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Labral Tears >> Treatment

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.