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Shoulder Labral Tear
The shoulder is attached and controlled by many muscles, tendons, and ligaments. The shoulder joint itself is composed of three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerous). The socket of the shoulder blade (the glenoid) is where the humeral head of the humerous attaches for mobility. This humeral head is covered by a soft fibrous tissue called a labrum. This labrum provides much needed joint stability due to the shallow socket and is also the attachment site for several major ligaments. This major connectivity that the labrum has allows for major damage to occur if injured.
What causes a labral tear in the shoulder
Labral injuries can come from acute trauma or constant shoulder motion. The labrum also gets more brittle with age due to natural wear and tear. When the labrum is torn, stretched, or otherwise pulled from its natural position, it is best to take action sooner than later. When injured, it is highly likely that there are additional tears or laxity in the shoulder joint, adding to the instability. This increases vulnerability to even further damage in the future. As one continues to use the unstable shoulder, osteoarthritis arises as the body attempts to stabilize the joint by overgrowing bone (bone spurs). This is a very painful and deforming condition that can greatly reduce range of motion in the shoulder. Common shoulder labrum injuries commonly occur from: dislocated shoulders, repetitive movements of the shoulder, lifting heavy objects, breaking a fall with an outstretched arm, and direct blows to the shoulder.
Main symptoms of a glenoid labrum tear
If you have a shoulder labral tear you may experience a loss of strength, a decreased range of motion, pain with daily activities, a sense of instability within the shoulder, and/or catching, locking and popping of the socket.
Verifying the diagnosis of a torn labrum and choosing a treatment
A traditional physical exam should be conducted, which will likely lead you to a Physical Medicine physician, Osteopathic doctor, pain specialist, chiropractor, or orthopedic surgeon. They may order an MRI scan to diagnose the cause of the pain. Imaging should only be done for confirmation of a diagnosis made on physical exam and medical history, due to the high frequency of false positives and negatives with MR imaging. The practitioner will give treatment options, which could range from anti-inflammatory medications (NSAIDs), physical therapy, or even just rest and ice applications when the shoulder aches.
For more severe cases, shoulder arthroscopic surgery might be a consideration, especially if an orthopedic surgeon is the one diagnosing the condition in the first place. In this type of surgical intervention, the doctor inserts a thin and light tube to see the problem and either shave, remove, or sew the cartilage back together. They may also use wires or tacks to re-attach any torn tendons in the area as well. The problem with this is that surgery for a labral tear is not necessarily very effective for getting a person pain free for the long term. It may address certain aspects of the issue but is not a treatment methods that can fully heal the shoulder. The lax ligaments, which can be tightened and healed with Prolotherapy, are the sections of the joint that need more attention. Despite the many drawbacks, surgeries are still becoming increasingly popular for labral tears and other conditions of the sort.
Prolotherapy, the alternative to shoulder surgery
Prolotherapy is a non-surgical procedure that uses the body’s natural immune system response in order to call more focused attention to an injured joint. This is done by injecting a dextrose proliferant solution (as well as Platelet Rich Plasma or a person’s own stem cells, when necessary) in and around the shoulder joint. This mild irritant causes inflammation cues the immune system to the need for repair in that specific area.
Comprehensive Hackett-Hemwall Prolotherapy involves multiple injections per treatment. In total, most patients need four to six visits, approximately one month apart, in order to heal a labral tear. The proliferants used allow the joint cartilage to rebuild by reducing abnormal wear and tear, and strengthen the labrum and the surrounding structures. This renewal of the shoulder brings back a patient’s range of motion and reduces their pain dramatically. Prolotherapy is an excellent treatment option for long term results after a labral tear.