How is a labral tear diagnosed?
Dr. Cooper will ask for a history of your injury and conduct a physical exam to check range of motion, stability and pain. X-rays will be ordered to rule out other injuries. Dr. Cooper will order an MRI to confirm the tear. The final diagnosis will be made with arthroscopic surgery.
Nonsurgical Treatment Option
Nonsurgical conservative treatment is the preferred first line treatment. It includes activity modification, anti-inflammatory medication to decrease pain and swelling, steroid injections for pain, and physical therapy to strengthen shoulder muscles and improve range of motion.
Arthroscopic Surgery
The decision to treat labral tears with surgery and the type of surgery depend on the location and type of tear as well as the patient’s and surgeon’s preference, and sport specific demands. Arthroscopy is minimally invasive surgery to view, diagnose and treat injuries inside the shoulder joint. An arthroscope is a small instrument that permits the doctor to see inside the joint and view any injuries. Tears can be surgically repaired with the arthroscope.
Using an arthroscope Dr. Cooper will examine the all the shoulder structures including the labrum, the tendons, muscles and ligaments. The stability of the shoulder joint will be evaluated. If there is instability in addition to a labral tear, the surgeon must stabilize the joint as well as repairing the tear.
If the shoulder is stable and the only problem is a labral tear, the surgeon can repair or remove the damaged tissue. Torn tendons or ligaments will be repaired at the same time.
Open Surgery
Occasionally labral tears are also associated with bone loss of the glenoid surface. The glenoid surface is the boney socket of the shoulder and is necessary for shoulder stability. If the boney socket has lost bone due to chronic injury, the shoulder will not be stable with labral repair alone. Glenoid bone loss is measured based on CT or MRI of the shoulder. When this occurs glenoid reconstruction is required.
Latarjet surgery is the most common option for this when the bone loss is anterior. This surgery involves moving a bony part of your scapula called the coracoid to the front of the glenoid where the bone loss has occurred and putting two screws in to hold it in place. The labrum is then repaired over the top of this new bone to provide a restored boney surface as well as a restored labrum.
Another option is reconstructing the glenoid with allograft bone. If a latarjet has been done prior and failed, or in other revision settings, Dr. Cooper may advise using a distal tibial allograft to reconstruct the bone of the shoulder socket. This has the benefit of also reconstructing a cartilage surface for the bone to move on.
Although the majority of time bone loss on the glenoid is anterior, posterior bone loss also occurs. Small amounts of bone loss can be treated arthroscopically, but large amounts of bone loss may require an open approach to the posterior shoulder with boney reconstruction similar to the distal tibial allograft reconstruction described above for the front of the glenoid.
Recovery
Recovery depends on the extent of surgical repair. After surgery a sling will be necessary for up to 6 weeks to immobilize the joint. Range of motion exercises will be prescribed. As the patient improves, exercises to regain motion, flexibility, strength will be added. Complete healing and full recovery can take about 6 months. A majority of patients will regain full use of the shoulder after surgery and can return to play without restrictions.
Dr. Joe Cooper is a fellowship trained shoulder surgeon and an expert in the diagnosis and treatment of shoulder injuries.
