“SLAP” Tear in Shoulder Labrum - Input Needed for Doc Appointment:
Hola EN!
I’m meeting with a surgeon tomorrow 09/13 to discuss an appropriate solutions, if any for my shoulder pain. My results are below and I’m told this is a “basic” SLAP tear plus some arthritis. I don’t know much about what this means, but I do want to be prepared with good questions and I’d appreciate any input on my thought process.
My specific questions:
1 – What should I ask the doctor?
2 – What can I expect for recovery?
My thoughts are:
1 - If my arm is about to fall off, obviously I’ll get it fixed sooner rather than later.
2 - If it is likely to remain attached to my body, I’d prefer to wait ‘till next year when my life is a little less complicated.
More info than you probably want, but why I’m conflicted: My sis-in-law is expected to pass away sometime in the next month and I’m anticipating staying with my brother on Oahu for a couple of months to help him move, etc. after she passes. Obviously I won’t be helpful if my shoulder is immobilized. Additionally, I was able to swim through it this year. With my “A” race at the end of August, I’m thinking it’s now or next year. Once we get past November/December I’m thinking it will be too late to really get to swimming well again.
Any input from any docs or folks that have had similar diagnoses would be much appreciated.
Thanks so much!
Narrative
MR arthrography of the right shoulder 9/11/2012 9:54 AM
History: Pain.
Procedure: The patient was previously injected with intra-articular
gadolinium. Axial T1 fat-sat, coronal proton density fat-sat, coronal T1
fat-sat, sagittal T1 fat-sat and ABER T1 fat-sat imaging was obtained
through the right shoulder.
Findings: Exam is compared to prior outside MRI dated 12/5/2011.
No abnormal bony signal suggesting fracture or contusion. There is a very
tiny osteophyte formation inferiorly along the humeral head. There is
very mild chondromalacia along the glenoid posteriorly.
No intra-articular loose bodies.
The is mild to moderate active arthropathy at the acromioclavicular
joint. A type 2 acromion is present with tiny lateral undersurface
subacromial spurring. No subacromial/subdeltoid fluid.
There is mild tendinopathy and bursal surface fraying distally along the
infraspinatus greater than supraspinatus. The biceps, subscapularis and
teres minor muscle tendons are intact.
There is a tear of the anterior and superior labrum extending posterior
to the biceps anchor, along the posterior labral cartilaginous junction.
The middle and inferior glenohumeral ligaments appear intact.
Impression
Impression:
1. Anterior and superiorly labral tearing with slight posterior extension.
2. Mild to moderate active arthropathy at the acromioclavicular joint.
Type II acromion with lateral subacromial spurring.
3. Mild tendinopathy and bursal surface fraying along the infraspinatus
greater than supraspinatus distally.
4. Minimal arthropathy in the glenohumeral joint.
General Information
Collected:
9/11/2012 10:30 AM
Resulted:
9/11/2012 10:30 AM
Ordered By:
Jason Dean Brayley, MD
Comments
First I am so sorry to read about your sister in law. I think considering this into your surgery decision is wise and thoughtful.
I am a PT and have seen these patients. The rehab is lengthy. I did a quick web search of a site for you to look at.
http://en.m.wikipedia.org/wiki/SLAP_tear#section_5
The labrum which is torn helps to hold the head of the humerus in place. You are likely experiencing impingement from that and the bone spurs under the acromion. You likely can hold off surgery until it works in your life. You will be in a sling initially and not allowed to use it or weight bear for a long time. See article.
I hope that helps.
Carrie
Thanks for the input guys.
@ Carrie: The info and your perspective is super helpful. I feel like, assuming no major surprises, I can go into the appointment with a reasonable long term plan.
@ Paul: Your pain and symptoms are very similar to mine. Actually, the pain varies quite a bit from day-to-day. The “regular” MRI I had in December was inconclusive as to the labral tear and my symptoms (which direction it hurts when the doc pushes on it) were also a little inconsistent, from what I understand. We decided to wait until after my “A” race to do the “contrast” MRI as I wouldn’t hav even considered getting it fixed beforehand anyway.
Thanks again and Paul keep us posted!
I had labral repair surgery on right shoulder in 2007 and left shoulder in 2010 and was able to regain full mobility. I am not a doctor but did learn a bit from the surgeries and rehab. The labrum will not heal itself so it is a question of comfort and stability.
I never had any shoulder pain but had stability issues meaning I was prone to dislocate if I moved my shoulder/arm the wrong way. The rehab was 6 weeks in a sling and then another 6 weeks with no running/swimming/biking outside.
Good luck!
I had SLAP tear in right shoulder in 2010, and had the surgery. While the sooner the better with that joint, it sounds like doing it now is not really an option.
But if it has to happen at some point. In my case I was done with the therapy in about 6 weeks, and had pretty good (but not full and painless) range of motion and strength with it. But it took almost 6 months to get the remaining strength and motion back into it. But I was not in the shape I am in now, and was not doing much exercise of any kind back then.
So if you are looking to have the surgery in late December or early January, you could be done with the physical therapy by March. Depending on the recovery you might be able to do some light swimming but might not be able to really push it. Has your doctor indicated how long after the surgery they anticipate that they would be able to release you to start swimming with it?
Hope that this helps in some small way, good luck.
What was the outcome?
I had a labral tear, diagnosed by ortho after stupid incident and 3 months of pain. I did not need/want an MRI unless I was going to surgery. I refused as my job is mental, not physical and I had only been working there for 6 months- I could not take the time off and was not eligible for FMLA. So he told me to baby the arm for a year and no swimming. So I did just that. The pain resolved in time. Now- 6 years later- Of course I aggravated it lifting something heavy, over my head while helping my sister. I am not swimming now so I can swim at IMAZ.
My point- it will not be the end of the world if you wait.
Good luck.
Hi,
Thanks a bunch for the thoughtful perspective John, Brian and Michele!
I had the consult with the surgeon yesterday and his input that it was an very correctable tear but that the recovery is essentially what has been discussed here. I’d be looking at six weeks in a sling, six months recovery and may not feel 100% for up to a year. His answer to my primary question was that he did not feel I was risking any long term functionality problems by continuing to swim and lead an active life without a repair. He stated it would be a little less stable and in the event of a fall there was a chance the damage would be greater.
My decision is just to keep on swimming, swimming, swimming (insert audio of Dori in Finding Nemo here) indefinitely. If the pain becomes too much to bear or life provides me with a nice big window where I can have it immobilized for a few weeks I’ll do it then.
As to the level and cause of pain I apologize that I’m gonna be a little vague because honestly it hasn’t been very consistent. I know I was able to swim through IM training and actually had a couple of really successful race swims. It always hurts a tiny bit on each stroke, but not enough to impact my mechanics - I’ve had this verified by a couple of coaches. It’s really other times that it bothers me like sleeping or reaching for something up high. Also, whether I do much swimming or not doesn’t seem to make a difference. For example, I was without a pool for a full week and was SURE I’d come back to a nicely rested shoulder but that was one of the WORST weeks from a pain perspective and had a really hard time even sleeping. Conversely, I did an Olympic race in March in Kona and the Waikiki Roughwater swim on 09/01 and my shoulder felt relatively good the day after both of those. You’d figure a hard effort on the ocean would be a sure fire way to flare it up but neither did. Michele this seems the opposite of your experience because yours DID resolve, though you took a lot more time off. Huh.
So, who knows? I’m just gonna keep on doing my thing until I can’t!
Many, many thanks again for the input!
Anyway- this time I had pain every stroke and it was annoying, not debilitating. But a "hard" rest, ie swim 1x/week with friends for fun after Vineman, has allowed it to heal. 2 days ago I swam in my sleeveless and had no pain at all. I guess it is about time I started swim training for IMAZ.
I saw the doc today and he said I might have a small tear in the rotator cuff but it could just be sprained. Even less likely in his opinion is a tear of the labral thingy. He gave me three options and I chose the PT referral for now. If that doesn't work he'll refer to me a sports medicine doc. The orthopedist will be the last resort. Meanwhile, I'm going to swim, ice it afterwards, do whatever PT asks of me, and hope I can get a decent swim in at Cozumel to finish this year out.