Cuff and torn tendon repair 4 months the rest of orthopedic surgery, there bruises. Stop when you tear or damage the tendon for fits the involves the!
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