The worst advice I've ever heard about shoulder labral tears
“Arthroscopic surgery is the only solution”
Shoulder injuries, and in particular shoulder labrum (or SLAP) tears are some of our favourite things to treat in the clinic. One main reason for this is because often an injured athlete will come to us after having been told that they have a tear in their labrum, and that surgery is their only option.
In reality, not only can shoulder labral tears often been treated successfully with physiotherapy and conservative management, but research also shows that some surgeries (and in particular surgical repairs to the shoulder labrum) may work no better than a placebo.
One study from 2017 (linked below) investigated sham surgery, versus labral repair surgery or biceps tenodesis surgery for SLAP tears in the shoulder. In this randomised control trial, 118 participants all with a history, clinical symptoms and an MRI indicating SLAP tears in their shoulder were randomly assigned to either a labral repair, a biceps tenodesis or a sham surgery group.
The results of the study showed that there was no significant difference between the groups at any follow up point (either 6 months or 24 months) for any outcome measure post surgery. So neither a labral repair or biceps tenodesis surgery had any significant benefit over sham surgery for patients with type 2 SLAP tears in this population.
“neither a labral repair or biceps tenodesis surgery had any significant benefit over sham surgery for patients with type 2 SLAP tears in this population.”
For this reason we generally recommend that the first option for the treatment of shoulder injuries such as a labral tear should be conservative management. This allows for a window of time to reduce symptoms and establish a comprehensive rehabilitation program. If conservative management does fail, then a specialist review would always be the next step (sometimes the structure of the injured shoulder joint is such that surgery is still required for a successful outcome).
How is long is the recovery from a labral tear?
It really varies depending on the individual. Some people report that they start to feel better within a few weeks, while others may take several months to recover. There are a number of factors that can influence the healing process, such as the severity of the injury, the person's age, and overall health. In most cases, however, it is possible to make a full recovery from a labral tear with proper treatment and rehabilitation.
What is the function of a labrum?
The shoulder labrum is a piece of cartilage that attaches to the shoulder socket (glenoid) and helps to deepen the socket. This provides more stability for the shoulder joint and helps to prevent dislocations. The shoulder labrum also acts as a cushion for the rotator cuff tendons and allows for a greater range of motion. The shoulder labrum effectively deepens the shoulder joint, allowing for greater shoulder stability.
Shoulder labrum tears are a common injury, particularly in athletes who participate in overhead motions (such as tennis or swimming). These tears can be treated with rest, ice, and physical therapy. In some cases, surgery may be necessary to repair the damage.
Can labral tears be prevented?
There's no surefire way to prevent a slap tear, but there are some things you can do to lower your risk. First, if you participate in activities that put repetitive stress on your shoulder (such as throwing a baseball or lifting weights), be sure to warm up and stretch first. This will help prepare your shoulder for the activity and reduce the likelihood of an injury. Second, maintain good shoulder health by practicing good posture and avoiding activities that put excessive strain on the joint. And finally, if you do experience a shoulder injury, be sure to see a physio and follow their recommendations for treatment. By taking these precautions, you can help reduce your risk of developing a slap tear or other shoulder injury. Prevention s always the best medicine!
How is a shoulder labral tear diagnosed?
A shoulder labral tear is usually diagnosed through a combination of a physical examination, imaging tests, and sometimes, special shoulder tests called shoulder arthroscopy.
The first step is usually a physical examination. The physio will check for signs of shoulder instability, swelling, and tenderness. They will also check range of motion and see if you have any pain when moving your arm or shoulder, as well as performing some special tests to rule out other potential injuries.
Imaging tests such as an MRI (Magnetic Resonance Imaging) or CT scan can also be helpful in diagnosing a shoulder labral tear. These tests can show the extent of the damage and whether the tear is partial or complete.
Sometimes, shoulder arthroscopy may also be needed to confirm the diagnosis. This is a minimally invasive surgery where a small camera is inserted into the shoulder joint to get a close look at the structures inside. Shoulder arthroscopy is usually only necessary if there is uncertainty about the diagnosis or if other injuries are also present.
Once a shoulder labral tear has been diagnosed, the next step is to develop a treatment plan. Treatment options will vary depending on the severity of the tear and the individual's goals. In most cases, however, a combination of rest, ice, and physical therapy, will be needed to recover fully from this type of injury.
The different types of shoulder labral tears
Shoulder labral tears are a common shoulder injury, especially in athletes. There are three main types of shoulder labral tears: Anterior, Posterior, and Bankart tear. The most common type of shoulder labral tear is the Anterior shoulder labral tear, which happens when the front part of the shoulder labrum is torn. A Posterior shoulder labral tear happens when the back part of the shoulder labrum is torn. The Bankart shoulder labral tear is the least common but most serious type of shoulder labral tear. It happens when the shoulder labrum is completely detached from the bone.
A Bankart tear is a shoulder labral tear. The shoulder labrum is a ring of cartilage that surrounds the shoulder socket. The biceps tendon attaches to the top of the shoulder labrum. The shoulder labrum helps to deepen the socket and gives the shoulder joint stability. A Bankart lesion occurs when the shoulder labrum is torn from the bone. This can happen as a result of a dislocated shoulder or a traumatic injury. A Bankart lesion can cause the shoulder to become unstable and may lead to recurrent dislocations.
References:
Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial
