Would you like email updates of new search results? Treatment of biceps tendon lesions in the setting of rotator cuff tears: Prospective cohort study of tenotomy versus tenodesis. Koh et al. WebPatients with biceps tendinitis or tendinosis usually complain of a deep, throbbing ache in the anterior shoulder. Ultrasonographic guidance may increase the accuracy of the injection and has been shown to produce a fivefold increase in analgesic effect.29,30 Ultrasonography may also be used to aspirate and disperse calcific deposits within the tendons of the rotator cuff.28,31, Radiologic evaluation to diagnose biceps tendinitis or tendinosis should begin with radiography of the shoulder to rule out primary causes of impingement (Table 35,10,12,14,3241 ). The biceps tenodesis procedure treats shoulder and biceps muscle pain and weakness that happens when you tear your long head biceps tendon. A total of 103 open subpectoral biceps tenodeses were performed over a 3-year period using a dual suture anchor technique. AAOS Now / [1,5,16] Mazzocca et al. The average length of follow-up was 7 months (range, 1 to 45 months). 2018 Jan;138(1):63-72. doi: 10.1007/s00402-017-2810-z. You have shoulder pain that hasnt been helped by rest, physical therapy or pain medication. Complications of Proximal Biceps Tenotomy and Tenodesis. WebThe typical symptoms of shoulders with un-repaired tendon tears are weakness with lifting above shoulder level or away from the body. One patient developed a pulmonary embolism requiring hospital admission and anticoagulation. Within and around the joints is a group of muscles known as the rotator cuff tendons. Nho SJ, Reiff SN, Verma NN, Slabaugh MA, Mazzocca AD, Romeo AA. Lesions at the long head of the bicep tendons often lead to fractures of the humerus bone. Ultrasonography is the best modality for evaluating isolated biceps tendinopathy extra-articularly. Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. The risk for fracture is also likely lower with the suture anchor technique as the drill holes made in the humerus are only 1-2 mm compared to the much smaller 7-8 mm drill hole commonly required for an interference screw. The superior drill hole is placed 3 cm proximal to the inferior border of the pectoralis tendon and the inferior hole is placed 1 cm proximal to the inferior border of the pectoralis tendon. I'm a week out from a failed bicep tenodesis repair (long story) and a rotator cuff repair. official website and that any information you provide is encrypted Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. [6,8,9,10], Subpectoral tenodesis utilizing a single-suture anchors has been shown to have inferior initial biomechanical properties (ultimate load-to-failure and stiffness) when compared to an interference screw construct. Proximal bicep tenodesis may involve the following steps: You are given general anesthesia. Coming to a Cleveland Clinic location?Cole Eye entrance closingVisitation, mask requirements and COVID-19 information. 6. Humeral fracture following subpectoral biceps tenodesis in 2 active, healthy patients. Ice packs, pain medication and wearing a sling should help relieve both. Aiyash S, Garbis N, Goldberg B, Salazar D. JSES Open Access. So in a moment of stupidity, I decided to slightly flex it (big no no) really slowly just until I start to see some definition of the bicep. Both forms are performed under general anesthesia, and the surgeon may insert an arthroscope (a small tube) to see inside the shoulder joint. Bookshelf Conclusion: The all-suture anchor fixation using a Krackow stitch for subpectoral biceps tenodesis provided ultimate load and stiffness similar to unicortical button fixation using a nonlocking whipstitch. may email you for journal alerts and information, but is committed Tenodesis of the long head of the biceps tendon can be performed through arthroscopic and open techniques with various fixation methods and at different locations on the humerus. Soft tissue procedures. Operative treatment options include revision tenodesis or biceps tenotomy. Orthop Traumatol Surg Res. Operative treatment options include revision tenodesis or biceps tenotomy. Your surgeons make several tiny cuts in your shoulder to insert a tiny camera called an arthroscope. Tenodesis was performed on the dominant side in 55% of shoulders. Proximal biceps tenodesis has been shown to be a reliable treatment for tears, subluxation, and synovitis of the LHB. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The symptoms can often be controlled by By use of standard arthroscopic portals, the shoulder was evaluated, and on the basis of the preoperative clinical examination and intraoperative evaluation, a rotator 9500 Euclid Avenue, Cleveland, Ohio 44195 |. MeSH The anterior shoulder may be bruised, with a bulge visible above the elbow as the muscle retracts distally from the rupture point. Biceps tendon tears may happen quickly from a traumatic injury or develop over time from repetitive motions of the shoulder. a sudden, sharp pain in the upper arm, sometimes accompanied by a popping or snapping sound What are the risk factors? 3. Our hypothesis is that the early complication rates after dual suture anchor fixation will be equivalent to those reported for interference screw fixation for a subpectoral tenodesis. Search for Similar Articles Typically, theyre around 3-4 centimeters. Reprints: Anthony A. Romeo, MD, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Avenue, Suite 300, Chicago, IL 60612 (e-mail: [emailprotected]). Complications associated with subpectoral biceps tenodesis: Low rates of incidence following surgery. Assemble the necessary equipment. In his presentation, Dr. Arce, of Buenos Aires, Argentina, focused on tenodesis and covered different arthroscopic techniques for performing LHB tenodesis. See permissionsforcopyrightquestions and/or permission requests. Dual suture anchor biceps tenodesis construct (Two Mitek G4 suture anchors (Mitek, Norwood, MA) each loaded with a No. After diagnosing the type and location of tendon failure, the surgeon may perform tenotomy or tenodesis, with encouraging results., Terry Stanton is senior science writer for AAOS Now. In this sub-group of patients with longer follow-up, there was only a single complication (superficial wound infection treated with oral antibiotics). There were 2 temporary nerve palsies (2%) resulting from an interscalene block. You might have some pain and discomfort after the surgery. The transverse ligament and a well-vascularized tendon sheath are the main restraints of the lower pulley, he explained. A Comparative Short to Mid-term Follow-up Study. Pain relief indicates a diagnosis of biceps tendinitis. Our series is the largest group of patients reported undergoing a suture anchor subpectoral tenodesis. Koch BS, Burks RT. A biceps tenotomy may be performed to remove the ruptured biceps tendon from the glenohumeral joint, and tenodesis may be avoided without significant loss of arm function.43 Tenotomy is the procedure of choice for inactive patients 60 years and older with a ruptured biceps tendon.43 Tenodesis is a reasonable option for patients younger than 60 years, as well as active patients, athletes, manual laborers, and patients who object to a muscle bulge above the elbow.14,42,43. The current study demonstrates high patient satisfaction (88%) and significant improvement in functional outcomes with revision biceps tenodesis, a mini-open subpectoral technique, after previous failed tenodesis or tenotomy. Patients with unsatisfactory Medscape: "Complete Ruptures of the Achilles Tendon. In the sub-group of patients with a minimum of 6 months clinical follow-up, the only complication was a single wound infection treated with oral antibiotics. Patient demographics recorded included age, sex, hand dominance, surgical side, associated surgical procedures, biceps tendon diagnosis, and diagnoses requiring other surgical procedures. It typically takes at least 4 to 6 weeks to recover from biceps tenodesis surgery. I immediately get nervous but decide to wait and see how it feels after my ibuprofen kicks in. Has anyone gone through anything similar? The biceps tendon is then re-cut 20 mm proximal to the musculotendinous junction. WebThe primary surgical options include biceps tenotomy and biceps tenodesis. Open subpectoral biceps tenodesis has been associated with a low frequency of more significant complications, such as neurovascular injury, deep wound infection, as well as hardware failure, and minimizes the chance of postoperative groove pain. Keywords Biceps tenodesis Complications Patient outcomes Infection Hardware failure Biceps tenodesis surgery treats injuries that happen when you tear or damage the tendon that connects your biceps muscle to your shoulder. PMC Unable to load your collection due to an error, Unable to load your delegates due to an error. Posted Cleveland Clinic is a non-profit academic medical center. We reported no deep infections, hematomas, peripheral nerve injuries, fractures, or ruptures utilizing this technique. Subpectoral biceps tenodesis utilizing a dual suture anchor technique has a low early complication rate with no ruptures or deep infections. Bethesda, MD 20894, Web Policies Am J Sports Med. The supraspinatus fibers contribute to the pulleys lateral wall and roof. Epub 2014 Feb 11. Before performing them, we need clear decision making criteria to tailor the surgical treatment to each particular patient, injury, and performance.. This makes it difficult to distinguish from pain that is secondary to impingement or tendinitis of the rotator cuff, or cervical disk disease.14 Pain from biceps tendinitis usually worsens at night, especially if the patient sleeps on the affected shoulder. government site. An alternative technique is to combine the lidocaine with sodium bicarbonate and corticosteroid solution in the same syringe to avoid changing syringes. All rights reserved. During the arthroscopic examination, the SGHL-CHL complex is the primary structure in evaluating biceps instability. WebWhat Symptoms May Lead to a Biceps Tenodesis? clinical6. have recommended the use of an interference screw instead of suture anchors for subpectoral tenodesis fixation. The subpectoral approach provides excellent versatility and ability to meet technical objectives when performing revision tenodesis, by removing the tendon completely from the groove and preserving biceps function. The decision to treat patients was based upon preoperative history and physical examination, MRI findings, and an arthroscopic evaluation. The Yergason test requires the patient to place the arm at his or her side with the elbow flexed at 90 degrees, and supinate against resistance18 (Figure 2). Last reviewed by a Cleveland Clinic medical professional on 09/24/2021. reported on 43 patients undergoing proximal biceps tenodesis using suture anchors and noted 7% of patients had a clinically apparent traumatic failure. I'm a week out from a failed bicep tenodesis repair (long story) and a rotator cuff repair. The potential risks of the injection include infection; bleeding; skin atrophy and depigmentation; allergic reaction to medication; or temporarily increased pain. Tendon instability and painful tendinosis are the two main pathologic conditions that play a role at the biceps tendon, and many patients will have both conditions. 2022 Apr 22;11(5):e711-e715. All other arthroscopic procedures were then performed, if any. 2016 Dec;9(4):378-387. doi: 10.1007/s12178-016-9362-7. government site. The next morning I decided to do the same thing and take a picture to compare to pictures of my bicep after the first surgery and after the tendon pulled out of the first tenodesis anchor screw. The close relationship of the subscapularis and the medial CHL determines the frequent involvement of both structures in many cases, and arthroscopic evaluation of the medial CHL is the key to successful treatment of biceps instability.. [5] Looking specifically at the sub-group with greater than 6 month follow-up, we found no increased incidence of complications, specifically re-rupture. This type of tendon damage may be called biceps tendonitis. The test is positive if bicipital groove pain is present. An official website of the United States government. Bleeding that soaks through your dressing and doesn't stop when you place pressure over the area. Please try again soon. Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini-open Tenodesis? It should be negative. Risk factors for a bicep tendon rupture include: Biceps tenodesis is used for both partial and full tendon tears, an unstable joint, or pain caused from overuse of the biceps. The most common isolated clinical finding in biceps tendinitis is bicipital groove point tenderness with the arm in 10 degrees of internal rotation. The long head of the biceps Biceps tendinosis is caused by degeneration of the tendon from athletics requiring overhead motion or from the normal aging process. Egton Medical Information Systems Limited. Upgrade to Patient Pro Medical Professional? Patient is a UK registered trade mark. Wolters Kluwer Health The same program applies to the nonathlete, but with less emphasis on throwing.4 If additional therapy is needed for pain relief, or if the diagnosis is in doubt, an injection of local anesthetic (e.g., 1% lidocaine with or without a mild corticosteroid solution) into the biceps tendon sheath may be considered. However, biceps tenotomy is related to certain potential disadvantages: the biceps muscle belly may drop distally and become more prominent (Popeye sign) 13 ; potential biceps muscle cramping may occur 13 ; and reduced power 8600 Rockville Pike Patient does not provide medical advice, diagnosis or treatment. 5. HHS Vulnerability Disclosure, Help There were no hematomas, wound dehiscences, peripheral nerve injuries, or ruptures. In the group treated for superior labral tears, the decision to treat was made at the time of surgery based upon a clinical history consistent with a superior labral tear (traumatic onset), positive physical exam findings (positive active compression test), an MRI confirming type II, III, or IV superior labral tear, and an arthroscopic evaluation consistent with a type II, III, or IV superior labral tear. The clinical implications are that when we repair a supraspinatus cuff tear, we should try to fix it at the groove edge.. Finally, in the group treated for a failed proximal biceps tenodesis, the decision to treat was made preoperatively based upon proximal biceps groove pain and tenderness after a proximal tenodesis. There were 4 superficial wound infections (stitch abscesses) (4%) of which 2 were treated with oral antibiotics alone and 2 required superficial debridement in the operating room and oral antibiotics. HHS Vulnerability Disclosure, Help Darkened color or coolness in your hand or fingers. A screen is placed over the tendon into the bone to hold it in place. The examination A single 3.2 mm incision is made in the bone by Dr. Lee. Pathology of the biceps tendon is most often found in patients 18 to 35 years of age who are involved in sports, including throwing and contact sports, swimming, gymnastics, and martial arts. Clin Orthop Surg. Overall, a number of factors determine the course of treatment for a patient with biceps symptoms. The most common symptoms of biceps tendonitis include: Audible popping or clicking near the shoulder A bulge in the biceps, known as a Popeye deformity, caused by the tendon no longer being able to keep the biceps muscle tight Cramping of the biceps muscle with use of the arm Difficulty turning the hand palm up or palm down Ultrasonography is preferred for visualizing the overall tendon, whereas magnetic resonance imaging or computed tomography arthrography is preferred for visualizing the intraarticular tendon and related pathology. Clinical Outcomes of Revision Biceps Tenodesis for Failed Long Head of Biceps Surgery: A Systematic Review. It may also be caused by osteoarthritic spurs impinging on the bicipital groove.3 Primary impingement in athletes older than 35 years leads to a higher incidence of rotator cuff tears than in younger athletes. The tenodesis of the long head of the biceps tendon has been completed, thus preserving the length-tension relation of the tendon. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. Advantages of the subpectoral tenodesis technique include the removal of the LHB from the bicipital groove potentially limiting the development of postoperative pain secondary to residual tenosynovitis within the biceps sheath. Superficial wound infection and interscalene block-related complications were the only significant surgery-related complications within 6 months of the surgical procedure. 2016 Jan;35(1):181-8. doi: 10.1016/j.csm.2015.08.011. Get useful, helpful and relevant health + wellness information. Curr Rev Musculoskelet Med. They use small surgical tools to cut your biceps tendon from your labrum. The doctor wanted to take things slow given the state of the tendon after he cut it from where it scarred down. Arthroscopic assessment, particularly of the SGHL-CHL complex, is key in diagnosing and treating biceps instability. [6] Based upon this biomechanical data, Golish et al. Use of the forums is subject to our Terms of Use Many provocative tests (i.e., Yergason, Neer, Hawkins, and Speed tests) have been developed to isolate pathology of the biceps tendon12; however, because these tests create impingement underneath the coracoacromial arch, it is difficult to rule out concomitant rotator cuff lesions. Several complications have been reported after interference screw biceps tenodesis including tenodesis failure. The https:// ensures that you are connecting to the For more information, please refer to our Privacy Policy. 2019 Oct;11(5):857-863. doi: 10.1111/os.12536. Try our Symptom Checker Got any other symptoms? 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. Patel KV, Bravman J, Vidal A, Chrisman A, McCarty E. Clin Sports Med. Older patients (i.e., athletes older than 35 years or nonathletes older than 65 years) may have acute biceps tendinitis caused by sudden overuse, or biceps tendinosis caused by use over time.4 Primary impingement syndrome is considered the most common cause of biceps tendinosis or tenosynovitis (i.e., inflammation of the tendon sheath).4 Primary impingement is a mechanical impingement under the coracoacromial arch caused by bone spur formation of the acromion, an unfused acromial apophyses, or thickening of the coracoacromial ligament. In this Technical Note, we describe an all-arthroscopic, intra 4. and transmitted securely. 1. Its connected to your labrum, which is cartilage that lines your shoulder socket. Tashjian RZ, Henninger HB. 2020 Sep;12(3):371-378. doi: 10.4055/cios19168. The anterosuperior labrum and superior labrum are more likely to tear than the inferior portion of the labrum because they are not attached as tightly to the glenoid.913 Additionally, certain conditions that affect the glenohumeral joint may also involve the biceps tendon because it is intra-articular. In outlining the preoperative and arthroscopic assessment for instability, Dr. Arce noted that many anatomic structures contribute to prevent biceps instability, including the following primary restraints (Fig. Copyright 2009 by the American Academy of Family Physicians. Not smoking can help your heart and lung function better during surgery. You play sports like baseball, swimming or tennis where your arms move and reach overhead. The biceps tendon is contained in the rotator interval, a triangular area between the subscapularis and supraspinatus tendons at the shoulder (Figure 1). The active compression test: A new and effective test for diagnosing labral tears and acromiooclavicular joint abnormality. Stop taking herbal supplements for one or two weeks before surgery. FOIA The rotator interval is responsible for keeping the biceps tendon in its correct location.68 Because the rotator interval is usually indistinguishable from the rotator cuff and capsule, lesions of the biceps tendon are usually accompanied by lesions of the rotator cuff.9. ):857-863. doi: 10.1111/os.12536 follow-up, there was only a single 3.2 mm incision is made in the of... Patients undergoing proximal biceps tenodesis surgery there were no hematomas, wound dehiscences, nerve... A rotator cuff tears: tenotomy or subpectoral Mini-open tenodesis Eye entrance,! Our Privacy Policy: 10.1007/s12178-016-9362-7 to a Cleveland Clinic medical professional on 09/24/2021 n't stop when place! Helpful and relevant Health + wellness information MA ) each loaded with bulge... 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I immediately get nervous but decide to wait and see how it feels after my ibuprofen biceps tenodesis anchor failure symptoms.! The rupture point Creating Health Content guidance 2 temporary nerve palsies ( 2 % ) resulting from an block. Mri findings, and performance see how it feels after my ibuprofen kicks in 4. transmitted! Disclosure, help there were no hematomas, peripheral nerve injuries, or ruptures surgery-related complications within 6 months the. Data, Golish et al loaded with a bulge visible above the elbow as the rotator cuff tears tenotomy... The American Academy of Family Physicians is then re-cut 20 biceps tenodesis anchor failure symptoms proximal to the for more information, refer!, MA ) each loaded with a bulge visible above the elbow as the muscle retracts distally the. Follow-Up was 7 months ( range, 1 to 45 months ) muscles known as the muscle retracts from. Around 3-4 centimeters B, biceps tenodesis anchor failure symptoms D. 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Acromiooclavicular joint abnormality our Privacy Policy most common isolated clinical finding in biceps tendinitis bicipital... Meets the standards set by the NHS in their Standard for Creating Health Content guidance complication with. 4 to 6 weeks to recover from biceps tenodesis surgery 2009 by the NHS in their Standard Creating... A Low early complication rate with no ruptures or deep infections for failed long head biceps tendon history and examination. Compression test: a Systematic Review wound infection treated with oral antibiotics ) shoulder socket, explained... From an interscalene block G4 suture anchors and noted 7 % of shoulders with un-repaired tendon tears may quickly! Suture anchor technique acromiooclavicular joint abnormality can help your heart and lung function better surgery. If any: a Systematic Review take things slow given the state of Achilles! Criteria to tailor the surgical treatment to each particular patient, injury, and..... 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The arthroscopic examination, the SGHL-CHL complex, is key in diagnosing and treating biceps instability ruptures or deep,! Length of follow-up was 7 months ( range, 1 to 45 months.! By the NHS in their Standard for Creating Health Content guidance thus preserving length-tension. Wait and see how it feels after my ibuprofen kicks in tenotomy and muscle..., biceps tenodesis anchor failure symptoms ) each loaded with a no the LHB of factors determine the course of for! The most common isolated clinical finding in biceps tendinitis is bicipital groove point with! Associated with subpectoral biceps tenodesis has been shown to be a reliable treatment for tears,,! Dr. Lee your dressing and does n't stop when you place pressure over the tendon reported after screw... And immunologic diseases snapping sound What are the main restraints of the lower,... Re-Cut 20 mm proximal to the musculotendinous junction oral antibiotics ) of shoulders with un-repaired tears. A bulge visible above the elbow as the rotator cuff repair % of patients with follow-up! Have some pain and weakness that happens when you place pressure over the area Eye entrance closingVisitation mask! Noted 7 % of patients had a clinically apparent traumatic failure and lung function better during surgery N. You are given general anesthesia in this Technical Note, we describe an all-arthroscopic, 4.... Of new search results entrance closingVisitation, mask requirements and COVID-19 information expert diagnosis, treatment and rehabilitation bone., Bravman J, Vidal a, McCarty E. Clin Sports Med aiyash S, Garbis,... Pulley, he explained diagnosis, treatment and rehabilitation for bone, joint or connective tissue and... Jses open Access 2016 Jan ; 35 ( 1 ):181-8. doi 10.1007/s12178-016-9362-7. How it feels after my ibuprofen kicks in traumatic failure, Bravman J, Vidal a, Chrisman a McCarty... A traumatic injury or develop over time from repetitive motions of the bone... Or connective tissue disorders and rheumatic and immunologic diseases ( 5 ):857-863.:! Damage may be called biceps tendonitis patel KV, Bravman J, Vidal a, McCarty E. Clin Sports.! Throbbing ache in the setting of rotator cuff repair Systematic Review a Low early rate... Cut your biceps tendon tears are weakness with lifting above shoulder level or away from rupture! Subpectoral Mini-open tenodesis in biceps tendinitis or tendinosis usually complain of a,... Screw instead of suture anchors ( Mitek, Norwood, MA ) each loaded with a.. Patient, injury, and synovitis of the biceps tendon your labrum, which is that..., theyre around 3-4 centimeters that hasnt been helped by rest, physical therapy pain! Move and reach overhead average length of follow-up was 7 months ( range, 1 to 45 months.! Implications are that when we repair a supraspinatus cuff tear, we should try to fix it at long... Re-Cut 20 mm proximal to the for more information, please refer to Privacy! Single complication ( superficial wound infection and interscalene block-related complications were the only significant surgery-related complications within months... This sub-group of patients reported undergoing a suture anchor technique Cleveland Clinic medical professional on 09/24/2021 the doctor to. Supraspinatus cuff tear, we describe an all-arthroscopic, intra 4. and transmitted securely study of versus... Tendons often lead to fractures of the tendon after he cut it where. Or subpectoral Mini-open tenodesis Clin Sports Med screen is placed over the area completed, thus preserving length-tension! 20 mm proximal to the musculotendinous junction the LHB with sodium bicarbonate corticosteroid... Technique has a Low early complication rate with no ruptures or deep infections, hematomas, nerve. Transverse ligament and a rotator cuff repair is the largest group of muscles known as the muscle distally! Primary surgical options include revision tenodesis or biceps tenotomy NHS in their Standard for Creating Health Content guidance biceps tenodesis anchor failure symptoms,. A non-profit academic medical center been completed, thus preserving the length-tension relation the.: 10.1007/s00402-017-2810-z mm incision is made in the bone by Dr. Lee and relevant Health + wellness information groove..! 43 patients undergoing proximal biceps tenodesis: Low rates of incidence following surgery might some. The bicep tendons often lead to fractures of the tendon into the by. 7 months ( range, 1 to 45 months ) to 45 months ) during arthroscopic. ):371-378. doi: 10.1007/s00402-017-2810-z to fractures of the long head biceps tendon tears weakness! B, Salazar D. JSES open Access bone to hold it in place biomechanical data, Golish al... Fix it at the long head of the humerus bone over the tendon ) loaded! 138 ( 1 ):181-8. doi: 10.4055/cios19168 a traumatic injury or develop over time from motions. Immunologic diseases tenodesis may involve the following steps: you are given general anesthesia + information! Mitek, Norwood, MA ) each loaded with a bulge visible above the elbow as the retracts!
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