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Shoulder Dislocations & Labral Tears
A Personalized Approach To Shoulder Injuries In Richmond, VA
The labrum is cartilage tissue that holds the “ball” (humeral head) in the “socket” (glenoid) of your shoulder. A shoulder labral tear can occur due to repetitive overhead use, a lifting injury, a fall on the arm, a sudden pull on the arm, or having the arm twisted at the shoulder joint. In the event of a shoulder dislocation, the labrum in the front of the shoulder almost always tears.
Types Of Shoulder Labral Tears
There are three primary types of labral tears, each of them affecting the same cartilage tissue in a slightly different way or location. The most common types of labral tears are:
Symptoms of Shoulder Labral Tear
Like many injuries that occur within the shoulder, a labral tear is often accompanied by pain and reduced mobility in the joint. Because we use our arms and shoulders for daily activities, it can be difficult to ignore the symptoms of a labral tear, and many patients find they can pinpoint the moment a tear occurs.
The most common symptoms of a labral tear are:
- A locking, clicking, or catching sensation in the joint
- Pain, though the location may depend on where exactly the tear has occurred
- Instability and a sense that the shoulder is coming out of place
- The shoulder actually dislocating
Shoulder Dislocation & Labral
Tear Diagnosis & Treatment
“Appropriate rehabilitation is critical to achieving a successful outcome. I work closely with the physical therapist to develop a specific rehabilitation program for every patient. For athletes, we also include the athletic trainer(s) and coaches in our ‘team’ approach to treatment.”
Because a history of shoulder injuries can make the joint more susceptible to further damage, your doctor may suspect a labral tear based on your medical history. At your consultation, you will be asked questions about your pain and past injuries to your shoulder that may suggest labral damage. Labral tears are very difficult to see even with an MRI, so the first step to confirming a diagnosis is often to order an arthrogram known as an MRA. In this process, a dye is injected into the shoulder prior to an MRI for improved visibility.
The proper treatment for a labral tear will depend on your particular injury, activity level, age, and orthopedic surgery needs. If surgery is required for a labral tear, it can
be performed completely arthroscopically through small skin punctures with
use of a fiber optic camera.
You will not know what the doctor will recommend in your particular case until you sit down for your consultation, but there are certain general guidelines that many patients fall under.
First-Time Shoulder Dislocations In Patients Under 25
If a patient has a first-time dislocation and is under 25 years of age, Dr. Goradia will discuss options for immediate surgery or trying a period of immobilization. The latest research shows that immobilization in external rotation wherein the arm is rotated outwards is best if nonsurgical treatment is also attempted. However, there is still a 75-90% risk of recurrent dislocations, so your personal needs and injury will be discussed in-depth to determine the best treatment for you.
Shoulder Dislocations In Patients Between Ages 25 And 40
It can be hard to group together the most common treatment plans for the middle group of patients between the ages of 25 and 40 without a consultation to discuss their particular case. Again, it is important to note their activity level, how loose their shoulder feels during the examination, and how large the tear appears on the MRA.
First-Time Shoulder Dislocations In Patients Over 40
For individuals over 40 years of age that have a first-time dislocation, Dr. Goradia bases his recommendations on the patient’s activity level and work requirements. Barring those with hobbies or careers that involve strenuous physical activity, many patients can be treated without need for surgery.
Regardless of age, if patients have recurrent dislocations or are apprehensive about participating in activities because of their shoulder, Dr. Goradia will discuss surgical options to repair the tear.
Shoulder Labral Tear Surgery Recovery
After Surgery:
- Patients are generally given a sling or immobilizer.
- Approximately one week after surgery, patients begin physical therapy for protected range of motion exercises.
- As the tear begins to heal over a period of 6-8 weeks, the therapist begins a strengthening program.
- At 12 weeks most patients can begin heavier strengthening and light sports-specific training.
- Most patients resume non-contact sports by 4-6 months post surgery and contact sports by 6-9 months post surgery.
As with all surgeries, it is important to work closely with the physical therapist to develop a specific rehabilitation program for every patient. For athletes, the surgeon should also communicate with the athletic trainer(s) and coaches for a “team” approach to treatment. For example, baseball pitchers and other similar overhead athletes require a slightly modified rehabilitation program that focuses strongly on throwing mechanics after the initial healing period.
