Pros and Cons of Shoulder Labrum Tear Surgery - Regenexx (2023)

Heim›The blog›Pros and cons of shoulder labrum tear surgery

Quick links:

• What is a shoulder labrum tear?
• What are the causes of labrum tears?
• What is shoulder instability?
• How is a labrum tear related to shoulder instability?
• What Happens If You Have Shoulder Instability After Labrum Tear Surgery?

I examined a patient this week who is boasting about the warts of our modern orthopedic care system; He was diagnosed with a shoulder labrum tear and offered surgery. Why? His shoulder labral tear was the bright, shiny object, and no one ever questioned how he got the tear in the first place.

As he considered the pros and cons of shoulder-labrum surgery, I made the decision easy for him. As with many patients with a shoulder labrum tear, the actual diagnosis and treatment was missed by the five-minute orthopedic visit. let me explain.

What is a shoulder labral tear?

Think of the shoulder labrum as a lip around the socket of the ball and socket joint. It serves to guide the shoulder joint in movement and to make the shallow socket a little deeper, allowing for better stability.

Photo credit: Shutterstock

A tear in the labrum used to be ignored and only seen as part of the spectrum of shoulder joint osteoarthritis, but then orthopedic surgeons found they could sew it up and an industry was born.

That's not to say that healing a labral tear shouldn't be a concern, but for most patients, surgical suturing is probably not the right choice.

What Are the Causes of Labral Tears?

In our modern orthopedic surgery system, dictated by insurance contracts and managed care, most patients spend more time with an assistant than with the surgeon. When they see the surgeon, they are one of 30 to 40 patients seen that day, each of whom gets 5 to 10 minutes of attention. In this world of factory-like mass medicine, asking how the labrum was torn in the first place only slows down the assembly line, so the question is rarely asked and answered.

While labral tears can occur from major trauma, such as a car accident or a serious fall, many only occur during seemingly harmless activities. Why? The answer is simple but often completely ignored by surgeons - hidden shoulder instability (1).

What is shoulder instability?

The shoulder is an odd joint in that it allows for maximum movement in many directions while also needing to remain stable. There's a symphony of millisecond and millimeter-level precision that allows the ball to stay in a tight range relative to the pan as you move. While the rotator cuff and other muscles play a big part in this, there are also strong ligaments that ensure the ball and socket joint sits perfectly in its flat socket.

Surgeons usually only look for these ligaments when the joint has been dislocated from its socket, and everything else might as well be invisible. However, in my experience, for every patient who has a dislocated shoulder and has a terribly unstable joint, there are five or six patients who also have an unstable shoulder that goes undiagnosed - a hidden shoulder instability. Often this is due to an old injury that the patient may have long ignored.

Eventually, however, that unstable shoulder that seems fine comes back to bite it in the form of a labrum tear (2). Therefore, one of the biggest drawbacks when evaluating the pros and cons of shoulder labrum surgery is hidden shoulder instability.

How is a labrum tear related to shoulder instability?

Check out the animated GIF above. The left side shows the ball in a stable shoulder socket. It moves a little, but it doesn't hit the labrum (lip of socket, represented by the small triangles). The image to the right shows what can happen when the ligaments are loose (hidden shoulder instability) and the ball comes too far out of the socket and hits the labrum. Ouch! While you might think you would know if your shoulder is unstable, it rarely works that way.

Two patient stories

Hidden shoulder instability is very common and almost always overlooked by orthopedic surgeons. Case in point, two patients I examined this week. They both saw me because they were evaluating the pros and cons of shoulder labral tear surgery.

One was a patient in his 20s who climbs rocks and during a workout he experienced a tearing sensation in his shoulder and then had chronic pain. He was diagnosed with a torn shoulder labrum front and back and the recommendation was surgery. No one has asked why a normally healthy guy would suddenly tear a labrum doing what everyone else is doing without injury.

On examination, the ball of his shoulder was unstable in his socket, a fact the orthopedic surgeon overlooked. Shoulder instability so hidden is why the ball suddenly went out of its socket and hit his labrum. How did he get the instability? He remembered a bad mountain bike crash 7 years ago that hurt his shoulder, but he never had it checked out.

The second active type I examined at the clinic this week was similar. He tore his left shoulder labrum while deadlifting 450 pounds. His right shoulder had no problems and was carrying the same weight. Why did he tear his left shoulder labrum and not the right? He too saw an orthopedist who told him he needed an operation.

On examination, his left shoulder joint was unstable and knew immediately when it was happening. During a mixed martial arts (MMA) fight the year before the deadlift, his opponent tore his shoulder (the "Kimura lock," shown above). He too had shoulder pain for a few weeks, but he blew it away. Here, too, the concealed shoulder instability was completely overlooked by the orthopaedist.

What Happens If You Have Shoulder Instability After Labrum Tear Surgery?

It doesn't take a rocket scientist to understand that if you have hidden shoulder instability and someone surgically repairs the labrum tear, as soon as the shoulder gets into an odd loading situation, the cup slips and the labrum tears again.

How can you prevent this? By skipping 20th-century orthopedic surgery and employing 21st-century interventional orthopedics (3). This means you place precise imaging injections of your own advanced platelet and stem cell mixes directly into the labral tear and also into the weak ligaments. Downtime is a fraction of that of surgery, and in our experience treating hundreds of shoulders, the results are as good or better than surgery - and the problem of hidden shoulder instability is eliminated.

The result? Hidden shoulder instability is very common and almost always overlooked by surgeons who spend 5-10 minutes with a patient. So when you look at the pros and cons of shoulder labrum tear surgery, a major downside is that you may have a hidden shoulder instability that has gone undiagnosed, meaning this shoulder labrum tear repair may be your will be the first of many shoulder surgery rodeos.

Save yourself the brain damage and get a good check-up (which means a 60-minute check-up by the doctor - not the assistant). Besides, why would you choose 20th-century technology when treating your labral tear? Why not opt ​​for advanced interventional orthopedics and skip surgery?

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references

(1) Van Blarcum GS, Svoboda SJ. Glenohumeral instability associated with specific disorders: SLAP tears, panlabral tears, and multidirectional instability.Sports Med Arthrosc Rev. 2017 Sep;25(3):e12-e17. doi:10.1097/JSA.0000000000000153

(2) Clavert P. Glenoid Labrum-Pathologie.Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S19-24. doi:10.1016/j.otsr.2014.06.028

(3) Schrøder CP, Skare Ø, Reikerås O, Mowinckel P, Brox JI. Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-arm randomized clinical trial.Br J Sports Med. 2017;51(24):1759–1766. doi:10.1136/bjsports-2016-097098