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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (bicep-tendinopathy.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Bicep Tendinopathy Cheat Sheet)
}

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\noindent
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Bicep Tendinopathy Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/25898/}}}
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 14th November, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
\raggedright
\raggedcolumns

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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Bicep Anatomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1609331336_bicep.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- Short head connects medial bicep muscle to coracoid process of the scapula (not suspectable to tendinopathy) \newline - Long head - connects to supraglenoid tubercle of the scapula and superior glenoid labrum - blood supply = anterior humeral circumflex artery. \newline - Inserts onto radial tuberosity  \newline - Innervated by the Musculocutaneous nerve (C5-C6)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Bicipital Tendinitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Avascular parts of the long head of bicep tendon = deep undersurface of the tendon in the groove and proximal near insertion at the superior glenoid} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Avascularity makes the long head of bicep tendon prone to injury at the bicipital groove in the proximal humerus} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Can be acute inflammatory tendinitis to degenerative tendinopathy} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Can be Primary (microtrauma, insidious)/Secondary (Primary more common)} \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- {\bf{Secondary:}} \{\{nl\}\} - Rotator cuff tendinitis/tendinopathy (especially subscapularis) \{\{nl\}\} - Subscapularis injuries \{\{nl\}\} - LHB tendon instability/dislocation \{\{nl\}\} - Direct/indirect trauma \{\{nl\}\} - Inflammatory conditions \{\{nl\}\} - Internal impingement of the shoulder (GIRD, superior labral lesions) \{\{nl\}\} -External impingement/subacromial impingement \{\{nl\}\} - GH OA} \tn 
% Row Count 19 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pathology}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Early tenosynovitis and inflammation when repeitive traction, friction and shoulder rotation occurs} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Swelling occurs in the tendon due to inflammation tendon becomes mechanically irritated in the confined space} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Tendon exposed to pathologic shear forces due to increased pressure and traction} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Then the LHB sheath thickens as fibrosis and vascular compromise occurs} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- LHB starts to degenerate - scarring, fibrosis and adhesions, anchoring the tendon onto the groove, shear forces and traction increases} \tn 
% Row Count 13 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Tendon can rupture due to this anchoring} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Demographics}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Common in young adults (18-35)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Repetitive overhead activity (abduction and external rotation- peel back phenomenon, bicep muscle eccentrically contracts to decelerate elbow extension)} \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Throwers, swimming, gymnastics, martial arts, racquet sports, contact sports} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Smokers} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Biomechanical risks: Repetitve overhead activity, repetitive shoulder activity, improper lifting, shoulder girdle muscle imbalances, poor posture, inflexability, scapulothoracic or eccentric overload, trauma, osseous anatomical abnormalities (narrowing of bicepital groove - f\#, OA and congenital disorders)} \tn 
% Row Count 15 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Classification}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Grade 0:}} \{\{nl\}\} - Tenocytes normal  \{\{nl\}\} - Myxoid degenerative material not present \{\{nl\}\} - Collagen remains arranged in tight, cohesive bundles \{\{nl\}\} - Blood vessels arranged inconspiciously between collagen bundles} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Grade I:}} \{\{nl\}\} - Tenocytes rounded \{\{nl\}\} - Myxoid degenerative material present (small amounts) \{\{nl\}\} - Collagen reminds arranged in discrete bundles with slight separation \{\{nl\}\} - Capillary clustering (\textless{}1 cluster/ten high power fields)} \tn 
% Row Count 10 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Grade II:}} \{\{nl\}\} - Tenocytes rounded and enlarged \{\{nl\}\} - Myxoid degenerative material evident (moderate-large amounts) \{\{nl\}\} - Collagen bundles lose discrete organisation - separation between individual fibres and bundles increase \{\{nl\}\} - Capillary clustering increased (1-2 clusters/ten high-power fields)} \tn 
% Row Count 17 (+ 7)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Grade III:}} \{\{nl\}\} - Tenocytes rounded and enlarged with abundant cytoplasm and lacuna \{\{nl\}\} - Myoxid degenerative material abundant \{\{nl\}\} - Collagen disorganised - loss of microarchitecture \{\{nl\}\} - Capillary clustering increased (\textgreater{}2 clusters/ten high-power fields)} \tn 
% Row Count 23 (+ 6)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Other changes:}} Tenosynovium: Synovial hypertrophy, hyperplasia and proliferation of the bicipital sheath/synovium} \tn 
% Row Count 26 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Presentation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Deep Throbbing ache over anterior shoulder or bicipital groove} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- May radiate to deltoid insertion/toward elbow/hand)} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Provoked by overhead activity, flexion of elbow and shoulder, forearm supination} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Can occur at night - sleeping on affected shoulder} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Relief from heat, ice, stretching and massage} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Rule out tendon rupture (painful audible pop then relief, popeye muscle on observation) \{\{nl\}\} {\bf{Risks:}} Chronic tendinopathy \{\{nl\}\} Concurrent rotator cuff tear \{\{nl\}\} Contralateral bicep tendon rupture \{\{nl\}\} Age \textgreater{}40 \{\{nl\}\} Poor conditioning \{\{nl\}\} RA or other rheumatologic pathology} \tn 
% Row Count 15 (+ 6)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Limited ROM - Active/resisted movements may provoke pain (forearm supination, elbow flexion, shoulder flexion) {\bf{Consider labral injury if popping, catching or locking during AROM occurs}}} \tn 
% Row Count 19 (+ 4)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Tenderness in rotator interval and bicipital groove} \tn 
% Row Count 21 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- +ve Yergasons, Speeds (most specific), Bear hug (most sensitive), Belly press(most specific), Upper cut (most sensitive), Backward Traction, Lippman test} \tn 
% Row Count 25 (+ 4)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Assess for dysfunction in Cx and Tx spine, Scapula dyskinesis, Upper crossed, AC joint, labral tear} \tn 
% Row Count 28 (+ 3)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Consider posterior capsule tightness} \tn 
% Row Count 29 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Consider Cx/Shoulder exam} \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Presentation (cont)}}  \tn
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Patient's occupational hx/current job/ hx of injury/trauma to the shoulder/neck, hand dominance, surgical hx} \tn 
% Row Count 3 (+ 3)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- AROM, PROM Cx, AROM, PROM, RROM Shoulder} \tn 
% Row Count 4 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Strength of rotator cuff (strength tests and IR lag sign)} \tn 
% Row Count 6 (+ 2)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Check for Impingement signs (may be +ve due to swelling of the tendon)} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Adhesive Capsulitis} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Biceps tendon rupture} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Cx radiculopathy} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Brachial neuritis} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- AC joint pathology} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- GH Arthritis/ instability} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Osteonecrosis of humeral head} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Subacromial impingement syndrome} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- f\#} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Neoplasm} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Rheumatologic disease} \tn 
% Row Count 11 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- SLAP} \tn 
% Row Count 12 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- GIRD} \tn 
% Row Count 13 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Calcific tendonitis} \tn 
% Row Count 14 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- RC tears} \tn 
% Row Count 15 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- AVN} \tn 
% Row Count 16 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Supracapular neuropathy} \tn 
% Row Count 17 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- TOS} \tn 
% Row Count 18 (+ 1)
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- QSS} \tn 
% Row Count 19 (+ 1)
% Row 19
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Rupture of pecs, deltoid, lats)} \tn 
% Row Count 20 (+ 1)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{-  Scapulothoracic dyskinesia} \tn 
% Row Count 21 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Imaging}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1636923732_sd_lhb_tendonitis_uss.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- Tendon thickening, hypertrophy of synovial sheath and fluid surrounding tendon \newline - Only if need to rule out osseous impingement/bony pathology (A-P, Y view) \newline - US- Gold standard \newline - MRI - if rupture/labral tears}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Rest, ice, activity modification, functional retraining (limit motion that requires repetitive overhead activity, elbow flexion, forearm supination)} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- 1st Phase: Pain relief and restoration of normal ROM, scapula stabilisation exercises (lower traps and serratus anterior), resisted internal and exernal rotation, low rows and cencentric bicep strengthening} \tn 
% Row Count 8 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- STW: Transverse friction massage over biceps tendon} \tn 
% Row Count 10 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Myofascial release and stretching exercises of biceps, cx, shoulder and periscapular musculature} \tn 
% Row Count 12 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Pendulum circumduction, wall walking, cane/wand stretching in flexion and abduction, sleeper stretchers} \tn 
% Row Count 15 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- 2nd Phase: Strengthen from isometric to concentric then eccentric} \tn 
% Row Count 17 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Advanced strengthening - Bear hug, reverse fly and resisted internal/exernal rotation at 90 degrees of abduction} \tn 
% Row Count 20 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- SMT for Cx and Tx, scapula dyskinesis (strenghten periscapula, mobilisation of scapula)} \tn 
% Row Count 22 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- NSAIDs} \tn 
% Row Count 23 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Surgical referral is considered if no better with conservative care greater than 3 months, intra operative findings of inflammed tendon (lipstick lesion, significant fraying, tearing, hypertrophy, partial thickeness tears, medial LHB subluxation and LHB subluxation with subcapularis tear/bicipital groove soft tissue compromise} \tn 
% Row Count 30 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Management (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Corticosteroids if symptoms persistent and no better with conservative care} \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Surgical complications}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Tenotomy:}} Popeye deformity \{\{nl\}\} Muscle spasm/cramping \{\{nl\}\} Biceps pain} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Biceps Tenodesis:}} Groove pain \{\{nl\}\} Popeye deformity \{\{nl\}\} Muscle spasm/cramping \{\{nl\}\} Biceps pain \{\{nl\}\} Humeral shaft fracture (spiral when humerus is stressed torsionally)} \tn 
% Row Count 6 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Post surgical Rehab}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Tenotomy:}} Sling for 1-2 weeks \{\{nl\}\} - AROM 2-4 weeks post op, sling discontinued \{\{nl\}\} - Strengthening 4-6 weeks \{\{nl\}\} - Light work 3-4 weeks post op \{\{nl\}\} - Full return 1-3 months post op \{\{nl\}\} - Unrestricted activities 3-4 months post op} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Tenodesis:}} Sling 3-4 weeks \{\{nl\}\} - PROM and grip strengthening \{\{nl\}\} - Avoid active elbow flexion and forearm supination for 6 weeks \{\{nl\}\} - Full AROM and PROM should be achieved by six weeks \{\{nl\}\} - Light work 3-4 weeks post op \{\{nl\}\} - Full duty 2-4 months post op \{\{nl\}\} - Unrestricted activities 3-4 months post op} \tn 
% Row Count 12 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}