Thread: Labral Tear In Shoulder -- Seeking Advice

How is the injury pain wise?

Where is the tear? any idea on how many degrees the tear is? Do you know what caused it?

I had surgery for a torn labrum Oct of 2008. Required two Anchors.

The thing with the labrum is the lack of blood flow to that area. so healing on its own is unlikely unless it is a minor tear.

Very little pain. It's more of an annoyance. For example, I'm doing 3 sets of 80lb weighted pullups...no pain at all. That's why I'm so shocked. I thought for sure it was tendonitis or something.

I've only just picked up a voice mail on this, but the message said that it's a "mild" tear and on a scale of 1 to 10 it's a "4."

I obviously need to ask many more questions. Degrees...I'll ask that.

I remember feeling a pain in the area doing heavy latpulldowns and weighted dips. It hasn't been the same since. Been 2-3 months since the origin.

I'm just so devastated. Worked insanely hard to go from 209 lbs and 16-18% bodyfat to 178 lbs and 10% bf and then gained lean mass to 185 today. All this at 41 years old.

And now this.

I'm grasping at straws right now.

KY

In general most labral tears are not operated on especially mild ones. Did he tell you if it was a SLAP tear, posterior impingement tear?, ( doubt Bankheart since you did not have a violent event)

Honestly, most surgeons are good at that, surgery.

When it does not need surgery, some surgeons invest their knowlede in how to heal it conservatively and or continual training if you are an athlete, but not all.

Unless this orthopod specializes in sports medicine ( and don't assume he does because they all don't) you may want to see a sports medicine specialist ( they may not be surgeons but physiatrists, family docs, and orthopods who do sports medicine fellowships and work with non surgical means of healing sports injuries).

This is something a damn good physical therapist could help you in terms of what part of your lifting training you can continue to do.

I notice with the orthopods in my area, they concentrate on the sports of their liking ( running, triathalons, biking etc.)

Have you had an MRI or an MRI-A?

Wow KY, that sucks brutha. Sorry to hear about that. I'm leaning towards Iain's thought of it being a SLAP tear. The other tear Bankart (not Bankheart) is usually associated with a partial or complete dislocation of the shoulder. SLAP tears are common with movements over the head. Football players usually get them allot. Tennis players too. The fact that it's not excessive pain also points to a SLAP. Mostly a dull, annoying pain. Resting the joint for a few weeks followed by some PT could get it to improve for you. You probably don't need surgery but if you opt to do so, recovery is a very very high rate. Something to consider.
Get more details from your doc and Iain's suggestion for an MRI is a good idea too. Best to know exactly what you're dealing with.

I had an arthogram MRI.

I talked to the Ortho assistant and here's the deal:

1. Mild Labrel Tear -- I asked him if it was a SLAP tear and he said it's similar. He gave it a "4" in terms of severity on a 10 pt scale.

2. Very Small RC Tear -- This was glossed over this quickly. Must not be too big a deal. That said, I'm sure it complicates the overall shoulder problem.

3. Impingement -- There's some rubbing going on. Probably due to 1. and 2. above.

So there seems to be a bunch of things going on, but none of the above seem too severe. And I'm not in any pain.

So now I really need help figuring out:

1. How I can get these tears to heal.
2. Where I can get some PT to help with the healing and impingement
3. What I can do between now and healing (besides rest and eating) to maintain as much of my current body composition I have.

The Ortho assistant seems quick to recommend the cortisone shot saying that it will eliminate the inflamation and that "there really isn't much down side to it." That's fine, but I want to fix the problem. What was shocking is that this person said that "physical therapy may not help if you're already working out and your shoulder is already strong."

I was like huh?

I like the idea of finding somebody in sports medicine. I'd rather forge a path that's non-surgical. And if there's any specific activity I can do to keep me from going to pot that would be gravy.

Thanks.

KY

if it is a Slap tear then the tear is in the part of the labrum with the poorest blood supply, so healing will be problematic. The orthopod I use says cortisone injections usually don't heal SLAp tears, but that is his opinion and I am not an expert.

Most people don't know what physiatrists are but think of them as orthopods who are not surgeons but treat similar problems non- surgically. These are the guys that do research in physical therapy so think of them as physical therapists with MDs behind their name as well. They are a good bridge between pure surgeons and physical therapists and many have sports medicine backgrounds. You may want to find if one works in your ortho group.

Your problem is in this gray zone between surgical therapies, injection therapies and physical therapy, I think these guys bridge this nebulous area better than most other types of specialists.

Originally Posted by bandaidwoman

Your problem is in this gray zone between surgical therapies, injection therapies and physical therapy, I think these guys bridge this nebulous area better than most other types of specialists.

It definitely feels like a gray zone based on the initial feedback I'm getting.

The cortisone shot may make the symptoms go away, but it doesn't heal the problem. Assuming I get a cortisone shot, the next step is to find somebody that can help with the healing process. I think this is where your physiatrists come in. I think the key here is seeing some progress in the healing process up until the point where the cortisone effect wears off. God knows if the ortho doesn't see progress, he'll recommend surgery.

Anyone know Eric Cressey in the Boston area? Lyle MacDonald recommended him as someone who knows tons about shoulder issues.

If anyone has any specific people in mind in the Boston area I'm all ears. Really need to talk/find the right people right now.

Thanks.

KY

Originally Posted by FMJ

Wow KY, that sucks brutha.

Yeah, it's killing me.

In less than 12 months I've used many of Lyle MacDonald's tools to go from 209 lbs and 16-18% bodyfat down to 175ish and insanely low bf and now up to 185 with some lean mass gained. And this at age 41.

It's a huge blow.

I'm just hoping I can forge the right path here. One that doesn't take months and months. 4-8 weeks of rehab/rest doesn't seem too bad, but I'm not sure that's the worst case scenario based on feedback/insight so far today.

KY

To anyone who knows shoulders...and I know we're not all doctors...I was initially diagnosed with a mild labrum tear among other things. From what I understand, the labrum is a tough cookie when it comes to healing. Well, I just got the MRI results document back and this is more or less what they found:

* Small, 5mm tear of the anterior aspect of the infraspinitus
* No evidence of supraspinitus tear
* Fraying of the posterior aspect of the middle glenhumeral ligament compatible with a partial thickness tear in the MGL
* Evidence of a partial thickness tear in the superior glenhumeral ligament
* The bicep tendon is intact.
* The glenoid labrum is intact.

Should I be confused here?

Wouldn't "intact" be the opposite of "tear?"

God damn it.

Not sure if this news would be any worse or better to be honest, but I'm just trying to figure out what I'm dealing with and this Ortho assistant needs to work on his communication skills.

Thanks.

KY

Not to discourage you but none of my MRI's ever detected Labrum tears. Shoulders are a very difficult to diagnose. I dealt with it for over 10 years before a doc finally just went in an looked.

Did he do any tests on your arm/shoulder, like the O'brien test?

I would suggest a good sports therapist who deals with shoulders, it is an amazingly complex joint, and so many things can impact the motions that is goes through. Try send P-funk a message.

Originally Posted by IainDaniel

Not to discourage you but none of my MRI's ever detected Labrum tears. Shoulders are a very difficult to diagnose. I dealt with it for over 10 years before a doc finally just went in an looked.

Did he do any tests on your arm/shoulder, like the O'brien test?

I would suggest a good sports therapist who deals with shoulders, it is an amazingly complex joint, and so many things can impact the motions that is goes through. Try send P-funk a message.

Ugh.

So I'm guessing you had a labrum tear?

He did many tests and none of them hurt. The O'Brien test looks like the empty can test. Doesn't really hurt. And I don't have any of the typical symptoms you'd think that come with a labrum tear...overhead pressing pain, reaching behind the back, etc.

Based on my basic understanding of shoulder anatomy, a small tear of the infraspinitus and the glenhumeral ligament tears seem to make sense understanding my discomfort. The discomfort is located in the back area of the shoulder. Hurts when I do dips for example...and I'm pretty damn sure that's how I did all this....weighted dips.

I'm really hoping it's not a labrum tear. Seems like those are hard to deal with...not that what I have in front of me is necessarily easier.

Thanks for the feedback.

KY

Originally Posted by kyoun1e

Ugh.

So I'm guessing you had a labrum tear?

He did many tests and none of them hurt. The O'Brien test looks like the empty can test. Doesn't really hurt. And I don't have any of the typical symptoms you'd think that come with a labrum tear...overhead pressing pain, reaching behind the back, etc.

Based on my basic understanding of shoulder anatomy, a small tear of the infraspinitus and the glenhumeral ligament tears seem to make sense understanding my discomfort. The discomfort is located in the back area of the shoulder. Hurts when I do dips for example...and I'm pretty damn sure that's how I did all this....weighted dips.

I'm really hoping it's not a labrum tear. Seems like those are hard to deal with...not that what I have in front of me is necessarily easier.

Thanks for the feedback.

KY

Yep I had a tear from 9:30 to 11:30 so on the posterior side, and i also had a posterior stabilization.

I didn't show typical symptoms either. However I am a sports junkie, and could no longer perform any overhead activities with out extreme discomfort and a feeling like my shoulder seperated. I gave up most overhead activities for a number of years out of sheer frustration with not getting an answer.

Here were my findings. LOL.

FINDINGS:

Informed consent was obtained. Under local anesthesia and with 1% Lidocaine 22 gauge needle
was placed into the glenohumeral joint. Following administration of tiny amount of Optiray
to ensure intra-articular location of the needle 0.1 ml gadolinium with saline and Optiray
were injected into the joint. No complications during the procedure.

Rotator cuff tendons: Small partial thickness bursal surface tear in anterior portion of
supraspinatous tendon. Infraspinatus, teres minor tendons are normal. Tiny articular surface
tear in superior portion of subscapularis tendon.

Long head of biceps tendon is normal.

Labrum: Is normal.

Glenohumeral joint is well maintained.

AC joint, mild degenerative changes. Mild lateral inferior tilt of acromion. Mild
thickening of coracoacromial ligament.

Muscles: Supraspinatous, teres minor, infraspinatus and subscapularis muscles have normal
bulk and signal intensity.

Bone marrow: No bone marrow edema.

IMPRESSION:

Tiny tears of rotator cuff tendons. Minimal subacromial impingement.

You could try posting a question here
ASMI Sports Medicine Forum - My Arm Injury

or here

slaptear.com - The Sports Injury Community - Home

How are you doing now?

Jeesh...you're results look like a walk in the park compared to mine.

Next week will be a big week for me: Seeing two other Drs for opinions and then seeing Eric Cressey next Friday for a consultation and possibly to set up a month's worth of programming.

KY

Originally Posted by kyoun1e

How are you doing now?

Jeesh...you're results look like a walk in the park compared to mine.

Next week will be a big week for me: Seeing two other Drs for opinions and then seeing Eric Cressey next Friday for a consultation and possibly to set up a month's worth of programming.

KY

Yep it was very frustrating, my MRI's always showed no problem.


I am about 95%, but that is a significant improvement, I am able to do the overhead activities that caused pain, with no problem. So I am ecstatic about my results, only wish I could have had it dealt with at 21 and not 32.

Eric, certainly knows about the Shoulder. And would probably have some excellent recommendations for Drs and Therapists in your area.

Ian,

Thanks much. Already found that slaptear site. This internet thing is really impressive.

How was your recovery from surgery? How long before you were back in the gym? And did you modify your behavior?

Something tells me, whether it's post non-surgical treatment or surgery, the way I train will change completely. I don't see any weighted dips or pullups in my future. Think that's just about done.

KY

Originally Posted by kyoun1e

Ian,

Thanks much. Already found that slaptear site. This internet thing is really impressive.

How was your recovery from surgery? How long before you were back in the gym? And did you modify your behavior?

Something tells me, whether it's post non-surgical treatment or surgery, the way I train will change completely. I don't see any weighted dips or pullups in my future. Think that's just about done.

KY

I had surgery in oct 2008 and was back to limited throwing, april/may 09. I was working out again around the 3-4 month mark(limited). My injuries were a little different, I was a Pitcher when younger, plus inadequate recovery from a shoulder seperation. Are my conclusions as to why I had the injury.

Weighted dips no-no. I don't do them at all anymore. I just started Squats with bar behind neck again, although I will probably limit them. I see no problem with pullups, I would put more attention to pull motions. And maybe start throwing in some more exercises like Push-up plus, Scarecrows, and YTA's

I still have some limitations with doing push-ups/bench press, don't feel as strong as I did before surgery, but I don't really care, as my goal is to play sports not move a shit ton of weight.

Proper rehab will be the key, I can't emphasize that enough, I changed my physiotherapist after surgery, cause I wasn't happy with the direction we were heading, and it is the best move I made. The shoulder is a very complex joint, Eric will be a good start for you.

Talked to two different sports medicine orthos today. They were more or less in alignment. Diagnosis:

1. Partial tear of the infraspinatus -- the main issue, but it's not that severe.

2. Partial tear of the middle glenohumeral ligament, but NO labrel tear. Thank god. The docs think this has been around for a long, long time and isn't much of an issue.

3. Scapular Dyskinesis -- My scapular muscles need stabilization. One of the Drs thinks this is the problem and the cause for my current pain.

4. Bone spurs -- nothing too ridiculous; average for someone who is 41.

On a scale of 1 to 100 with 100 being most severe, one doctor gave my situation an 8 while the other gave me a "2 or 3" on a scale of 1 to 10.

Bottom line: 4-6 weeks PT, can keep working out, but avoid pressing movements.

No surgery even mentioned!

I'm esctatic.

Thanks all.

KY

KY! Great to hear from you brother and some really good news!
So glad it wasn't something more severe or something needing surgery.
So after your PT can you ease back into pressing moves?
When you starting your PT?
Damn good news man. Good for you

Should start PT next week. Both orthos didn't see any reason to stay away from the gym, but I don't see shoulder presses in my short term future. They seemed ok with chest presses.

I think I'm going to be de-loading for the rest of February. I needed it anyway. I'll then ramp up as PT progresses with a goal of hitting the ground running April 1.

KY

Avoid behind the back squats as well.

Originally Posted by IainDaniel

Avoid behind the back squats as well.

Gave up those a long time ago...after I ruptured a lower lumbar disc in my back skiing.

I figure I'll be limited to pinkie curls in another few years.

KY