Shoulder

Subpar Success Rates of Shoulder Labrum Surgery Should Point you to Alternative Treatments

By September 27, 2019 October 25th, 2019 No Comments

Subpar Success Rates of Shoulder Labrum Surgery

The shoulder is a common source of pain for many individuals. Due to the repetitive nature of the tasks associated with shoulder movement, the soft tissues of the joints in the shoulder are especially susceptible to injury over time.

Of all the soft tissues within the shoulder, the labrum is the most commonly associated with pain. While many believe that surgery is the best option for chronic pain due to labrum injury, regenerative therapies may offer an alternative, less invasive treatment.

The labrum is a special type of cartilage which cushions the ball-and-socket portion of the shoulder. The circular end of the humerus, a long bone in the upper arm, is held into the socket of the shoulder via a thin strand of tendon tissue which wraps from within the shoulder socket to the outside of the arm. Between the socket and the “ball” of the humerus, lies the labrum tissue which cushions and provides fluidity to the movements of the arm.

Hyperextension, untreated sprains, or acute injuries can cause a tear to form in the labrum and overtime this tear can develop into a chronic problem. Chronic injuries often develop in a throwing athlete or a person that does a repetitive overhead motion for their job. Oftentimes when a person dislocates their shoulder, a labral tear results from the injury.

Most common symptoms of a labral tear include:

  • Pain/ache deep inside the shoulder joint
  • Loss of velocity when throwing or swinging the arms
  • Instability of the shoulder (feeling that the shoulder is going to ‘pop out’)
  • Popping or clicking sensations inside the shoulder
  • Pain with overhead activity
  • Pain in the front or back of the shoulder
  • Trouble sleeping at night
  • Numbness or tingles down the upper arm

Labral tears are best diagnosed by orthopedic physicians. An evaluation for a tear may include common tests such as:

Obrien’s test

With the arm protruding straight ahead, a doctor will apply a downward force as the patient rotates their arm. Rules out a tear in the front portion of the shoulder.

Jerk test

With the arm bent at the elbow, a doctor will place one hand on the elbow and the other at the base of the blade of the shoulder. The doctor will apply a quick shot of force to the elbow while palpating the shoulder blade. Evaluates instability in the back portion of the labrum.

While these tests will give the doctor a relative idea of the location of the injury, imaging tests will help them define the scope of the injury. A popular diagnostic tool for labral tears is MR arthrogram. An MR arthrogram uses a special, injectable dye and MRI technology to give doctors an image of the soft tissues within the shoulder. Once the images have been developed, a doctor will be able to properly diagnose one of several types of labral.

There are a few varieties of labral tears. These include:

  • SLAP tears: stands for “Superior Labrum Anterior Posterior” which means that the tear is in the upper part of the labrum and extends to the back and the front of the Labrum.
  • Anterior and posterior tears: this means that the front part of the labrum is torn while a posterior tear means that the back portion of the Labrum is torn.
  • Bankart tears: are at the bottom of the labrum and usually result after a person dislocates their shoulder.

Though the various types of labral tears induce pain in different portions of the shoulder, they are all treated similarly via conservative or surgical treatments. Conservative treatment includes:

  • Anti-inflammatory medication
  • Physical therapy
  • Steroid injections
  • Rest

If these conservative treatment options don’t reduce a patient’s pain, surgical options are typically explored.

The purpose of the labrum surgery is to reattach the torn tissue to the socket of the shoulder. This can be done with a standard incision on the front of the shoulder, or it can be done using a special technique known as arthroscopy.

Arthroscopic surgery entails a camera that is inserted by making an incision close to the injured joint. This makes it easier to understand the extent and the exact place of the injury. With that information, a surgeon can then re-attach or staple the labrum using the appropriate tools.

After surgery, a patient will be required to wear a sling until they regain their mobility, typically between one to two months. After that time physiotherapy will be necessary to regain strength and movement. If the procedure was minor, the average patient is able to resume normal activities around 6-8 months after the surgery.

Surgery typically has positive results for all but Bankart tears. Patients with Bankart tears are much more likely to experience repeat dislocations of the shoulder post-surgery. Additionally, while most patients are able to return to daily activity after their surgeries, this does not account for the continued pain and instability these patients typically experience after such invasive procedures, especially over time.

Studies involving surgery patients well after their procedures prove that long-term results for shoulder surgery don’t seem to be reliably good. For example, a large review prospectively examined 225 patients with SLAP tears. After a follow-up at an average of 40.4 months, 179 patients completed the study. 

Results looked at the range of motion of the shoulder. After shoulder surgery, the range of motion actually became far worse for many patients. Flexion and external rotation both decreased by 5 degrees and abduction decreased by 15 degrees on average. The summary is that while surgery may be able to re-attach the labrum, it isn’t statistically proven to restore the shoulder’s ability to its original health. This, along with extended recovery periods, make surgery a non-ideal option for most working-class individuals.

To many individuals, conventional treatment options may not be the answer. Advancements in alternative treatment methods such as stem cell therapy have led many to turn to these radical new medicines to treat their acute shoulder pain.

By harvesting stem cells from the bone marrow or fat tissues of an individual and reinjecting them into the site of injury, many of the patients at Cellaxys have experienced relief from their chronic shoulder pain. Stem cells have the added benefit of not only relieving the pain but treating the causes as well. These injections restore unhealthy tissue while boosting the body’s natural healing processes.

If surgery seems too drastic a treatment, or if you’d like to boost the effects of physical therapy, it may be time to consult one of the trained medical experts at Cellaxys.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni