# Torn Shoulder Labrum



## MHanraha (Aug 2, 2006)

So probably 4 to 5 years ago I had a reall good crash, where I landed with my left arm out to protect my face. After that it took me about a week before I could lift my hand above my head. 

Flash forward 5 years. No real problems to speak of the ocassional mild stain of the deltoid when benching, but nothing major. This last summer, I also had several good crashes similar to the on 5 years ago, afterwards while sleeping shoulder would start partially slip out of my socket while sleeping.

By the fall everything seemed to have resolved itself. Right around January first, I went for a run, and went to the gym, my shoulder felt great. I was doing dead lifts, and my last rep was a little sloppy, but I felt absolutely fine. I woke up the next morning to go skiing, and my shoulder felt like I'd had the worst deltoid strain I'd ever had. Took two weeks off, everything went back to normal, but then my shoulder started clicking, it never really hurts, but will feel kind of irritated. Did alot of rehab and my shoulder feels more stable, but still irritated, and it still clicks.

Went to an orthopedic doctor, got an MRI with an Arthrogram. The result is that I have a labral tear from the 3 O'clock to the 10 O'clock. I'm meeting with a surgeon a week from monday. 

I'm told I can do it when ever I want. So I'm trying to figure out when a good time would be to do it, because I ski, bike, hike, run and lift. So pretty much there is no off season for me. I'm leaning towards sooner than later. I figure if I get it done within the next month by mid summer I'd probably be able to road bike? Six weeks in a sling, with 4-6months recovery time right.

I really waiver back and forth about having it done. But right now, I'm in great shape, minus the tear, I have good insurance, I live within walking distance to work, and a grocery store. The surgeon that would be doing my surgery is the head of the department, and is supposed to be "the guy" for shoulders in the area.

I just worry that if I don't take care of it sooner than later it's just going to get worse and take longer to heal. Not to mention I'm probably destroying the cartilage in my shoulder.

I guess I'm looking for other peoples experiences with this surgery and input.


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## Suenos (Feb 1, 2010)

I had surgerey on my left shoulder labrum. Sling and no movement for a few days. Physical Therapy began after one week. Ice, Ice, Ice and range of motion I was back to work full duty (firefighter) after four weeks. 
I will admit I probably rushed it getting back but that's what I wanted to do.
It has been a slow recovery to get back to as close to 100% as I am. Almost a year later and I still can not lift weights (especially bench) like befor injury/surgery but it is better then befor and still improving. 
I had back surgery also (fracture L5/S1) and would say in my experience the shoulder recovery was more difficult in comparison. 
Not trying to deter you just stating my experience.


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## ptcutch (Aug 3, 2009)

sorry to hear about your luck. I am a physio and rehab post-op shoulders all the time. Post-op labral repairs (yours is a SLAP lesion)---most common) rehab well especially if you go in with good range of motion and shoulder strength. No biceps involvement in the arthrogram? Every surgeon has a different protocol for rehab but early rehab is crucial to ensure a speedy recovery. The sling estimate and 4-6 months are also accurate as long as everything goes according to plan. Not sure of your age but the issue with the ongoing instabilty and structural defect is that it can accelerate degenerative changes. Good luck with your decision.


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## Nubster (May 15, 2009)

I had surgery in September 08 for a front and rear tear requiring implants for reattachment. Not sure if this is the common fix for the injury or not but that is what was done to me. I was supposed to be in a sling with no use of my arm for 6 weeks then 12 weeks of PT. Of course I didn't follow instructions and I was lucky that everything turned out ok but I still have pain and always will I am sure. Pain is less than pre-op and range of motion is probably 95% of what it was before the injury. It took every bit of a year to get as good as it is now.


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## The Squeaky Wheel (Dec 30, 2003)

Not all labral tears are created equal. Also, surgeons can have varying opinion on rehab protocols. But, generally speaking, for extensive tears, 4-6 weeks of immobility (aside from very mild ROM exercises) is routine, followed by another 6-12 weeks of rehab. It's a slow recovery. Trying to force the rehab is dumb and not productive. The labrum is a soft tissue, not bone, and it takes a long time for the repair to fully mature. Push it, and run the risk of the repair failing.

My personal experience? Traumatic dislocations of both shoulders with repair of both within the past 3 years. I'm now 7 weeks out from #2 and doing great - and that has a lot to do with taking my surgeon and PT's advice. I was freed to ride the spin bike at full effort and I'll be back on my road bike at week 10, MTB weeks 12-14. The repair on the other side from 3 years ago is rock solid and I've never had a moment of pain since. I have full ROM and full strength and expect the same outcome on this side.

Keep in mind that the more time you dislocate (yes, when sleeping counts too), the less success for ultimate repair. Ptcuth also makes a good point when stating that ongoing instability can accelerate degenerative changes.


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## MHanraha (Aug 2, 2006)

Ptcutch what do you consider early rehab. I've been searching around the internet and I've seen anything from the day after starting with ROM, to waiting the 6 weeks before the sling gets off. 

I read the abstract to a journal article comparing early pt to later pt, and the result was that people who started earlier were able to return pain free sooner to there activities.

I've been maintaining my strength at the gym, as well as focusing on specific rotator cuff exercises and scapular exercises. As far as ROM goes, I have really good, or well maybe to the point of bad, I'm hyper-mobile in both of shoulders. 

I'm trying to come up with a list of questions to bring to the surgeon, so far all I have is when he plans on having me start physical therapy, and a time line for when I can return to certain activities.

I'm thinking that I can be on a trainer shortly after the surgery? Maybe some road biking after the sling is off? And I'm guessing the full 4-6 months before i can return to mountain biking and weight lifting. Maybe running sometime before that.


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## The Squeaky Wheel (Dec 30, 2003)

MHanraha said:


> Ptcutch what do you consider early rehab. I've been searching around the internet and I've seen anything from the day after starting with ROM, to waiting the 6 weeks before the sling gets off.
> 
> I read the abstract to a journal article comparing early pt to later pt, and the result was that people who started earlier were able to return pain free sooner to there activities.
> 
> ...


You can ride a trainer from day one....but, trust me....you won't want to. Maybe around week 2. A spin bike would be a better idea because you don't have to worry about balance and can do that one handed a lot more easily than a standard trainer.

Not smart to road bike until approx week 10 - you'll need to let the repair mature so as to support the load of your upper body weight, and you also don't want it to rupture should you fall.

Return to full activity around month 4. Think long term goals with a labral repair and don't rush it.

Caveat: provided all goes well.....


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## MHanraha (Aug 2, 2006)

Squeaky glad to here your recovery is going well. If I do end up getting the surgery, I will be closely following the advise of the surgeon and pt.

Ptcutch have you ever seen anyone with my sized injury recover without surgery and just physical therapy. I'm well aware that a torn ligament won't heal with out surgery, stupid avascular connective tissue. But have people been able to get there stabilizing muscles strong enough to compensate? After I do the scapular retraction exercises, and rotator cuff exercises, my shoulder feels significantly more stable. Today while exercising I experienced very little irritation, which I thought was a good sign.


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## ptcutch (Aug 3, 2009)

MHanraha-----The surgeons I work with typically start PT 5 days post-op with controlled passive range of motion and modalities (US, etc) to deal with pain and inflammation. The rest of the protocol is very progressive with different stages depending on time post-op. The Cryo-cuff is worthwhile if your ins. co. covers it as I find patients that use it recover quicker and have less pain. As you mentioned the issue with the labrum is the avascularity. If you have good strength, good mobility, no pain and no episodes of instability (shoudler "popping out") then you are doing well as people normally have issues with a SLAP lesion. Depending on your age the issue long term is continued incongruity of the joint surfaces which leads to altered arthtokinematics and potential for accelerated degenerative changes. Not an easy choice given your asymptomatic state but given your level of activity the potential for further damage (i.e.: long head of biceps avulsion @ the 2 o'clock position) is also there. Good luck and as with everything medical make a good informed choice as it seems like you are doing by asking all the right questions.


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## Berkley (May 21, 2007)

I had a right shoulder labrum tear repaired on 8/8/08 (first day of the Olympics). History of 3 dislocations and it was time to get it fixed because it was becoming a problem. As I recall I was back on the bike riding tame trails in late September, and back to riding techy trails in mid October. 

It's excellent that you're in good shape. That way when you come back you won't be totally out of it.


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## Mt. Tam Haze (Feb 23, 2009)

Sorry to hear about your injury. I have had two labrum, bankart


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## chwee (Oct 29, 2008)

I had a left shoulder labrum tear almost 2 years ago. Super techie and narrow rocky descent with cliff on one side. There was no place to roll when I didn't stick to my line so outstretched left shoulder took the brunt of the crash. SLAP lesion as someone else mentioned earlier.

Saw two top Orthos at different hospitals and the concensus was that the a surgical operation was going to be needed. I've had a partially torn ACL from skiing which was put through only rehab, and a crappy ankle which had bone spurs in the joint which needed a scope. But I wasn't fully sold on the necessity of a surgical op for my shoulder.

From the research I did, the key reason why such tears don't heal (or heal well) is the lack of bloodflow in the area. One of the orthos told me that full GA was needed as they will need to pop the shoulder out to really see the full extent of the damage, as the MRI still gives an incomplete picture - so if there's stuff that the MRI didn't pick up, that's good as the surgeon gets a chance to try and fix it. But if you were not too severely injured, the surgery procedure will create a higher degree of injury by default. 

Around that time, word was also leaking out that the NFL teams were able to get key players back on the field by centrifuging their own blood to extract the platelets which actually does the body repairs, and then injecting it into the injured areas. A typical 6 week injury would see a player fit again within a week, due to the concentration of the platelets. But it's a super expensive process.

I asked about doing the same procedure for myself, but the surgeons were not keen.... mainly coz they didn't have access to the million dollar machines to spin the blood. So I did it the cheap man's way. A combination of cortisone shots to relieve the pain and acupuncture. First time I tried acupuncture in my life.... and there was noticeable improvement within a week of each treatment. The skill of the acupunturist matters a lot, of course... I lucked out with the first one I tried.... tried others who didn't seem as effective. The key is that acupuncture can help to redirect blood flow to a certain extent. 

I'm back to 90% from next to useless after about a year and a half. Each subsequent treatment sees less incremental improvement. According to the surgeon, there would have been no guarantee of a 100% recovery after a good surgery either... so overall I was pretty happy with my chosen course of action, as it allowed me to get back to my activities in a much shorter timeframe.


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## smkogan (Jan 25, 2010)

*intervals on the trainer?*

HI,
Wonder if you guys have advice for me. I am having my labrum repaired (torn from 1 oclock to 6 oclock). I was thinking after a week or two I would get on the trainer. I want to try and do an interval program during the 12 weeks off the bike. I am wondering if its feasible. There seems to be two issues, having balance while I'm doing an intense interval and if the interval would cause me to tense my upper body so much that I strain the injury. I really don't want to lose all my fitness!
steve


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## xcguy (Apr 18, 2004)

smkogan said:


> HI,
> Wonder if you guys have advice for me. I am having my labrum repaired (torn from 1 oclock to 6 oclock). I was thinking after a week or two I would get on the trainer. I want to try and do an interval program during the 12 weeks off the bike. I am wondering if its feasible. There seems to be two issues, having balance while I'm doing an intense interval and if the interval would cause me to tense my upper body so much that I strain the injury. I really don't want to lose all my fitness!
> steve


It's getting up on the trainer one handed that will a problem. And back off. And forget "intense" just spin like your grandmother.


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## smkogan (Jan 25, 2010)

Really? For 12 weeks? I'll die of boredom. Even after 2-4 weeks of recovery I won't be able to work out hard if I keep my arm in a sling?


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## chainsawgeoff (Jan 25, 2012)

smkogan said:


> HI,
> Wonder if you guys have advice for me. I am having my labrum repaired (torn from 1 oclock to 6 oclock). I was thinking after a week or two I would get on the trainer. I want to try and do an interval program during the 12 weeks off the bike. I am wondering if its feasible. There seems to be two issues, having balance while I'm doing an intense interval and if the interval would cause me to tense my upper body so much that I strain the injury. I really don't want to lose all my fitness!
> steve


I've had both of my labrums done, and as someone who was always trying to get back on the bike and into the weight room sooner than what was initially advisable, I know exactly how you're gonna feel.

I tried doing the trainer thing when I had my left labrum done. I quit out of boredom but it's totally doable, just don't go too crazy at first. If you're hooking your road bike up to the trainer, put on a short stem and raise the stack height/handlebar tilt as much as possible to bring the controls closer to you. That way you can rest your arm on the bars without stretching it out too much. Also, keep your arm in your sling as much as possible and don't take ANY pain pills before you hop on the trainer. That way you'll know exactly if what you're doing is hurting you and holy **** stop if it does.

In addition to the trainer, get in the weight room and add leg and core exercises to your workouts. Doing lunges even without carrying around weights will still be effective, especially if you focus on power, and it doesn't require any shoulder movement. Also do a leg press, again focusing on power. Body squats, box jumps, and agility drills are also kickass exercises.

If you want to get really serious about it, talk to the guys at Mountain Athlete about a training program that works around your surgery/recovery. They train people to climb Mt Everest, special forces units, and all kinds of outdoor endurance athletes. They have special programs for athletes that are injured so you can still train, and whatever they end up having you do is probably going to be insane. It's the best gym in the world to work with if you want to turn yourself into an all out badass.
Mountain Athlete


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## chainsawgeoff (Jan 25, 2012)

smkogan said:


> HI,
> Wonder if you guys have advice for me. I am having my labrum repaired (torn from 1 oclock to 6 oclock). I was thinking after a week or two I would get on the trainer. I want to try and do an interval program during the 12 weeks off the bike. I am wondering if its feasible. There seems to be two issues, having balance while I'm doing an intense interval and if the interval would cause me to tense my upper body so much that I strain the injury. I really don't want to lose all my fitness!
> steve


I've had both of my labrums done, and as someone who was always trying to get back on the bike and into the weight room sooner than what was initially advisable, I know exactly how you're gonna feel.

I tried doing the trainer thing when I had my left labrum done. I quit out of boredom but it's totally doable, just don't go too crazy at first. If you're hooking your road bike up to the trainer, put on a short stem and raise the stack height/handlebar tilt as much as possible to bring the controls closer to you. That way you can rest your arm on the bars without stretching it out too much. Also, keep your arm in your sling as much as possible and don't take ANY pain pills before you hop on the trainer. That way you'll know exactly if what you're doing is hurting you and holy **** stop if it does.

In addition to the trainer, get in the weight room and add leg and core exercises to your workouts. Doing lunges even without carrying around weights will still be effective, especially if you focus on power, and it doesn't require any shoulder movement. Also do a leg press, again focusing on power. Body squats, box jumps, and agility drills are also kickass exercises.

If you want to get really serious about it, talk to the guys at Mountain Athlete about a training program that works around your surgery/recovery. They train people to climb Mt Everest, special forces units, and all kinds of outdoor endurance athletes. They have special programs for athletes that are injured so you can still train, and whatever they end up having you do is probably going to be insane. It's the best gym in the world to work with if you want to turn yourself into an all out badass.
Mountain Athlete


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