Shoulder labrum surgery recovery can be a nightmare. Months spent in a pillow immobilizer and months more of rehab. Is there a way to treat a shoulder labral tear without surgery?
The images above are an example of Interventional Orthopedics, in this case treating a shoulder superior labrum tear through a 25 gauge needle without the need for surgery. You can see the dark radiographic contrast spreading at the tip of the very fine needle being used (dark stuff). Why is this a big deal? First, to treat a shoulder labral tear without surgery required two imaging technologies-both ultrasound (which can image most of the biceps very well in everybody) and fluoroscopy (which is needed to see the last stretch of the biceps tendon as it attaches to the superior labrum). In this case you can see the progression of images as we place the needle into the superior labrum tear and switch to fluoroscopy as the needle can no longer be seen on ultrasound (this structure is too deep and protected by bone for the sound waves that make up an ultrasound image to bounce in and out). So a superior labrum tear can only be injected with high accuracy if you’re one of those rare practices that has expertise in both ultrasound and fluoroscopy. Second, a 25 gauge needle is tiny compared to a surgical arthroscope. I have placed an illustration of the position needed to open the shoulder for a surgical arthroscope below as well as the relative sizes if the smallest shoulder arthroscope commonly used (many surgeons use bigger ones) and a 25 gauge needle. If you look at the pictures above you can see the fine needle coming off from the right side. Using this needle based approach means minimal recovery time, as tissue isn’t harmed by placing the cells. Finally, Interventional Orthopedics focuses on trying to help the tear to repair itself rather than sewing it back together or placing artificial anchors. Again this usually means much quicker recovery time. On the other side of that coin, it also means that bigger retracted tears may still need the traditional surgical approach.
The upshot? We’re in a new age of treating orthopedic injuries where physicians will seek and develop ever less invasive ways to heal injuries rather than using more invasive procedures that remove tissue. In this case, the highly accurate injection of the patient’s own stem cells into the labrum tear.