Shoulder labral tear

Hi guys, 

I injured myself last week when climbing a roof. I heard a snapping sound on my shoulder and then I lost the strength.  

Did the MRI without contrast 2 days later and the doc said it looks like a small labral tear and he doesn't think I need any surgery. Knowing I'm a climber,  he suggested PRPbut I'm hesitating becaus of the cost ($1200 for the injection and machine). I'm thinking of doing PT first and if it doesn't get better I can always go back to PRP but I also want to see your options about it.

Thanks!

Have you googled "profit-rich placebo"?

I shall be stealing that in future! I was discussing PRP yesterday with a medical Prof. who specialises in musculoskeletal injuries. His verdict: "a solution looking for a problem". 

I had a very similar injury and this is my line of work. I had surgery from a world-famous specialist to "tidy up" the tear. This didn't help me. 

What worked for me: retraining shoulder and shoulder girdle stabilising muscle recruitement and strength. I had several failures with exercise, but making the exercises as climbing-specific as possible, with the shoulder in the problematic position(s) was key. Elastic band exercises are not very climbing-specific. Shoulder stretching didn't help me. 

These exercises help a lot but I have to be consistent. They are now part of my daily routine like brushing teeth and I'm more succeptible to tweaks if I neglect them. I also learned prolonged rest after a tweak doesn't help me, I'm better if I get going again after a couple of days instead of waiting to be completely pain-free. 

Good luck.

After 5 to 6 weeks, the pain in a partial tear will go way down (usually). However, if you go to an M.D. during the acute initial pain phase and whine and whine, they'll book you for surgery quicker than a hot knife cutting through butter. Solution? Tough it out for 5 weeks before getting near an ortho. If the pain hasn't disappeared by then, maybe, just maybe, something the allopathic M.D.s do will help, but it's still not a sure thing. Shoulders are problematic.

I am recovering from arthroscopic surgery to fix a labral tear in my left shoulder. After researching the heck out of this topic, I have concluded that while it is possible to function with a labral tear and work around it, it will require constant maintenance. Because the labrum is cartilage, it will never heal the way a rotator cuff injury will. I have heard of only one climber who was able to use PT to return to completely normal function with a labral tear (this climber is also a PT by profession). I have heard from or read accounts from hundreds of athletes who have recovered fully with surgery. There's a reason that Ethan Pringle, Beth Rodden, Hazel Findlay, and Shauna Coxsey all opted to surgically repair their labral tears.

Because shoulders are finicky, and easily misdiagnosed, I do think it is beneficial to do PT for some period before electing surgery. I did for 6 months. I do not recommend waiting longer, however, because the strength losses and frustration are simply not worth it (based on conversations I've had with climbers who waited 1+ years). I do not recommend wasting money on PRP...it can't make the labrum re-attach itself to your humerus. That's my completely non-medical opinion though.

I had a small tear as well, which became a larger tear as I continued to climb on it (even while doing PT). If you're worried about being kept out of the game, look into biceps tenodesis which has about a 6-week recovery timeline for labral tears. I opted to go with anchors since they are a more conventional solution --timeline of my injury diagnosis and recovery here near the end of the thread.

EDIT to add: MRI's are notoriously bad at diagnosing labral tears. What may appear "small" on your scan may actually be a large tear. The web is littered with accounts of this. Just don't assume that they're a perfect science and let that weigh too heavily in your decision-making.

I tore my right shoulder labrum twice in the last decade (skiing fall, bike wreck) and got it to come back to 100% both times with a bunch of PT work, no surgery.  Took me 3-4 months to get back both times, and about 6-8 months before all the pain was gone.    Seems to be strong and pain free, but I did tear it twice so I suspect it is structurally not as sound.  My PT wife guesses I will need surgery if I tear it again, but we will see.  Worst part of this injury is the way it ruins your sleep!   

Tearing your labrum is one of the easiest things to do. Many people have one and function fine. Do PT for a while and see if it helps. I've subluxed one shoulder and torn my labrum (most likely) in the other. I've done the same PT for both for the past couple years and neither cause major issues.

Learning how to properly engage your back muscles will prevent further injury. Lots of people hang off their joints without engaging muscle, which leads to problems. When you hang straight arm, your lats should always be engaged.

It's interesting to hear from people who have recovered with PT! Certainly more than when I was researching my options. My boyfriend was diagnosed with a labral tear and rehabbed, but we concluded later that it was just a rotator cuff injury. Assuming no misdiagnosis in others, I wonder if rehabbing through PT is specific to the type of tear (SLAP I, II, III, IV, or bankart). I had a SLAP Type IIb which, logically, seems almost impossible to re-attach on its own or through simple strengthening exercises. 

All the more reason to wait and do PT though. At 6 months, mine had only gotten worse.

Alissa Doherty wrote:

It's interesting to hear from people who have recovered with PT! Certainly more than when I was researching my options. My boyfriend was diagnosed with a labral tear and rehabbed, but we concluded later that it was just a rotator cuff injury. Assuming no misdiagnosis in others, I wonder if rehabbing through PT is specific to the type of tear (SLAP I, II, III, IV, or bankart). I had a SLAP Type IIb which, logically, seems almost impossible to re-attach on its own or through simple strengthening exercises. 

All the more reason to wait and do PT though. At 6 months, mine had only gotten worse.

These injuries don't get better unfortunately. The best you can do is strengthen your rotator cuff for stability. And the PT needs to be done for the rest of your life, or it's likely to get worse. 

Conghui Song wrote:

Hi guys, 

I injured myself last week when climbing a roof. I heard a snapping sound on my shoulder and then I lost the strength.  

Did the MRI without contrast 2 days later and the doc said it looks like a small labral tear and he doesn't think I need any surgery. Knowing I'm a climber,  he suggested PRPbut I'm hesitating becaus of the cost ($1200 for the injection and machine). I'm thinking of doing PT first and if it doesn't get better I can always go back to PRP but I also want to see your options about it.

Thanks!

Supposedly, a lot of people are walking around with asymptomatic labral tears, and are doing just fine. Even climbers, I know several who climb with it just fine.

I had a SLAP tear in my left shoulder about 2 years ago. Did PT, rehabbed it, it definitely got better, and I was able to climb reasonably well. But certain moves would still hurt, and weakness in some specific moves never quite went away.  I was guarding the shoulder for sure, I couldn't even make myself do a deadpoint move on that side, just wouldn't commit. And sometimes my shoulder would subluxate slightly, and the pain was quite sharp and unpleasant when that happened.

So after about 8 months I decided that I would go for a surgery in April of 2016. They don't repair the labrum, instead they do biceps tenodesis, where they cut the biceps tendon that is attached to the labrum and is pulling/tearing it, and reattach it with a titanium pin in a different spot. In my case there was also some minor rotator cuff damage that was fixed, a bone spur, and bursal scarring.

Going in, I was told to expect 5-6 months before I would be allowed to climb again, but at 3 months the Dr gave me a go-ahead to ease into climbing. The PT was quite intensive, and lasted a lot longer than those initial 3 months-- about 8 months, actually.
At 4 months post -surgery I was barely climbing easy 5.10, and thinking that the surgery was a mistake, and I would never fully recover. I had some complications with scarring around the radial nerve, and still had not regained full range of motion at that point. That's where PT was really invaluable... according to Dr. I was fully recovered, because my range of motion  and strength was within normal range... but it was nowhere near my normal! At 5 months I did the first 5.11a post-surgery. After that things went quite quickly. At 6 months I got a first 12a post surgery, and at 7 months I was back to 12c.

It's been 13 months now, almost exactly. No problems at all,  I just don't think about my shoulder anymore.

I would recommend definitely going for PT, and doing it religiously. I can't stress how important it is to find a PT who would understand climbing and your goals for rehab! You might have to do some extra shoulder exercises for the rest of your climbing life, but it is a small price to pay. Most people SHOULD be doing more shoulder exercises than they are doing, as a side note, to avoid shoulder problems. And even if you do end up getting surgery later, doing PT beforehand, and having that shoulder as strong as you could have it, would make post-surgery recovery much better. 

Thank you all for the good advices and sharing your experiences!

Looks like what I should do now is to try my best to maintain the current situation with right PT and get ready for the surgery when it gets worse. Sounds pretty pessimistic. Was hoping there's a better way out. :)

Do you have any recommendation for the exercise which will help? I was reading this article https://www.ukclimbing.com/articles/page.php?id=119 

Good luck to everybody's shoulders!

Destroyed my shoulder arm wrestling and was out for several months. Those exercises linked are decent but wont be enough on there own. The best my shoulder ever felt post injury was after PT. 

Shoulder injuries/elbow injuries happen to most climbers if you climb for long enough. Alex honnold had elbow tendinitis for a while. Shoulder inujuries suck big time because it really limits what I could do - I couldn't even hike at first without pain. I ended up doing tons of sit ups and crunches (300ish a day while watching TV), as well as played with grip strengthening things. I couldn't believe my ab strength after a few weeks, slacklining seemed way easier. 

I will have to do shoulder conditioning for the rest of my life. Reflecting on the event - I should have been doing shoulder strengthening exercises anyways. 

Conghui Song wrote:

Thank you all for the good advices and sharing your experiences!

Looks like what I should do now is to try my best to maintain the current situation with right PT and get ready for the surgery when it gets worse. Sounds pretty pessimistic. Was hoping there's a better way out. :)

Do you have any recommendation for the exercise which will help? I was reading this article https://www.ukclimbing.com/articles/page.php?id=119 

Good luck to everybody's shoulders!

Those are good. That's more or less what I do twice a week at work. Get a routine down and it's only about 15 minutes total. Once you're more confident in your shoulder after doing those for a while you can do internal/external rotations with your arm up.

Also, push-ups and dips on rings are an amazing way to stabilize shoulders. But don't try that until you feel confident enough in your shoulder.

Conghui Song wrote:

Thank you all for the good advices and sharing your experiences!

Looks like what I should do now is to try my best to maintain the current situation with right PT and get ready for the surgery when it gets worse. Sounds pretty pessimistic. Was hoping there's a better way out. :)

I've been in the same boat. I tore my labrum in 2013 bouldering in the gym, but heard no pops or tears. That was later confirmed by an MRI and surgery, but first I trained and climbed on it (sending my hardest boulders and sport routes, like an idiot) through the pain, doing PT along the way of course (home and professional) for close to a year before deciding it was never going to be pain free, and getting surgery a year later. I'm now basically pain free, so long as I don't slump over a desk with poor form (holding my head up with my left arm/shoulder braced on the desk, again, like an idiot) for hours, or sleep on that side oddly. I think being careful and pursuing PT first is the right call—it's not "wasting" a few months if your tear is minor enough that you can avoid surgery and recovery times.

I've had a handful of orthopedic surgeries now and I can say at the very least I've come back from each one in under a year, sending harder than before or at least matching/sending the same grades quicker. Stay optimistic and find some new side-hobbies to keep yourself busy and invested in things!

If you haven't already, take a look at the TrainingBeta podcast by Neely Quinn, she's had a similar tear and surgery and talks about it a good amount, especially in the episode with the PT Jared Vagey (sp?). 

duncan... wrote:

I shall be stealing that in future! I was discussing PRP yesterday with a medical Prof. who specialises in musculoskeletal injuries. His verdict: "a solution looking for a problem". 

I had a very similar injury and this is my line of work. I had surgery from a world-famous specialist to "tidy up" the tear. This didn't help me. 

What worked for me: retraining shoulder and shoulder girdle stabilising muscle recruitement and strength. I had several failures with exercise, but making the exercises as climbing-specific as possible, with the shoulder in the problematic position(s) was key. Elastic band exercises are not very climbing-specific. Shoulder stretching didn't help me. 

These exercises help a lot but I have to be consistent. They are now part of my daily routine like brushing teeth and I'm more succeptible to tweaks if I neglect them. I also learned prolonged rest after a tweak doesn't help me, I'm better if I get going again after a couple of days instead of waiting to be completely pain-free. 

Good luck.

curious what your climbing specific exercises are duncan..? mostly for the knowledge/best practice sharing, please.. :)

also, aside from everyone is saying on here about MRIs being inaccurate and PT working or not working, etc.

since you have heard that there are MANY different kinds of labral tears a lot of what your decision should be made on will reflect most intimately on that, in my opinion. 

many people function just fine with undiagnosed or unknown labral tears, RC tears, and all kinds of other things.

i think often PT is where most places/people want you to start anyway. id try that. do it religiously and see what happens. (also +1 for someone intent on helping you with you climbing specific goals...

go from there.

good luck!

injuries fucking SUCK!!!

Downtownt Kay wrote:

curious what your climbing specific exercises are duncan..? mostly for the knowledge/best practice sharing, please.. :)

injuries fucking SUCK!!!

I get tweaks pulling hard, straight down or gastoning, with my arm in 90 -150 degrees elevation (T to Y position or a wide grip pull-up). This is a high intensity, closed-chain, nearly static activity. I try to make my exercises as specific as possible to this. 

Theraband rotator cuff exercises with big sweeping movements like in jmmlol's picture tend to aggravate me. I think these exercise are popular because the movements are like those in tennis or baseball pitching, the staple diet of shoulder sports injuries, but they don't resemble anything in climbing.

I do lots of overhead work - in the aggravating position - using theraband to resist ‘gastons’: pulling hard but with little movement. Open-chain, so not ideal, but otherwise quite specific to climbing. 

My other mainstay is the side plank. This is good for the scapular stability muscles like serratus anterior and I get a strong static co-contraction of the rotator cuff group doing this, just like in climbing.

I also do front planks and the downward-facing dog. Sometimes I do dynamic versions of these: single-arm push-up, push-up into side-plank, or from a downward dog. Occasionally I do supported hand-stand push-ups
http://manbicep.files.wordpress.com/2013/06/handstand.pngs

When I've got a good base of strength doing some of the above, I'll progress to holding wide-grip pull-up positions on a bar or fingerboard but taking exceptional care to maintain good form, engaged shoulders, and stopping well before you get tired. This is on the border between rehab. and training which is where a specific rehab. program should take you.

All these are closed-chain, low reps., semi-static, arm elevated at 90 or above, so quite specific to my aggravating activity. They need good form, I think you need someone who knows to teach you and correct any movement faults. I don't use external instability (TRX, rings, gym balls) as climbing never involves external instability (unless you're on the Fisher Towers).

This is not a recipe. It’s meant to be an illustration of how I have attempted to analyse my own problems and address them. I’m still learning about why things go wrong - and why they don’t - training and climbing style, lifestyle issues. You have to become an expert in your own management.

Injuries most certainly suck.

mine was a SLAP tear(both times), rehab took a long time. but it works.   I have made my "shoulder PT" just a part of my workouts, so it is just part of life.  started with sometimes 1 or 2 lbs and now 10 lbs or more is good. I can climb but still can't throw a ball worth a shit.  I admit, i expect the next tear may only be a bike endo away, and then maybe surgery?

I tore mine in 2008 and had several subluxations before I went in to get it checked out. Multiple doctors recommended surgery, but I did PT and I'm glad I did. Surgery is not guaranteed to fix the problem and it's possible to lose some ROM. It will never heal but it's possible to stabilize the joint be strengthening it.

I still do band exercises and General shoulder work regularly. Every climber should make shoulder maintenance a part of their routine whether you have healthy shoulders or not.

I just wanted it to update my case a little bit for anybody who's also going through this.

One month after my injury, I went to see a PT and after some test, he didn't think it's a tear but more like a pinch. I chose to trust him more because 1. I'm going to do PT anyways even it's a SLAP tear, 2. the doctor I went to see before didn't even do any exam on my shoulder but sent me directly to the MRI and when I asked him to write a prescription for my PT(it's required in Texas), he wrote tendinitis. 

I have been doing PT for 6 weeks, twice/week and has three more visits left. I made some progress on my shoulder. I already started to climb and I can climb most of the routes as before my injury (I'm not a strong climber anyways). Only have some sharp pain when doing dead hang or overhead reachy moves. 

I will see how it goes.