Labral Tear Surgery in Wayne & Paramus, NJLabral tears of the shoulder involve the cartilaginous lining of the glenoid (socket).
The shoulder is a ball and socket joint that is composed of the humerus bone in the upper arm, the scapula, and the clavicle. The head or “ball” of the humerus sits in the socket portion of the scapula called the glenoid. The cartilaginous lining around the outside of the glenoid is called the labrum. The labrum helps to stabilize the shoulder and deepen the socket, or the glenoid. The labrum essentially functions as a bumper that helps stabilize the shoulder. Athletes that sustain a shoulder subluxation or dislocation may concurrently injure their labrum. In these cases, the labrum is torn off the bone when the humeral head comes out of socket. This tear may also make the shoulder less stable and increase the shoulder’s propensity to sublux or dislocate again. Many times an athlete may not even realize that their shoulder is sliding in and out of socket, but they have shoulder pain and sometimes catching or clicking.
Other labral injuries involve the biceps tendon which attaches to the top or superior portion of the labrum. These are often referred to as SLAP tears, superior labral tear from anterior to posterior, and are a common type of labral tear. This injury is common in athletes when exerting maximum effort throwing, but is also seen in patients who may experience pain with overhead activities. There are different types of SLAP tears and they are classified according to the severity of the tear and the involvement of the biceps tendon. These athletes usually present with pain and sometimes catching or clicking in the shoulder with certain motions. Athletes affected by labral tears are likely unable to achieve peak performance due to pain. Sports that require extensive arm and overhead motion may be near impossible to play in some cases.
SLAP tears are a common overuse injury in baseball and softball players. It is important for athletes, coaches, and parents to understand the importance of limiting pitch count, especially in young athletes. Proper technique is also extremely important and can help to avoid unnecessary injury to the shoulder. Lastly, stretching and strength training is crucial for any athlete. If you or your coaches are unsure as to what stretches, exercises, or muscle groups to focus on don’t hesitate to reach out to a local physical therapist who can help.
Labral tears are sometimes difficult to diagnose with physical examination alone. An MRI and an MR arthrogram is a good diagnostic test used to evaluate for labral tears. Although not always necessary, a MR arthrogram may be done where dye is injected into the shoulder joint. This dye allows your doctor to more clearly visualize labral tears in particular. If for some reason a labral tear cannot be visualized on an MRI, but is still highly suspected then a shoulder arthroscopy is the best way to definitively diagnose the problem. A shoulder arthroscopy is invasive, but will allow your doctor to directly see the labrum and surrounding structures.
Initial treatment for small labral tears or fraying may be conservative and involve anti-inflammatory medications and rehabilitation focused on strengthening of the rotator cuff muscles and periscapular stabilization. Physical therapy can often strengthen the surrounding muscles and alleviate or eliminate the pain. Usually if physical therapy is prescribed, our doctors will recommend that you stick with it for at least 6 weeks to see if it actually makes an improvement. Oftentimes, patients are surprised by the improvement they have with physical therapy and they can return to their sport stronger than before. Other patients do not have success with conservative management and they may be a candidate for an arthroscopic labral repair.
Labral repairs are done arthroscopically. Shoulder arthroscopy involves introducing a small camera and instruments into the shoulder joint through a series of small incisions to examine different parts of the shoulder. This may oftentimes be both diagnostic and therapeutic. Arthroscopy allows your surgeon to visualize the labrum, biceps tendon, capsular ligaments, undersurface and superior surface of the rotator cuff, the glenoid, humeral head, and subacromial space. Debridement and repair of the labrum can be done through the small portals made in the shoulder.
The repair involves putting the labral tissue back in its native location around the glenoid. Anchors are placed in the bone, and sutures are used to secure the labrum. Your surgeon will also clean up any frayed tissues and address any other issues in the shoulder. The biceps tendon may be repaired, but often the biceps tendon is cut and attached in a different location or just left alone. Your surgeon will discuss these treatment options with you prior to your surgery.
Rehabilitation following a labral repair is very important. Early gentle motion is encouraged after surgery to avoid stiffness. Your therapist will guide you through specific motions and exercises that are prescribed by your doctor. At about two months after surgery, the patient can begin to progress their physical therapy to stretching and strengthening exercises. A full recovery can be expected within three to six months after surgery.
Labral tears can cause serious setbacks for any athlete. Our goal at Modern Orthopaedics is for you to return to your sport better than before. This may take time and patience, but we want you to experience a full recovery. We understand that each athlete and sport is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office to have an initial evaluation for shoulder pain and receive superior care from our doctors and staff.
Frequently Asked Questions
Most shoulder pain can be treated with rest, anti-inflammatories and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem.
At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.
Before deciding on the treatment for your shoulder pain, our doctors will first diagnose your problem. Depending on the type and severity of your problem, the treatment options will vary.
Generally, physical therapy will be involved in the first step of treatment. You will work closely with a therapist two to three times a week to develop a routine that is tailored to your diagnosis and needs. Therapy may take some time to help, which is why a six-week trial is generally recommended before proceeding with other treatment options.
Cortisone injections are often used in orthopedics. Our doctors are conservative when it comes to using cortisone injections and reserve them for specific situations. They are most commonly used for patients who may have a stiff or frozen shoulder or shoulder arthritis. They use them less commonly for rotator cuff issues, but there are exceptions. Each patient’s situation is unique, and our doctors will work with you to ensure the highest level of care.
Surgical intervention is reserved for shoulder issues that do not respond to more conservative measures or acute injuries that need to be addressed right away. The most common shoulder surgeries performed by our doctors are done arthroscopically. This allows for smaller incisions and a quicker recovery for our patients. The length of recovery, immobilization period and rehabilitation protocol differ depending on the surgery.
Many patients complain of shoulder pain that disturbs their sleep. It can be caused by many different shoulder issues. The pain comes from inflammation in the shoulder that may be a result of tendinopathy, rotator cuff tear, frozen shoulder, arthritis or a number of other issues. When lying in bed, it is difficult to find a position that is comfortable due to the fact that many people lie on their sides, stomach or with their arms overhead. In many cases, if the pain is persistent, patients will find sleeping in a recliner is most helpful. Whether you have had months of restless nights or just a few days, we can help you understand what is wrong and determine the best ways to improve your quality of life.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.