Labral tears including SLAP tears. What are they and how do we treat them.
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- เผยแพร่เมื่อ 2 มิ.ย. 2024
- In this video Dr Orcutt explains what the shoulder labrum is as well as what the treatment options are for labral tears. The proximal biceps plays a signficant role in labral tears, specifically superior labral tears anterior to posterior (SLAP). There are several options available for labral tears and biceps tears. This is the first of two related videos on this subject.
I'm a 21-year-old pitcher who is 3 months post-op of a labrum repair in which consisted of the anchors you're talking about. Also, this surgery required the biceps tenotomy along with making my rotator cuff with a "band or patch" for future strength. Currently, I reside at around 180 degrees flexion and 90 degrees external. The first few months of therapy after my 15-day rest period was by far the most painful thing I've endured as they crank on my arm in different ways. I appreciate the informal video and am curious where my bicep tendon was reattached.
Typically in pitchers the biceps is repaired along with the labrum anatomically (where they were normally). Your surgeon can tell you for sure. Hope you get back to pitching soon!
great share !!!
Thank you 👍 Hope it helped!
I have Extensive tear of the superior and posterior glenoid labrum. I was told My bicep has detached and Rotator cuff has multiple small tears. I am 54 and had the same exact injury in my opposite shoulder last year. Its 1am and the pain is so severe, Its only been two weeks since I tore it and am waiting to see my orthopedic shoulder dr ad my orthopedic knee surgeon was the one who diagnosed me while my Shoulder dr was out of town….I am miserable. I have an allergy to nsaids, so I was given gabapenton. flexeril and hydrocodone 7.5….I am miserable. Thanks for the video
Ellen so sorry to hear about your pain. I hope you get to see your shoulder surgeon soon. Please consider joining our newsletter. Just email us at dro@mybodyprotector.com and put "yes" in the subject line. We will get you signed up and also give you a couple tip sheets!
So when the rotator cuffs are so bad and you do a reverse....question is ....do you just push the rotator cuffs away or do you cut the mush out or leave them hanging? cut them out to rid pain? How far back ? take them off the scapular blade? Please educate me.....also obviously the labrum ring is cut out....and so is the bicept tendon,where does that attach to and son on......I have 3 bad cuffs and need reverse surgery
Reply
Usually the rotator cuff tears are not specifically addressed, except the subscapularis is often repaired if possible because we think it helps the Rev TSA function better. Most often the biceps is reattached with a biceps tenodesis. Great questions. Good luck Jacob.
Hi. I read that the outcomes of SLAP tear surgery go down as you get older than 40 years and typically results in a stiff and painful shoulder. Can the same be said for outcomes of inferior posterior labral tear surgery as well?
E.g. a patient in his 50s who exhibit good physical conditioning and have arthroscopic findings consistent with an acute trauma-related inferior posterior injury. If there hasn't been any previous pain or untreated injuries would surgery in this case be an acceptable choice?
There are a few issues here. First, it really depends on what kind of inferior tear. Usually a tear in this area in the 50s are more degenerative and would be debrided 'Cleaned up" not repaired. Also SLAP repairs are different because the repair includes the attachment of the biceps, which I believe is more of the pain and stiffness generator. Just my thoughts, good luck!
Do you do phone or web consultations?
Hey popeyrugby, Not at this point. But please consider joining our FB group or join our newsletter. Just email us at dro@mybodyprotector.com and put "yes" in the subject line. We will get you signed up and also give you a couple tip sheets!.
reading from my MRI result Full thickness tear of the supraspinatus and infraspinatus.. Long head of the bicep tendon is torn and retracted. extensive circumferential tearing of the labrum. I am a very active athletic 75 year old male and this injury occurred during a jujitsu class. What can I expect from surgery is my main question.. PT did nothing for me certain movements cause a sharp pain still
Well Vincent, that is a difficult question to answer. That is a big tear and lots going on inside your shoulder. An experienced Ortho surgeon will need to look at you and your images (pictures, not just the report) to see what the best course of action is for you. And also taking into consideration your age, the severity of the tear, and your activity level. Good luck and let us know how you are doing
I got a slap tear at the end of 2020 from doing incline bench.
right now im about 80% id say from pre-tear. If i use machines to workout I feel pretty good.
Some instability here and here but I notice if I vary a few movements her and there and really concentrate on stablizing my shoulers before pressing, I can lift pretty good while and train to failutre but not using as heavy weight.
You think I should consider surgery?
Active Male, 30 years old, into bodybuilding type of lifing.
Thanks!
Michael, It is really hard to say. SLAP tears come in many shapes and sizes. Some are more debilitating than others. The best way is to have an MRI arthrogram (which I assume you have already had) and get a good evaluation by a surgeon who does this type of surgery often. That way you can have an educated conversation about your specific tear. Good luck and let us know how you are doing.
Michael, please consider joining our email newsletter for more information and insights and we will send you 2 Free PDF fact sheets that will help you through your surgery. Send an email to info@mybodyprotector.com just put "yes" in the subject line and we will get you signed up!
What if you have a rotator cuff tear a bicep tear and a scapula tear?
They all can be repaired, if needed. Some times they can just be cleaned up (debrided) and may not need formal repair. Talk it through with your surgeon, make sure you understand what the plan is before surgery.
Hello doctor. Would you mind to give me some opinions sir?
I am a male, 50 years old and I just have slap type 3 tear from accident (MRI). Is slap type 3 tear require surgery?
If do not do surgery, the pain will be there forever? It hurts when I move my right arm to some certain positions. Sorry for my broken English.
Thank you very much in advance sir.
Hi Windsurfer, Typically a type III SLAP requires surgery. The labrum is unstable and moves irregularly when the shoulder is in motion. Please consider joining our newsletter. Just email us at dro@mybodyprotector.com and put "yes" in the subject line. We will get you signed up and also give you a couple tip sheets!
How many times do you typically repair a slap tear? I had one two years ago and the Dr did a tenodesis. A year later it happened again along with my rotator cuff plus the tenodesis failed and a different Dr did the repair minus the bicep. Now the rotator cuff repair has failed and I think the labrum tear is back again. I’m so frustrated and ready to just do a replacement but I’m 45 years old and I don’t know if the dr will do it or not.
Oh man Chris! That is really tough. In general a SLAP is repaired once, but I'm sure there are circumstances that it can be repaired more than once. Unfortunately the rotator cuff can fail and there are some people (like you) who have to have it repaired several times. Hopefully repaired in a different way this next time to help it heal and stay healed. Good luck and let us know how you are doing.
Thank you. I’ll keep you updated.
Chris, Please consider joining our email newsletter for more information and insights. Send an email to info@mybodyprotector.com just put "yes" in the subject line and we will get you signed up!
I had a subpectoral tenodesis and a labrum debridement for a type 4 slap tear. Now i have alot of pain and instability in my shoulder and need another surgery . I met with a new surgeon who says he can put some anchors and suture my shoulder tighter to help with the stability. Have you seen this done? He said the last surgeon cut out alot of my torn labrum so he doesn't have much to work with . What is your experience with this and options
Frank that is a tough question. We typically do not have symptoms of instability after biceps tenodesis. In the adult population >40 yo we are more apt to have stiffness after this surgery. The typical reason for instability in a shoulder after the age of 40 is a rotator cuff tear. So it would be unusual. Hope this helps.
@@rotatorcuffexpert
Thanks for the reply , initially the MRI said I had rotator cuff tears but when the surgeon went in he said they were not bad enough to repair .
Interesting... If you get a chance watch my video on the "patch". I will link to it below.
th-cam.com/video/Zz-AYUhphYs/w-d-xo.html
I recently had an MRI after chronic (14 yrs.) "bicep pain". MRI report: Infraspinatus tendinosis with low partial grade articular surface/insertion tear,Mild tenosynovitis of the long head bicep tendon, Superior glenoid labral tear extending anterior and posterior to biceps tendon anchor involving the bicipital complex, and Fluid in the subacromial subdeltoid bursa. I am 38 yr fit/active female who works as a PTA. I am very anxious about my upcoming ortho visit. Can you give any
Well that MRI give you good reasons for shoulder pain. The ortho will need to see how your physical exam matches your MRI findings. Some of the finding most likely relate to your pain and others may not. The only way to know is to have that evaluation by an ortho. Good Luck!
@@rotatorcuffexpert When this initially happened (14 yrs ago) my shoulder was very weak, very painful, and couldn't hold it up against gravity. I have full ROM, it took a while to get that back. Pain is better and take Mobic. My workouts may sometime aggravate (I don't lift very heavy and I'm about 115lb.), but the pain seems to be triggered at work when lifting/transferring patients that require mod to maxA (heavy loading on biceps). When working out, there is crackling, popping, rubbing with catching sensations.
Please get it checked out soon!
I have an ortho appt first thing Wednesday morning. Also wanted to mention I have been twice to have checked out. First time when it happened, ortho did X-ray which was normal, gave me drugs, held off on MRI. Second time was January 2021, saw on call Dr (sport medicine guy) at the orthopedic clinic, he was in and out, did X-ray which also was normal, gave me drugs; Very frustrated. I RICED it (what I normally do when something I do that “injuries or re-injuries” it and go back to my normal routine until it “flared” up again. Just this past December I decided to see my GP, he’s very thorough and attentive, didn’t have to ask, he ordered me an MRI.
I'm sorry you had such a hard time getting an ortho to truly listen and look at you. I hope you find a better one!
What is a posterior chondrolabral separation
Erin, typically it is referring to a posterior labral tear. Is this what you have?Please consider joining our newsletter. Just email me at dro@mybodyprotector.com and put yes in the subject line and we will get you set up with a few tip sheets as well!
The arthrogram says superior labral tear. The Ct scan says posterior. My main pain is in the bicep
Hello, I have been facing clicking and popping in my shoulder with an acute pain on my anterior part of the shoulder. I have full rang of motion and can perform normal pushups and workout but with less weight. The thing I realized is that my biceps sort of move when I do incline chest workout. The mri suggested that I have a slap tear, and even my orthopedic confirmed that. The thing I don’t understand is that I read couple of research papers and suggested that a subscapularis tear could be the source of my biceps and anterior pain. How do you differentiate between a slap tear and a subscapularis tear
Often it is difficult to tell between SLAP tears, biceps tendon pathology including biceps subluxing out of bicipital groove and subscapularis tear. In Fact, to make it even more confusing it can be a combination of these!. A good MRI arthrogram, a good history and physical exam often gives us clues. Often we don't exactly know until we are performing the surgery. Good Luck!
@@rotatorcuffexpert thanks for answering doc. My background is engineering so I try my best to understand what is going on anatomically. But one thing that worries me is that, how can my tendon endure stresses later in the future. I do crossfit, will I ever be back to normal or actually improve after my surgery?
That is a very real concern. It all depends on the severity of tear, how your surgeon does the repair, how well your body heals, and how well you comply with the postoperative instructions. Good Luck!
Same…..absolutely same things I am feeling right now…did you opted for surgery…if so plz tell how it went and how are u doing now…plz 😭😭
@@fahadblack98 could you plz share how your surgery went…I am facing similar kind of issues 😢
Could I show you my mri to get your opinion?
pls see below
I just found out I have a SLAP 2 tear that extends both anterior and posterior of the biceps attachment. I hurt myself in two car wrecks 14 days apart last December and I am 50 years old. I have had two cortisone shots (one in the joint with xray) and had minimal relief that did not last more than 4 1/2 - 5 weeks. I am continuous pain at this point, my shoulder pops and cracks and I have limited ROM and often feels like it is unstable. I am an in patient psych nurse (that sometimes gets physical when a patient requires restraints) and am finding it hard to do my job without a lot of pain. I have tried exercise but it is too painful to get good ROM to complete them and pushing or pulling is extremely hard to do (both because of pain and strength). I see my MD again on Wednesday and hope to have a plan after that. I am trying to learn as much as I can before I see him in two days.
Amy Jo, good luck. It sounds like you have done everything you can do to avoid surgery. If you haven't watched the biceps video I recommend you do that (I will link to that below). Also consider joining our private FB group. facebook.com/groups/409240847744184
th-cam.com/video/eAqmidWTVBI/w-d-xo.html
If I have mild Bicep tendonitis and tendonosis, Can they just do shaving and not do a tenodesis?