So you tore your labrum. Now what?
If you break your arm, you’re headed straight to the nearest emergency room – do not pass GO and do not collect $200. And if it’s displaced or comminuted, you’re almost certainly getting scheduled for surgery before you even leave the building.
But things are a little less black and white when it comes to soft tissue injuries. Does it need surgery, or can it heal with rest and rehabilitation? How do you know?
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Case in point: shoulder labrum tears. For some they’re career killers (they’ve been called baseball’s most fearsome injury) while for others they’re simply minor bumps in the road.
What’s a labrum?
First things first: what the heck is a labrum? Here’s Bob’s Burgers to explain:
The labrum is a piece of fibrocartilage in the shoulder that keeps the ball of your shoulder (aka the humeral head) tight against the socket (aka the glenoid). It creates a suction seal, similar to the o-ring on a valve stem, to stabilize the shoulder joint. The labrum also functions as the attachment site for one of the tendons of the biceps muscle.
Tearing it can be pretty painful. It may feel like your shoulder joint is popping, locking, catching or grinding. You’ll also likely feel a sense of instability in your shoulder, a decreased range of motion, and a loss of strength.
There are two common types of labral tears. The first, SLAP (Superior Labrum Anterior/Posterior) tears, generally occur over time as abnormal shoulder biomechanics combined with repetitive activities weaken the cartilage that makes up the labrum (such as throwing a ball, swinging a racket or working overhead). These tears occur across the top of the labrum from front to back.
The second type, Bankart labral tears, usually result from one single, forceful event (like falling on an outstretched arm or suddenly catching a heavy object). Bankart tears happen on the bottom half of the labrum. This type of acute labral tear is most often seen in younger athletes who play contact sports like football or hockey.
There are also tears categorized as superior labral tears and posterior labral tears, but these are relatively uncommon.
How can you tell if it’s a labrum tear?
While MRI arthrogram imaging is the gold standard for diagnosing a labral tear, and what your doctor will probably order if they suspect one, there’s a test you can do yourself at home that’ll give you a good idea whether your shoulder pain is due to a problem with your labrum or not.
It’s called O’Brien’s test, and to do it you’ll start by extending your arm out in front of you 90º and then adducting your shoulder by about 10º until your hand is directly in front of your face. Internally rotate your shoulder so your thumb is pointing straight down and have someone push down on your forearm. Then externally rotate your shoulder so your palm is up and again push down on your forearm.
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The test is positive if you feel deep pain or clicking in your shoulder when you perform it with your thumb down, but not when your palm is up. While there’s no perfectly reliable clinical test to diagnose a labral tear, a positive O’Brien’s test is a good indicator that your labrum is the problem.
Do I need surgery?
For those who’ve had a labrum tear confirmed by an MRI, the next question is usually “Is surgery necessary?”
The answer is that it depends – but surgeons are delaying surgery in favor of conservative treatment much more frequently today than they were just a decade ago.
Why? Surgical labrum repairs don’t exactly have an outstanding success rate.
A recent review of SLAP labrum repairs tracked by the American Board of Orthopedic Surgery doesn’t inspire a ton of confidence in the surgical route. Out of 4,975 surgical labrum repairs, only 26.3% of the patients said surgery eliminated their pain. Worse, only 13.1% of them reported a return to normal function.
Another study published in the American Journal of Sports Medicine looked at the post-surgical outcomes of 179 athletes with SLAP lesions. 36.8% of these surgeries were designated failed procedures and another 28% had to be redone within two years.
Even worse, most labral repair patients are told that they should never go back to high-intensity activities ever again after surgery. No more overhead weight lifting. No more pull-ups. No more tennis. No more basketball. That’s not a great outcome for anyone who’s active.
The good news? 2/3 of patients with a labral tear don’t need surgery and can recover to full pain-free function with conservative treatment. That means manipulative therapy to correct joint motion and rehabilitative therapy to restore muscle balance in the shoulder. That’s the approach we take at Ascent Chiropractic, combining both chiropractic manipulation with soft tissue therapy.
The 1/3 of patients who require surgery are generally those with clear traumatic injuries that result in larger labral tears. That usually means labrum repair surgery if you’re under 40, and labrum repair plus bicep tenotomy or tenodesis (repairing or cutting away part of the bicep tendon) if you’re over 40.
But the goal should be to avoid surgery if possible.
Fixing both joint function and muscle imbalance
Fixing a labrum injury (without surgery) is a two-part process: returning proper motion to the scapula (shoulder blade) and glenohumeral joint and correcting muscle imbalances. If you’re only addressing joint motion (manipulation), but ignoring the muscles that control and support that joint with specific active rehab exercises, you’ll never get long-term correction.
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Conversely, if you’re only doing muscle and myofascial rehab – stretching soft tissue that’s tight and strengthening weak muscles – without actually correcting the joint dysfunction that’s at the root of the problem in the first place, you’ll be stuck with low-level chronic inflammation forever because the joint still isn’t working correctly and the labrum never has a chance to heal.
At Ascent Chiropractic, we make it a point to do both.
So how do you strengthen the labrum?
You don’t – not directly. The labrum is fibrocartilage, not muscle, so protecting your labrum while it heals is best done through keeping your entire shoulder strong, therapeutic taping as necessary, monitoring your workloads and avoiding overuse while you give your labrum a chance to heal.
Here are four closed-chain (hands and feet on the floor) weight-bearing exercises that help encourage proper shoulder function and stability. They’ll engage the labrum and recruit all of the surrounding muscles to help improve shoulder stability.
1. Shoulder Taps
2. Toe Taps
3. Tactical Roll
4. Under The Fence
Keep in mind that these are accessory exercises, which means they don’t replace a well-rounded resistance exercise program. Don’t know where to start? The Ascent Gym Fundamentals are six of the most popular, evidence-based, spine-and-extremity-safe workout programs I give to patients – click here to download them now.
Disclaimer: This is not a substitute for medical care. Please consult a doctor or healthcare professional to get a medical diagnosis, rule out any serious complications and get advice on a treatment plan for your particular condition before beginning any self-treatment described here.
Brookfield Chiropractor Ascent Chiropractic
While what we do at Ascent to correct a labral injury isn’t necessarily a quick fix, it’s a solution that gets rid of pain naturally. And it’s a solution that allows you to return to all the activities that you love in life – even the high-impact, high-intensity ones.
Ready to get started? To make an appointment at Ascent Chiropractic, call 262-345-4166 or schedule an appointment with our online scheduling app.
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