Any experiences with labrum tears, and rehab with or without surgery?

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  Aug 03, 2007 6:45 AM GMT

  I've been having shoulder issues (PAIN) for awhile and have finally gone to an ortho for help. After an examination and looking at my x-rays, he mentioned that it seemed to be an issue with the labrum. A scheduled MRI will show the exact extent of damage.
  
  Has anyone else experienced these same issues? Did your damage require surgery? If so (or if not), what was the rehab like? Any info and personal experiences would be greatly appreciated by this tennis freak... who's probably going to be playing a lot less tennis very soon.

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• gymingit
  
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  Aug 03, 2007 12:53 PM GMT

  I worked for orthopaedic surgeons for over 5 years. The best orthopaedic surgeons are found in Columbus, MS. I would trust my life with those guys any day. (Also the team doctors for Mississippi State)
  
  Rehab rehab rehab.... JUST DO IT!! Walk that wall with your fingers and Follow Through on All the Exercises. You will be fine.
  
  Have a recliner ready. You will sleep in it for a week keeping your arm completely still and make sure you have someone near by to help you throughout the day.
  
  Always take your meds as prescribed. Some people don't take their meds thinking they will get addicted to pain killers. The problem is.... once you actually feel pain, it's harder to control it at that point and then stronger meds may have to be prescribed to get the pain under control. An anesthesiologist may give you a nerve block, but don't let that block wear-off without taking your meds. So take your pain meds as recommended by your doctor.
  
  My mom had a slap repair done several years ago and I took care of her. My mom was also the transciptionist for the surgeons and knew already the problems patients faced for NOT FOLLOWING INSTRUCTIONS. She was back to typing with one hand after a 1 1/2 weeks and she gradually worked back into typing with the hurt shoulder in no time. Remember REHAB REHAB REHAB... WALK THAT WALL!! LOL
  
  Remember, don't ever push your luck. Wait until the doctor gives you an all clear before getting back into tennis. You don't want to start all over...... Follow All Instructions and bug the nurses anyway if you have questions. They have to attempt to return phone calls before they go home for the day. If you have questions, write them down so you don't forget. Remember, you will be on pain meds...lol
  
  Take care, LANCE

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  Aug 03, 2007 1:18 PM GMT

  That all depends on what type/grade of SLAP you have and if there are other associated leisions with it...
  
  There are basically 5 types of SLAP leision (SLAP stands for superior lateral anterior posterior labral lesion, the other quadrant of larbal tear would be called Bankart lesion).
  
  Type I:
  Just basic fraying of the labraum cartilage. Sometimes if the degree is not so severe, you can do without surgery but just rehab.
  
  Type II:
  The longe head of the bicep tendon originates just above the superior labrum. Type II is a SLAP tear of the labrum that involves this long head bicep tendon where the whole portion maybe detached. YOU NEED SURGERY FOR THIS. AND NO BICEP FIRING pre or post surgery during rehab!
  
  Type III:
  Like Type II, but more severe as an actual piece of labral cartilage tissue is flapping down into the whole complex... SURGERY!
  
  Type IV:
  Like Type III, but even more severe as the torn cartilage flap is extending into the tendon, can can severe the bicep tendon. SURGERY!
  
  And SLAP leision almost never happen alone, it is usually accompanied by biceptial synovitis, suparspinatus impingement, hooked tyep V acrominon, lax/loose shoulder, or more sever cases, Hill Sach lesions and such...
  
  So there is really no particular advise until your MRI results are back. Even then, they often find more stuff going on once they go in athroscopically...
  
  And of course, like the knee meniscus, it all depends on the shape and degree of the cartilage tear, and how much they can salvage by tagging it down (with a bio degradable nail) or actually has to shave off the offending piece that is not repairable... The more they shave off, the looser your shulder and you may experience some clicking and cluncking post surgery...

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  Aug 03, 2007 1:40 PM GMT

  Oh forgot to give a general recomendation (for those who complain that I get too technical..):
  
  Do NOT rehab it yourself until you have some instructions from the ortho team. SLAP lesions come with very specific instructions, case by case. Even if youhave a common and not so severe Type II SLAP, it is best to ask your ortho team waht is safe to do as the shape of tear and possible other related lesions are unknown. Generally, if you have SLAP II or beyond, NO BICEP firing, that means no shoulder or elbow flexion at all...

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  Aug 03, 2007 1:55 PM GMT

  Oh forgot to mentione this as well.
  
  No bicep firing is not the only precautions. You cannot put the bicep in a stretched position, during a work out or even during passive stretching.
  
  The long head of the bicp is responsible for flexion, so no more shoulder in extension position. That means the shoulder should never go behind/beyong the trunk in any movement combinations.
  
  That means no dips, or lowering the bar too low during incline presses, or lowering the bar behind your neck in a shoulder overhead press (when you do that, your shoulder will naturally go into extension), or do behind neck pull downs (your shoulder end up at the same place as the over head behind neck shoudler presses)...

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  Aug 03, 2007 2:08 PM GMT

  And for tennis (I have had so many patients with SLAP whoare avid tennis players)
  
  Watch out when you are serving especially. If your shoulder blade of the active arm is NOT stabilized and moving in the right pattern in synch with the actual shoulder gleno humeral joint, you will experience clicking...
  
  In other words, your active shoulder blade cannot have an appearance of "forwad and slutching" shoulder while you do any flexion or rotation movements of your shoulder. If your arm has to extend behind your body, the shoulder blad better be retracted and tight against your thoracic cage (flat on your back)..
  
  If you do this correclty, you should not experience any clicking or clunking after surgery.
  
  Many rehab clinics out there are shake and bake and they treat 4 patients at the same time, and they are not very skilled (I am embarrased of my profession in this light)... This is OK if yoaure treating a geriatric patient and her goal is to be able to do garden work again, but quite different if you ar an athlete... This is the same when it comes to picking your roth surgeons. Ask him about your goals and what his experiences are with atheltes... And look around in his clinic as well...
  
  Shop around!

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  Aug 03, 2007 3:04 PM GMT

  Trust me: I am a very, shall we say, educated and motivated patient!! LOL
  So we'll see what happens after the MRI. BTW NYCM4M, I already have the clunking, clicking, and popping. And it's not the good popping, trust me. ;) UGH. It sucks to have an aging infrastructure.

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  Aug 03, 2007 4:27 PM GMT

  Best of luck!
  
  Shoulders should never clunck or pop...
  
  Just shop for a good ortho team and rehab place. If you see a "factory", which 90% of the clincs are today in order to survie and make $, stay away!

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  Sep 24, 2007 2:23 AM GMT

  I've had a torn labrum since high school. I could pop my shoulder out of place etc etc. YAY.
  
  After my current doctor told me that it was "perfectly normal" we dropped his ASS like a ton of bricks, incompetent *bleep*. He could barely speak English.
  
  So once I got a new doctor, he ordered up an MRI etc etc. When I finally had an appt to go over the MRI results, the doctor there decided to tell me that I had a TUMOR ON MY HUMERUS. So why did nobody catch it on all the previous X-Rays I had???
  
  Well, anyway, I'm sitting there shirtless and terrified that I'm going to die of bone cancer, and he keeps going on about physical therapy.
  
  So to shorten the story, I opted out of physical therapy so that my doctor and I could spend resources on getting bone scans and all that to figure out if I was dying of cancer. Well, no surprise by now, but everything came back fine, or I wouldn't be typing this.
  
  So, anyway, nobody really told me for certain, but I'm pretty sure that the tumor on my humerus somehow caused the tear, maybe either directly (somehow pushing or tearing at the ligament as it grew) or indirectly (putting too much stress on my joint by tearing or weakening the muscles around the joint).
  
  I'm finally realizing that I need to start rehabilitating it NOW, so that I can start exercising regularly. I've been too afraid since high school to damage it even further, and it's not like I can afford physical therapy on my own.
  
  So, bigguysf, how has rehabilitation been working out for you?

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  Sep 25, 2007 5:18 AM GMT

  Torn labrum update: NOT!
  The initial x-ray did show a spur causing shoulder impingement. The MRI showed another good sized spur that was pressing into my rotator cuff and causing a partial tear.
  
  Surgery was scheduled soon thereafter and I'm now in the Physical Therapy for my rehab period. My PT was very honest upfront and admitted that even though I would benefit from a shorter rehab period because there was no repair work done, my rehab would be a little more painful. She was right!
  
  It's been two weeks since my surgery, and after a pretty painful first week and a half or so, I'm making very good progress.
  
  So I guess it's like jarrem85's experience, that first impressions aren't always what they seem for shoulder issues. Happy endings all around though... :)

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