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  1. #1
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    Oct 2002
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    Labral tear, tenodesis. Need opinions.

    I've read every thread I can find, but most of the injuries are more severe than mine. I'm mostly wondering if surgery is really necessary at this point, and whether it can be avoided altogether.

    Quick overview. I felt a stabbing pain between my neck and the tip of my shoulder doing wide-grip push-ups. After trying to ignore it and then taking some time off, I started physical therapy. PT for about 4 months. Minimal progress that was erased every time something minimal happened, like catching myself on the handrail when I tripped going up the stairs.

    I finally got an MRI that showed a low grade rotator cuff tear (not a concern) and a labral tear. Stability and strength are normal, the only issue being pain and discomfort. Pull-ups have never really bothered me since the "injury", but push-ups have been an issue. I got in with "the shoulder guy" that comes highly recommended, and is known for being conservative...for a surgeon. He and my running doc agree that, given the lack of progress with PT, surgery is the best option. The surgeon says he won't know until he sees it, but suspects that repairing the labrum won't be ideal, and that I should plan on a Biceps Tenodesis.

    During PT, I did the prescribed exercises and anything that was okayed by the PT. Any pain during or after led to a slow elimination of many exercises. After the MRI, I worked with my PT to develop a set group of shoulder exercises and a modified upper body workout. However, knowing that "the damage is done" and that surgery is imminent, I've been less concerned about pain, and have essentially gone back to doing everything I was before. This, along with upping the weight for my PT exercises has led to a gradual decrease in pain.

    Day to day, pain is minimal and mostly manifests itself as neck pain/stiffness and a burning at the tip of my shoulder. Workouts are mostly painless, swimming and biking can be uncomfortable, but are completely doable. More severe pain comes from random stuff like handing money to the toll booth guy. Playing with the kids generally leads to a couple "oh shit" moments, but isn't really limited. I have found that certain activities can lead to soreness. We spent a week at the beach, and towards the end, I was sore to the point that I couldn't sleep in certain positions. That resolved with a day or two of returning home.

    I guess that's not a quick overview. I sort of feel like surgery has to happen at some point, but I'm in good shape and in minimal pain, so I don't really want to do it now. There is some pressure to do it before the end of the year since we've met our family deductible for the year, so that would save a lot of cash, but I'm not going to let money be the clincher for something as major as this. I'd appreciate any thoughts or experiences.
    Remind me. We'll send him a red cap and a Speedo.

  2. #2
    Join Date
    Jan 2008
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    alpha centauri
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    If it were me Id probably wait longer before considering surgery. Shoulder MRIs are similar to low back MRIs with respect to the damage consistently found in healthy shoulders. For example check out:

    http://www.ncbi.nlm.gov/pubmed/23775245/

    Where the authors found ~10% of a sample of UNINJURED, ACTIVE MLB pitchers had a full thickness rotator cuff tear show up on MRI. Before this study i bet 99% of Orthopedists would have said it was not possible to throw a baseball overhead with such an injury. It just goes to show how little we understand the relationship between structural damage and function in the human body.

    My ex-wife is a very good rock climber and she suffered a labral tear several years ago. She had pain for well over a year and still to this day wont do push-ups but she has no other limitations. SLAP tears are much more commonly operated on than other types of labral tears but again, if your only complaint is pain then I would wait longer and continue strengthening.

    Also, have you absolutely ruled out the possibility that you have a subtle neck injury that is radiating pain into the shoulder? This is a VERY common scenario and it becomes especially suspicious when you have neck stiffness combined with full range of motion (but pain) in the shoulder.

  3. #3
    Join Date
    Oct 2004
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    50 miles E of Paradise
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    There appears to be a contradiction. On one hand surgeon wants to operate because you haven't responded to PT. OTOH you have been upping the weights and pain is subsiding? Sorta sounds like positive response.

    When you say "rotator cuff tear" which of the four muscles are damaged?

    Can you reach into the back of the refrigerator's top shelf and remove a 22 without pain intensity >6? If yes, you can do what you want without agony, and your PT is getting results, I would hold off.

    Have they given you any cortisone injections? They work wonders but leave soft tissue at risk of injury for a few weeks. So don't - for example - go over the bars on an MTB one week after the shot.

    Good luck

  4. #4
    Join Date
    Oct 2002
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    Shadynasty's Jazz Club
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    jma, thanks for the link. The nurse initially told me about the two tears, without mentioning that the rotator cuff tear is insignificant. I did some research and found similar stuff. One of the most interesting was a study done on cadavers that found a high percentage of tears in people who had never had known shoulder issues.

    Quote Originally Posted by jma233 View Post
    Also, have you absolutely ruled out the possibility that you have a subtle neck injury that is radiating pain into the shoulder? This is a VERY common scenario and it becomes especially suspicious when you have neck stiffness combined with full range of motion (but pain) in the shoulder.
    Would that not have been seen in the X-Ray or MRI? I've asked whether the pain could be in the neck, but once the MRI came back and they showed me the labral tear, I figured that was that. Your comment makes me realize something, though. My daughter and I were "fighting waves" in the surf. She was on my shoulders using my forehead to hold on. My neck and upper back definitely felt strained from it the next day, and that's about the same time my shoulder started bothering me. My wife has been pushing for a second opinion, maybe I'll listen to her.

    bobby, I'm 38. No doubt things are taking longer to heal. I also stay sick longer. Where can I opt out of this getting old shit?

    telebob, not sure which muscle. Just did the fridge test, and pain was a 1-2. All I had to test with was my wife's 22 of cider, though. You think that counts? I agree about the positive response. There are some stretches I was doing that I've since eliminated. Also, in ignoring the pain, I've been able to increase the weight and the range of exercises I've been doing. Not really sure, but I definitely wasn't slacking on the PT early on.

    I was prescribed a cortisone injection. I initially put it off because I was coming up on an event, and didn't want to stop training. Since then, I've not really felt the need. With the exception of the beach, daily discomfort has been minimal.
    Last edited by bagtagley; 09-22-2014 at 10:17 AM.
    Remind me. We'll send him a red cap and a Speedo.

  5. #5
    Join Date
    May 2002
    Posts
    33,440
    This stuff heals. I've had shoulder tears that took over 15 years to heal (bodysurfing). Trying to work through it with too much exercise exacerbated it. Tore rotator cuff and bicep tendon five years ago. Doc said mri looked like hamburger in there. He was gonna pin the tendon to the bone. Insurance balked last minute, so it didn't happen. Hurt for two plus years, especially when supinated. It's like it never happened now. I did get stem cells and followup prp but, like the first one that I fucked up from not giving it a rest, time and favoring it worked best.

  6. #6
    Join Date
    Mar 2006
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    Missoula, MT
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    22,462
    Labral tear = surgery. Sorry.
    No longer stuck.

    Quote Originally Posted by stuckathuntermtn View Post
    Just an uneducated guess.

  7. #7
    Join Date
    Sep 2011
    Location
    Kirkland, WA
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    213
    I'm sitting at the docs getting my shoulder checked out. Rag doll ski wreck in March with a hyper extension lots o pain when lifting beer to mouth.

    Took it easy for lots of time. Yesterday caught some air mountain biking, landed off balance, laid it down right on my shoulder. I hate shoulders man. Sounds like yours is much worse than mine. Best of luck, surgery if it can be afforded is better now than in two years when you still can't scratch your back (maybe not your problem, but damn it sucks for me).

  8. #8
    Join Date
    Apr 2014
    Posts
    15
    Sorry about the labral tear. I was in a similar situation as you; labral/slap tear but my pain levels for daily activities and skiing were tolerable or non-existent. Unfortunately though, my injury was on my dominant side and a lot of the sports I enjoy are overhead. The injury severely limited me there. I opted for surgery and am now 5 weeks out. That being said, I wouldn't have gotten the surgery if it was on my non-dominant side.

    Also, I was scheduled for a biceps tenodesis, but once the doctor opened me up, he saw that there was no damage to the biceps. The tenodesis might just be something they make a game-time decision on, I don't think it shows up on the MRI.

    Good luck. Surgery and initial recovery are boring but pretty uneventful. With a labral repair though, it's a long road to full recovery.

  9. #9
    Join Date
    Jan 2009
    Posts
    24
    Quote Originally Posted by stuckathuntermtn View Post
    Labral tear = surgery. Sorry.
    Unfortunately, this does seem to be the case. I had a SLAP tear and held off on surgery for about 9 months. I saw three doctors (including a non-surgeon) who all said that surgery can be put off without further damage - it's just a pain tolerance issue - but that the tear won't heal on its own. My pain and lack of mobility kept increasing despite PT, cortisone, and acupuncture, so I finally bit the bullet and had (arthroscopic) surgery. I should note that I'm not at 100% but I am much, much better.

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