Shoulder Labral Tear Surgery Pros and Cons: Hidden Shoulder Instability

Shoulder Labral Tear Surgery Pros and Cons

I evaluated a patient this week who shows off the warts of our modern orthopedic care system; he was diagnosed with a shoulder labral tear and offered surgery. Why? His shoulder labral tear was the bright, shiny object, and nobody ever asked how he got the tear in the first place. As he considered shoulder labral tear surgery pros and cons, I made the decision easy for him. Like many patients with a shoulder labral tear, the real diagnosis and its treatment was missed by the five-minute visit with the orthopedic surgeon. Let me explain.

What Is a Shoulder Labral Tear?

shoulder_anatomyThink of the shoulder labrum as a lip around the socket of the ball-and-socket shoulder joint. It’s there to help guide the shoulder joint in movement and to make the shallow socket a bit deeper, allowing for better stability. A tear in the labrum used to be ignored, considered just part of the spectrum of shoulder-joint arthritis, but then orthopedic surgeons figured out they could sew it together and an industry was born. This isn’t to say that one doesn’t need to worry about healing a labral tear, but for most patients, surgically sewing it back together is likely not the right choice.

Why Did Your Labrum Tear in the First Place?

In our modern orthopedic surgery system, dictated by insurance contracts and managed care, most patients spend more time with an assistant than the surgeon. If they do see the surgeon, they’re one of 30–40 patients seen that day, each of which garner 5–10 minutes of attention. In this world of factory-type, high-volume medicine, asking how the labrum was torn in the first place just slows down the manufacturing line, so the question is rarely asked and answered.

While labral tears can occur in big traumas, like a car crash or a serious fall, many just kind of happen with seemingly innocuous activities. Why? The answer is simple, but it is often completely ignored by surgeons—hidden shoulder instability.

What Is Shoulder Instability and Why Should You Care?

The shoulder is a strange joint in that it has to allow for maximum movement in many directions, but it also has to remain stable at the same time. There’s a symphony of millisecond-timed and millimeter-oriented precision that allows the ball to stay in one tight region in relation to the socket as you move. While the rotator cuff and other muscles play a big role in this, there are also strong ligaments that make sure the ball joint stays perfectly seated in its shallow socket.

Surgeons usually pay attention to these ligaments only when the joint has been dislocated out of its socket, and everything else might as well be invisible. However, for each patient who has dislocated a shoulder and is left with a horribly unstable joint, in my experience there are five or six patients who also have an unstable shoulder that goes undiagnosed -hidden shoulder instability. Oftentimes this is from an old injury that the patient may have long since discounted. However, at some point that unstable shoulder that seems fine comes back to bite them in the form of a labral tear. Hence one of the biggest cons in evaluating shoulder labral tear surgery pros and cons is hidden shoulder instability.

How Is a Labral Tear Related to Hidden Instability?

ezgif.com-video-to-gif (1)

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

Two Patients Who Show How Common This Problem Is and How Often It’s Missed

Hidden shoulder instability is very common and is almost always missed by orthopedic surgeons. Case in point is two patients I evaluated this week. Both saw me because they were evaluating shoulder labral tear surgery pros and cons.

One was a patient in his 20s who rock climbs, and during a workout, he felt a tearing sensation in his shoulder and then had chronic pain. He was diagnosed with a torn shoulder labrum in the front and the back, and the recommendation was surgery. Nobody asked why a normally healthy guy would suddenly get a labral tear doing what everyone else does without injury. On exam his shoulder ball was unstable in its socket, a fact the orthopedic surgeon missed. So hidden shoulder instability is why the ball suddenly shifted out of its socket and banged his labrum. How did he get the instability? He remembered a bad mountain-bike fall 7 years ago where his shoulder hurt, but he’d never had it checked out.kimura lock shoulder injury

The second active guy I evaluated in clinic this week was similar. He tore his left shoulder labrum while dead-lifting 450 pounds. His right shoulder had no issues and was also loaded with the same weight. Why did he tear his left shoulder labrum and not his right? He, too, saw an orthopedic surgeon who told him he needed surgery. On exam his left shoulder joint was unstable and knew immediately when it happened. While in a mixed martial arts (MMA) fight, his opponent wrenched his shoulder (the “Kimura Lock” as shown) the year before the dead lift. He, too, had shoulder pain for a few weeks, but blew it off. Again, the hidden shoulder instability was completely missed by the orthopedic surgeon.

What Happens if You Get Shoulder Labrum Surgery and Have Hidden Shoulder Instability?

It doesn’t take a rocket scientist to understand that if you have hidden shoulder instability and someone surgically repairs the labral tear, as soon as the shoulder gets into a weird loaded situation, the socket will shift out of place and the labrum will tear again. How can you prevent this? By skipping the 20th-century orthopedic surgery and using 21st-century interventional orthopedics. This means placing precise imaging-guided injections of your own advanced platelet and stem cell mixes directly into the labral tear and also into the weak ligaments. The downtime is a fraction of that of surgery, and in our experience of treating hundreds of shoulders, the results are as good as or better than surgery—and with the hidden shoulder instability issue fixed.

The upshot? Hidden shoulder instability is very common and almost always missed by surgeons who spend 5-10 minutes with a patient. So if you’re looking at shoulder labral tear surgery pros and cons, a huge con is that you may have hidden shoulder instability that was undiagnosed, meaning that this shoulder labral tear repair will be your first of many shoulder surgery rodeos. Save yourself the brain damage and get a good exam (which means a 60-minute evaluation by the doctor-not the assistant). In addition, why go with 20th-century technology when addressing your labral tear? Why not go with advanced interventional orthopedics and skip the surgery?

 

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Read 23 Comments
  1. I have had shoulder pain since Thanksgiving. I had an MRI the end of December. My doctor said I have two tears one in the front and one in the back. I did two months of physical therapy which helped some. I continue to do the exercises at home. I’ve tried to play tennis a handful of times but it’s to painful and weak. At my doctor appointment last week he recommended surgery. Your article here is very, very interesting. I wish I could get involved in your trial. Thank you for all your wonderful information.

    1. Janet,
      We’re still recruiting for the Rotator Cuff Tear trial, but because of the nature of RCT’s the inclusion and exclusion criteria are very specific: http://www.regenexx.com/stem-cell-research/#studies. While it’s always better to begin with the most conservative treatment like Physical therapy, if that hasn’t helped, being evaluated for treatment with your own platelets or stem cells, rather than surgery would be important. That way you’re giving the injury what it needs to heal, rather than giving it the bigger problem of needing to heal from the surgery without discovering and treating the cause of the tears…most probably, instability: http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ If you’d like to be evaluated for a Regenexx procedure, fill out the Candidate form, and we can take a look.

      1. Hi,
        I contacted your office several weeks ago to find out more information regarding the trial but was told by your office that it was only for those living in the state. I was disappointed because I do believe I meet your criteria.

        After being told this I went back to the Regenexx website and found a doctor several hours away from where I live. I have an appointment with him this Wednesday which I am looking forward to.

        Thank for responding to my first email.

        Janet

        1. Janet,
          That’s good news! Good for you for taking the initiative to look further! Given the amount of times the patient would need travel to Colorado, it’s simply unrealistic for a patient to be able to do that if they don’t live in Colorado. Will be thinking of you on Wednesday…

  2. I have either rotation cuff or unstable shoulder with pain and aching on movement and even at nite. Any doctor in Tn? That does stem cell?

    1. Barbara,
      Here’s some additional info on Rotator Cuff Tears and shoulder pain. If you’d like to be evaluated for a Regenexx procedure please fill out the Candidate form: http://www.regenexx.com/rotator-cuff-tear-causing-shoulder-pain/ http://www.regenexx.com/most-common-shoulder-problems/ Nearest to you would be Louisville, KY: Here is the interactive list of all the Regenexx Providers. Depending on where in Tennessee, a different one might be closer: http://www.regenexx.com/find-a-physician/

  3. Hi I also have a shoulder injury it’s a labral tear, would I qualify for this? Where can I go for treatment here in Arizona?

    1. Lilly,

      Shoulder labral tears are something we treat regularly. Here is the Interactive list of Regenexx Providers. There’s one in Phoenix, but depending on where in Arizona you live, one of the others may be closer: http://www.regenexx.com/find-a-physician/ Please see:http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ and http://www.regenexx.com/shoulder-labrum-surgery-alternative/ If you’d like to see if your particular shoulder would be a good Candidate for a Regenexx procedure, please submit the Candidate form.

  4. Hi I’m a chiropractor, and avid athlete. I just had mri that revealed a 12 to 6 posterior labral tear with a 2cm pseudocyst at 9 o’clock. Tendons are all strong and tree shoulder is stable. But I get excruciating pain with any attempt at vertical or horizontal pulls.i have no pain benching or any other movements except pulling. I don’t want surgery. What is your track record with labral tear?

  5. So I’ve been having right shoulder pain for almost a year since a motorcycle accident, but no amount of physical therapy has helped. I’m in the military if that tells you anything. Anyways, I just had an MRI done, and when I saw the results (mild tendinosis of the supraspinatus and infraspinatus tendons without tear in the rotator cuff, labrum tear from anterior to posterior, mild AC joint arthrosis, trace joint effusion). I’ve been doing some research on my own before I meet with my military doctor. I broke my right collar bone when I was 15. I was 38 when the motorcycle accident occurred. I’m 39 now. I think the broken clavicle contributed to the shoulder instability, which then led to my labrum tear. Also, I don’t think the crash itself caused the injury. When I got up from the accident, I was somewhat frustrated because I had been riding for 12 years a that point, and to have some gravel force me to lay it down pissed me off. So I picked the bike up on my own. I think picking the bike up caused the injury to my labrum. Anyways, I will discuss this with my military doc, and see where it goes. Thanks for giving me a bit more information as to what treatment options I should look at. I am in New Orleans, and since we have no military surgical facilities in the area, stuff like this is usually referred out to the local civilian surgeons. If you know of any in the area that might be able to help with this, please let me know! Thanks!

    1. Andrew,
      The best person to contact would be Dr. Thomas Bond, TotalCare Health & Wellness Medical, 1101 South College Suite 201, Lafayette, Louisiana 70503 His website: http://totalcare-la.com/. He is the president of the American Association of Orthopedic Medicine (AAOM), has the largest skillet to draw from, and would be able to refer you to a good surgeon if needed.

  6. When I was 20 I started getting pain in my right shoulder (didn’t know form what at the time). After 2.5 years of getting nowhere with a surgeon I decided to go to another surgeon who “repaired” 4 tears in my labrum. That was 2012 and over 5 years later I feel no better. My shoulder hurts, my rotator cuff hurts, and my bicep tendon hurts. All the while I had back/neck pain that felt like a pinched nerve and was dismissed by professionals. That pain has led to a tingling and burning near my scapula (which wings). I’m convinced that these are all related and the neck issue is what caused the scapula to wing and that caused the shoulder to be misaligned or unstable. If I were to be evaluated again I would want all of this to be taken into account. So my question is do Regenexx doctors evaluate all of this info during a consultation? Do I need up to date MRIs? Where do I go to find this information out? I split time between Buffalo, NY and Tampa. Who should I talk to?

    1. Adrian,
      Yes, this is the prospective from which we examine patients. What the situation is, but not what caused it, is not enough information to effectively treat patients. You do need up to date MRI’s for the Candidacy Evaluation The two locations that look like they’d work in your case would be Vermont or Tampa, FL. Would you like staff to contact you by email to assist you in the processan answer any questions? Please see: http://vermontregenerativemedicine.com/ and http://newregenortho.com/. Here is the entire list: https://www.regenexx.com/find-a-physician/

  7. My 18 year old son injured his shoulder while wrestling. Orthopedist accessed it was a labrum tear. Opted for no surgery just PT to make it stronger. Wears brace while wrestling but is still popping out of socket. Thoughts?? No MRI done.

    1. Rebecca,
      Yes. This is something that should be treated as the instability it’s causing will cause wear and tear and ultimately arthritis in the shoulder, which you really don’t want at 18. No surgery, and therefore lengthy surgical rehab, is needed as this can all be handled through injections of his own stem cells or platelets. If you would like us to take a look to see if he’d be a good Candidate for a Regenexx procedure, get the MRI done, then submit Candidate form which would allow you to upload it. Please see: https://www.regenexx.com/shoulder-labrum-surgery-side-effects/ and https://www.regenexx.com/watch-advanced-image-guided-injection-shoulder-step-procedure-suite-dr-schultz/

  8. I’ve had Labrum “repairs” done in both shoulders about 8 years ago. My passion is weight lifting. My shoulders have never been the same. 6 weeks ago I’m feeling bi lateral pain in both shoulders but not in the “old labrum” spot as before, and also both pectoral tendon areas. My physician wants me to wait 6 weeks for our follow up appointment. I’m going to ask for MRI on both shoulders, and also to check for pectoral tendon damage.

    If I have damage in shoulders and Pec I would like to do regenex and skip surgery!! I live in Michigan, but I’ve been told to make the trip to Colorado.
    Can regenexx help my pectoral tendons and shoulders? If both sides need it, can they do it all at once? That way it’s not inconvenient with the numerous travel trips!

    Thanks

    Carlo

    1. Carlo,
      Labral “repairs” generally leave the shoulder unstable and the effect of that over time has consequences. Once you have the MRI’s, you can upload them and a medical history by submitting the “Candidate” form (to the right of the blog). A time will be set for one of our Physicians to call and grade your Candidacy, learn more about what’s going on, as well let you know what type of procedure or procedures will likely be needed in your case. Some procedures use stem cells, some platelets. Stem cell procedures require a certain dose of stem cells, so if stem cell procedures will be planned for bilateral shoulders, there are things you can do in advance of the procedure to increase your chances of having enough for both shoulders. Please see: https://www.regenexx.com/8-ways-improve-your-stem-cells-prior-treatment/

  9. I am female 56. AUG 2016 was pulling the LG metal heavy dock plate with a metal hook back toward me to drop on the back of a semi to load. The curve tipped hook slid out and I fell backwards at high speed onto concrete and the pointes ends of a palate jack. A bit afterwards I had numbness and tingling in my right arm I couldn’t sleep on my rt side for months, had pain in the shoulder area. In Feb 2017 was walking up a steep ramp and hit black ice didn’t want to fall on my right arm so I twisted to the left fell back but my right arm took the blow. I think this is what caused a tear that they haven found yet. Have ortho appointment on Aug 18. If I lay on my left side the pain in my right shoulder and bicep is like a 9. I have to roll to my right so the weight is under me. If I’m on my left side and try to raise my arm, I really cant. The MRI isn’t showing anything but I’m sure it’s atleast a labrum tear.
    I was researching options to surgery before I see this Ortho doctor. I am very interested in your procedure. I head a doctor in Stevensville MT. has done this. Do you know who to recommend in MT.?
    I have relatives in Col. So that is an option. Have you found that workman’s comp. Approves your procedure?

    1. phyllis,

      It sounds like you really need a good exam – the type that actually seeks to track down what’s going on as this could be a shoulder issue, a spinal issue, or both. An MRI is a snapshot. A dyamic ultrasound to watch what the shoulder is doing upon movement is a much better diagnostic tool. Unfortunately, we can’t recommend anyone in Montana, as there’s not a Regenexx Provider there, and all you read here pertains only to Regenexx procedures. Some of our Providers work with Workman’s comp cases, as it is up to the individual practice. If you’d like to see if you’d be a Candidate, please submit the Candidate form. Please see: https://www.regenexx.com/a-colorado-regenexx-patient-review-pain-free/ and https://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ and https://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/

  10. I am currently active duty Army and I originally injured my shoulder playing softball (pitcher) in High School I went to 2 different doctors both gave me x rays and said they couldn’t do anything and one was the orthopedics which the Rays Baseball team players go too. After I joined the Army during combative’s my shoulder froze and I assume it tore more, again the Army didn’t go anything, so 3 years later while still in the Army I went back to our Aid Station and complained of the pain, they gave me a x ray and MRI and the MRI showed I had a labrum tear in my right shoulder from the 1 o clock to 5 o clock position along with my entire shoulder is tendinitis. Anything I can do to relieve the pain or tell the Army Orthopedics when I see them September 26th? My pain is a constant 7 out of 10.

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