July 10, 2019
Dr. Steve Hamilton, a sub-specialty trained sports medicine surgeon at Beacon Orthopaedics, offers insight for when shoulder surgery is necessary and when it isn’t.
The labrum is a cartilage buffer in the shoulder joint that provides stability and reduces force and friction for the bones. When healthy, the labrum is an important part of correct, pain-free shoulder function. However, the shoulder labrum, like other cartilage discs in our body (such as the hip labrum or meniscus), can succumb to injury or degeneration. The shoulder is a complex joint that can be fragile, so it is important to have any pain analyzed by a sports medicine orthopedic specialist.
The 2 Common Types of Labral Tears
There are two common causes of labral tears. The most widely publicized is undoubtedly an acute trauma to an athlete or weightlifter. These typically happen to those 15-35 years of age and can be caused by an impact, fall, or overloading the shoulder. These are common for contact sports like football and hockey. A shoulder dislocation or subluxation events can injure the labrum and result in shoulder instability. This is typically referred to as an “acute labral tear.” If a Certified Athletic Trainer (ATC) is on-site, they will be able to assess the injury and immobilize the shoulder so no further damage occurs.
The second type of labral tear in the shoulder is a tear due to degeneration or a combination of degeneration and activity. This is more typical in someone over age 30 who often tries to perform at the same level of athleticism as they did in their 20s. It may occur from swinging a golf club or tennis racquet or from a variety of other shoulder movements. SLAP tears (Superior Labrum from Anterior to Posterior) are much more common among those 30 and over. The most important thing following a shoulder injury of any kind is to immobilize the joint to prevent further injury, and to get a proper diagnosis from a trained physician.
I Have Instability, is my Labrum Torn?
If you recently fell, were hit in the shoulder, or felt shoulder pain while lifting weights, any those may indicate a torn labrum. If overhead arm movement or other similar shoulder movements cause pain, but there was no traumatic injury, it may still be a torn labrum. Here are a few symptoms that may point to a torn shoulder labrum. As always, a diagnosis by a professional is the best way to know if your labrum is torn and the extent of the damage.
- Feeling of instability or shoulder dislocation
- Loss of strength or discomfort with shoulder exercises
- Dull pain or aching in the center of the joint
- Pain with overhead arm movement
- Inability to participate in sports that require continual arm movements
- Discomfort or noises such as grinding, grating, clicking, popping or feeling “sticky” during movement
For a complete list of frequently asked questions (FAQs) about shoulder labrum tears, please click here.
When is Surgery Necessary?
Depending on the severity of damage to the cartilage, surgery may not be necessary. In fact, some labral damage may be virtually undetectable because it won’t cause pain or instability. For more traumatic shoulder labrum tears, factors such as medical history and desired levels of activity will also be taken into consideration by a board-certified sports medicine physician. Generally speaking, athletes and those desiring to return to an active lifestyle will be recommended for surgery.
The labrum is crucial for shoulder stability, which is necessary for nearly all sports. Surgery ensures that the labrum will heal in the right place. The procedure is performed through an arthroscope where a surgeon uses a tiny camera and canula to access the joint. The labrum is re-attached to the glenoid (socket) with an anchor and suture through a very short and minimally invasive procedure.
After surgery, it is absolutely crucial to listen to your surgeon’s instructions and follow the prescribed rehabilitation protocol which often involves physical therapy. All too often athletes will re-injury their shoulders because they try to return to play too soon. Not respecting the post-surgical instructions may compromise labral healing, which can ultimately lead to chronic shoulder instability. Your doctor will clear you to return to play after he has examined your progress in follow up appointments.
For non-athletes or weekend warriors, surgery often is not necessary
Although the procedure is fast and minimally invasive, injections and physical therapy will often provide great results. Injections for shoulder labrum tears include cortisone and platelet injections (platelet injections). These can increase promising results in the future. There are other growth factor injections that may be considered, but treatment should only be recommended by a board-certified, fellowship trained orthopedic sports medicine surgeon.
For more information
If you are suffering from shoulder pain, and you suspect it may be a torn labrum, Dr. Steve Hamilton is a board certified, sub-specialty trained orthopedic surgeon. Dr. Hamilton will provide a thorough physical exam and a comprehensive review of your medical history to ensure a proper diagnosis and the right treatment recommendation for you. He also uses diagnostic imaging, such as MRI and X-ray, to help ensure that your treatment will be as effective as possible. Don’t let shoulder instability keep you from sports or an active lifestyle! Take the next step to address your shoulder pain and schedule your appointment with Dr. Steve Hamilton at Beacon Orthopedics. You may also schedule by phone 24/7 at 513.354.3700.