Shoulder Labral Tears
What is a shoulder labral tear?
The glenohumeral (shoulder) joint is a ball and socket joint. The humeral head makes up the “ball” portion of the joint, while the glenoid makes up the “socket” portion. The glenoid labrum is a fibrocartilaginous structure along the periphery of the glenoid that helps stabilize the shoulder joint by deepening the glenoid cavity and increasing surface area between the humeral head and the glenoid (the ball and socket). For a variety of reasons, the glenoid labrum can incur injury, leading to shoulder pain and instability.
What causes a shoulder labral tear?
Shoulder labral tears typically occur due to either a traumatic event or repetitive microtrauma. For example, traumatic onset with either a compression or traction force to the affected shoulder. Alternatively, repetitive motions and movements such as that seen in throwing athletes may also lead to labral injuries.
How is a shoulder labral tear diagnosed?
Patients with shoulder labral tears may present after an acute traumatic onset or more insidious onset (see above). They may complain of shoulder pain and/or instability. Physical examination may demonstrate painful shoulder range of motion, reproduction of pain with certain provocative tests, or instability with a variety of maneuvers. X-ray, ultrasound, magnetic resonance imaging (MRI), and/or MR arthrography may aid in confirmation of diagnosis.
How is a shoulder labral tear treated?
Initial treatment options for management of shoulder labral tears may include medications and physical therapy. Physical therapy should primarily focus on improvements in posture, shoulder region biomechanics, range of motion, and multi-planar shoulder and scapular strengthening. If a patient is still experiencing significant pain and dysfunction despite the aforementioned treatment options, interventional options may include corticosteroid or platelet rich plasma (PRP) injections. Finally, referral to orthopedic surgeon skilled in shoulder arthroscopy/sports medicine may be considered for further evaluation and consideration of surgical intervention.
Glenohumeral Joint Injection
Using x-ray (fluoroscopic) or ultrasound, a needle is carefully and precisely guided to the shoulder joint. Once the shoulder joint has been accessed, a steroid solution is instilled through the needle and into the joint capsule to coat or bathe the joint with anti-inflammatory medication. This helps to decrease inflammation and, subsequently, decreases pain and improves function.
Platelet Rich Plasma (PRP)
PRP is component of the patient’s own blood. It is rich in growth factors and other cells that signal an increased healing response to a damaged tissue. It is used to treat a variety of painful spine and musculoskeletal conditions.
Blood is drawn from a patient and then placed in a centrifuge for it to be “spun down.” This causes the different components of the blood to separate out in the vial. The PRP solution is then drawn up into a syringe and prepared to be injected at the site of the patient’s injury.
Discontinue use of all non-steroidal anti-inflammatory drugs (NSAIDs) at least 7 days prior to the procedure. These may include ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam (Mobic), diclofenac (Voltaren), indomethacin (Indocin), and celecoxib (Celebrex). If you are taking oral corticosteroids such as prednisone or a Medrol Dosepak, please discuss this with Dr. Best prior to your procedure. In some cases, Dr. Best may request that the corticosteroid medication be discontinued in preparation for the PRP injection. Do NOT stop aspirin unless specifically instructed by Dr. Best. Depending which body part is injected, you may need a driver to and from your procedure. If you have any questions or concerns about whether to continue or discontinue any of your medications leading up to your PRP injection, please discuss these issues with Dr. Best and his team.
Once the PRP solution is created, the patient is positioned for the procedure. The skin is thoroughly cleaned and the target for the injection obtained with ultrasound or fluoroscopy (x-ray). Then, a numbing solution is injected at the skin and subcutaneous tissues for increased procedural comfort. Finally, under ultrasound or fluoroscopic (x-ray) guidance, the needle is guided to the injury site and the PRP solution is deposited.
It is common to experience mild to moderate pain or discomfort during the initial 0-3 days after the PRP procedure. Post-procedure pain can be easily managed with acetaminophen (Tylenol) or other non-NSAID pain medication. Try to avoid applying ice or heat to the injection site.
During the 3–14-day period after the PRP injection, you may gradually increase physical activity. Please continue to avoid use of NSAIDs; however, ice may be applied for short periods of time throughout the day to aid in management of post-procedure soreness/discomfort if present.
During the 2–4-week period after the PRP, Dr. Best may recommend initiation of a course of physical therapy to aid in recovery and optimization of healing. The patient may begin to note improvement in pain during this time period, though it often takes 1 month or more for the benefits of PRP to take hold.
At this time, PRP injections are not typically covered by any insurance companies. Pricing and payment options can be discussed with Dr. Best and his team prior to your procedure.
As an alternative to PRP injections, glenohumeral shoulder injections with corticosteroid can be performed to help alleviate shoulder region pain. Using x-ray (fluoroscopic) or ultrasound, a needle is carefully and precisely guided to the shoulder joint. Once the shoulder joint has been accessed, a steroid solution is instilled through the needle and into the joint capsule to coat or bathe the joint with anti-inflammatory medication. This helps to decrease inflammation and, subsequently, decreases pain and improves function.
At a Glance
Dr. Craig Best
- Harvard Fellowship-Trained Interventional Spine & Sports Medicine Specialist
- Double Board-Certified in Physical Medicnie & Rehabilitation and Pain Medicine
- Assistant Professor of Physical Medicine & Rehabilitation and Orthopedic Surgery
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