Torn labrum options

[Mike Antonio]

 Hello everyone! Happy holidays and happy new year to everyone! 

 

 So I wrote before regarding a slap tear that I have. I just went for my second MRI with an arthogram.  So the verdict is I have a small tear in my infraspinatus small tear in my supraspinatus and I have a labral tear at the insertion point of the biceps long head.  According to my orthopedic surgeon, he says the Teat is small it just happens to be in one of the worst places possible.  Hence the reason it’s causing me so much pain. I can’t even do push-ups without severe pain. 

 I asked him about platelet rich plasma injections which this doctor does and he seems to be trying to steer me away from it. He advised if it was my knee or my elbow he would say let’s definitely try it but he hasn’t seen much luck with PRP and labrum tears in the shoulder. 

So the options now are: 

1. Subcromial decompression and rotator cuff repair surgery

2. Bicep tenodesis and rotator cuff repair. 

 

 I’m not sure which direction to go.  Just wondering if anyone has had either of these surgeries and comment on their ability post surgery. I do have a lot of faith in my surgeon and will likely tell him to do what he thinks is best once he gets inside but just looking for some opinions. Thanks everyone. 

[Nick Murray]

I've had two shoulder stabilisations, the right including a slap repair, long-head biceps reattachment and reattachment of the entire labrum (looking at the socket from the right) from the 3 o'clock to 9'oclock position. This was in 2012.

The literature I've read suggests that acromial decompression isn't usually successful, mainly because tears happen/begin on the lower side of the infra/supra tendons, not the side exposed to the acromion. I chose surgery for my right shoulder over conservative treatment (physio, exercise) as the shoulder literally felt as if it was going to fall off.

I might have been able to get away with conservative treatment for the left shoulder, but I chose surgery as I wanted to make sure the shoulder was safe to use, plus the surgeon (who admitted he had over-tightened the right shoulder) had learned a few things.

My opinion: go with the biceps tendonesis and RC repair. you will have to do the rehab anyway if you choose the conservative route (and this is probably not an option given your current pain levels.).

As all surgeons have different post-op protocols, so get really clear advice on what physio/exercise you should do, and when. Be VERY clear that you want to return to gymnastic activities. Hopefully this surgeon has treated gymnasts before.

Hope this helps.

[Mike Antonio]

8 hours ago, Nick Murray said:

I've had two shoulder stabilisations, the right including a slap repair, long-head biceps reattachment and reattachment of the entire labrum (looking at the socket from the right) from the 3 o'clock to 9'oclock position. This was in 2012.

The literature I've read suggests that acromial decompression isn't usually successful, mainly because tears happen/begin on the lower side of the infra/supra tendons, not the side exposed to the acromion. I chose surgery for my right shoulder over conservative treatment (physio, exercise) as the shoulder literally felt as if it was going to fall off.

I might have been able to get away with conservative treatment for the left shoulder, but I chose surgery as I wanted to make sure the shoulder was safe to use, plus the surgeon (who admitted he had over-tightened the right shoulder) had learned a few things.

My opinion: go with the biceps tendonesis and RC repair. you will have to do the rehab anyway if you choose the conservative route (and this is probably not an option given your current pain levels.).

As all surgeons have different post-op protocols, so get really clear advice on what physio/exercise you should do, and when. Be VERY clear that you want to return to gymnastic activities. Hopefully this surgeon has treated gymnasts before.

Hope this helps.

Thanks for the reply. My biggest concern is returning to the rings. My fear of the bicep tendonesis is that the shoulder won’t articulate properly and I will have a new weakness I never had before. But long term it seems to make the most sense. I will have to have a talk with my surgeon to be a little clearer on his suggestion. 

 

Cheers! 

[Nick Murray]

Google "bulgarian pullup". This is one of the GB progressions. It hits the long head pretty hard (I've found it to be a weakness, as you feared!), so I'd do microprogressions starting using less than bodyweight, and doing isometrics only for a while. Like most exercises you can scale it pretty easily.

Definitely tell the surgeon you want as much external rotation and flexion as possible,