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Surgery for Glenoid Labral Tears

Mar
12
2014

glenoid-labrum-tearIs there a better option than shoulder surgery for glenoid labral tears?

We’ve mentioned before how the shoulder’s broad range of motion leaves it susceptible to injury. As with all joints, there are various stabilizing structures and one of the most important soft tissue stabilizing structures of the shoulder is the glenoid labrum. Injury to the glenoid labrum results in instability, dislocation and pain.

 

Diagnosis and treatment of a glenoid labral tears

One challenge with a glenoid labrum tear is that it is difficult to diagnose. MRIs and arthrography have proven unreliable and many studies have shown that arthroscopy is both sensitive and specific when diagnosing labral tears and injuries. Although arthroscopy can diagnose a labral tear, it is not the best treatment for it. In fact, controversy surrounds arthroscopic treatment for labral lesions since clear, evidence-based guidelines for surgical repair are lacking.1 Further, studies have shown short-term success with shoulder arthroscopy but long-term results have been associated with continued pain, instability, and decreased function over time.2-5

Some physicians choose to treat suspected labral tears with conservative treatments such as NSAIDS, physical therapy exercises and cortisone injections. Some, however, skip all conservative treatment when symptoms of a labral tear show up and go straight for surgery. During arthroscopic treatment, the damaged portion of the labrum may be removed or debrided, and/or the labrum may be reattached to the glenoid. Following surgery, patients wear a sling for four to six weeks and then proceed with exercises to regain motion and flexibility in the shoulder.

Prolotherapy for glenoid labral tears

The problem with the arthroscopic treatment previously mentioned is that it involves removal of tissue. If you recall, the glenoid labrum is the one of the most important soft tissue stabilizing structures of the shoulder. So when removed, the shoulder becomes less stable and more susceptible to further injury. An alternative to arthroscopy would be Prolotherapy, a regenerative injection technique that stimulates the healing of soft tissue. Prolotherapy injections aim to initiate or recreate the inflammatory stage of the healing process. It triggers a cascade of anabolic events and stimulates the new growth of cells. In short, it stimulates healing and indirectly rebuilds depleted tissues.

 

  1. Bedi, A., Allen, A.A. Superior labral lesions anterior to posterior—evaluation and arthroscopic management.  Clinics in Sports Medicine.  2008;27:607-630.
  2. Cordasco, F.A., Steinmann, S., Flatow E.L., Bigliani, L.U.  Athroscopic treatment of glenoid labral tears.  American Journal of Sports Medicine.  1993;21(3):425-430.
  3. Katz, L.M., Hsu, S., Miller, S., Richmond, J.C., Khetia, E., Kohli, N., Curtis, S. Poor outcomes after SLAP repair: descriptive analysis and prognosis. The Journal of Arthroscopic and Related Surgery. 2009;25(8):849-855.
  4. Green, MR, Christensen, KP. Arthroscopic Bankart procedure: two-to five-year follow-up with clinical correlation to severity of glenoid labral lesion.  American Journal of Sports Medicine. 1995;23(3):276-281.
  5. Kartus, C., Kartus, J., Matis, N., Forstner, R., Resch, H. Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. The Journal of Bone and Joint Surgery (American). 2007;89:1442-1448.

 

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