Non-operative Treatment for Labral
Tears
There are probably a large number of untreated labral tears that
heal spontaneously since the labrum has a rich blood supply that helps
the healing process (except in the anterior and superior locations).
Physical therapy is helpful for certain cases such as internal impingement,
in which the rotator cuff rubs the posterior labrum. Physical therapy
options include:
- changing the throwing mechanism.
- strengthening muscles that externally rotate the shoulder.
- stretching the posterior capsule with the help of a physical
therapist.
Operative Treatment for Labral Tears
Tears
that need treatment are usually seen in the chronic stage when spontaneous
healing has not occurred. Tears of the biceps tendon anchor are
unlikely to heal without treatment because the biceps constantly pulls
on the labrum.
Chronic tears may require surgery if patients are unwilling or unable
to modify their activities sufficiently to allow for healing and comfort.
Surgery should be considered if:
- pain is unresponsive to anti-inflammatory medications such
as ibuprofen, rest, and activity modification.
- the labrum has not healed after an acute injury.
The arthroscope allows direct visualization and evaluation of the
entire shoulder joint. Using this small instrument, the orthopaedic
surgeon first examines the labrum and all attachment sites for instability
requiring repair. Once other disorders are treated or ruled out, the
labral injury is addressed.
Arthroscopic treatment is the standard of practice for most labral
injuries not associated with instability. The majority of these
can be treated with simple debridement (removal of abnormal,
damaged, or excess tissue). This procedure will eliminate flaps that
may impinge the movement of the humerus on the glenoid and/or remove
any unstable portion of the labrum.
Certain painful and unstable SLAP tears, in which the biceps is detached,
need special attention. If the biceps tendon anchor is no longer
firmly attached to the glenoid, it must be re-attached to the bone.
The surgeon uses suture anchors and /or arthroscopic knot tying techniques
to repair the torn labrum of younger patients.
It is often safer for older individuals to have a debridement of
the labrum and a biceps tenodesis. A tenodesis is a procedure
in which the biceps is repaired to the bone outside the glenohumeral
joint to relieve pain, yet allow it to retain some strength and function.
This procedure can be a good choice for older patients because the
blood supply to the labrum diminishes with age, making the healing
process more difficult. The decision to perform a tenodesis repair
should be made by the doctor and patient together, after a thorough
discussion of the surgical options and the healing process.
What types of complications can occur?
Complications associated with surgery for labral tears are few:
- The risk of infection in arthroscopic procedures is extremely
low and can be a complication of any surgical procedure.
- Stiffness after surgery is unlikely since debridement allows
early arm movement. Physical therapy will usually relieve stiffness
resulting from the sling that is needed for four or more weeks
for labral repairs.
- Failure of healing can occur due to technique, biology, or the
patient's unwillingness to follow post-operative instructions
and the prescribed rehabilitation program.
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