My name is Hoang, and I’m gonna talk to you today about what is a labral tear and can I avoid surgery? And I’m bringing these questions because I’ve recently had these questions in my clinic, and our clients are asking these types of questions. So, I wanted to share with you, just in case you’re someone who has shoulder pain, or you recently found out that you have a labrum tear, and you’re wondering, “Did I really need the surgery or can I avoid it?”
What is a Labrum?
So, what is the labrum? The labrum is essentially connective tissue. a labrum is kind of a type of ligament, and that type of tissue doesn’t stretch as much. So, if we’re talking about muscles and tendons, like in the rotator cuff video, and I talk about muscles getting long and getting short, a ligament essentially is very tight in nature and doesn’t give too much. It gives just enough in all directions essentially to move. But ligaments hold essentially bone and bone together, so you have a certain amount of stability, so your bones just don’t fall all over the place.
The labrum is a very specific type of ligament, and basically, it surrounds the socket of your shoulder. So, if this is your humerus, right? This ball right here that you see in the top of your shoulder, this is your ball. And your shoulder blade actually has a socket, right? And the socket is really small as compared to the ball, so they don’t fit. Like, so if you look at your hip, like your hip and your pelvis, your ball and your socket are the same size, so, they fit really nicely.
In the shoulders, so that you can have tons of movement in all directions, your socket is quite small, and then your ball is quite large. So, how does your body sort of take care of that? That’s the labrum. So, the labrum goes all around the socket and builds it out. So, the socket is just slightly bigger, right? And the labrum, the job of the labrum essentially is like a suction cup. And if you imagine a suction cup, what does it do? It sticks, right? So, because it builds out, its job is to, you know, maintain a certain amount of stability of that ball being stuck into its socket. And then the rotator cuff also gives it stability, but that one has much more movement, whereas the labrum has very little movement. So, the key thing is that it holds that ball in place.
What happens if you have a Labrum Tear?
What happens if you have a Labrum tear? If you think about that socket like a clock, right? Like a clock, that’s how I usually teach it. But you have 12:00, you have 6:00, 3:00, and 9:00. Now, there’s some very common areas and places where your labrum tears. So, you might have what’s called the slap lesion, right? So, it goes between 10:00 and 2:00, just like a clock, right? You know, in advertisements, you have the handles at 10:00 and 2:00. So, a slap lesion is between 10:00 and 2:00. So, depending on how large that tear is, you start to lose the stability of that shoulder and starts jamming too much. Not really good, right? It’s painful, it doesn’t feel really good. And then your other type of tear is really at the bottom. So, at that 6:00, so you might have between a 4:00 and 6:00, or you might have like, let’s say an 8:00 to 6:00. So, you can have tears either at the bottom or tears at the top. And those are some of your more common, just very simplified labral tears.
How can I Avoid Surgery?
And the question is, how can I avoid surgery? The way that you are able to avoid surgery is based on your symptoms, right? And also based on your age, your activity, and the size of your tear. If you have a very large tear, then the majority of the time, you may need to have surgery for it. Well, how do I really know? Well, you wanna work with your surgeon. You want to find a trusted occupational therapy, physical therapist, or someone who specializes, like a certified hand therapist, who specializes in shoulder and labral types of injuries, and they are committed to helping you achieve your goal. So, what is your goal, right? If your goal is to avoid surgery, then you wanna have that type of conversation with your patient. Now, recently I had a patient, she had a labral tear. She actually had a labral tear and a rotator cuff tear. And with the labral tear, ligaments don’t have blood supply, right? So, ligaments don’t have blood supply. So, what do they rely on to “heal?” Well, one way is to suture them up. That’s the surgery, right? Another way is to use scarring, right? To stop and immobilize for a certain amount of time. So, your tissue’s kind of scarred down.
And then the therapy is very specific. Unlike a rotator cuff tear, with a labral tear, you actually want to stiffen the joint and then start to slowly gain the motion without the pain. So, the protocol that your therapist utilizes is key in helping you to determine, can you avoid surgery, right? So, if the labral tear is rather small, based on the size, usually I’ll talk to my own patients and say, “Based on the size and based on your symptoms, the first step is always conservative therapy.” The thing that happens with therapy is that conservative therapy looks different to different therapists and to therapy clinics. If you go into your very typical run-of-the-mill where you’re sitting there with three or four people at a time and your therapist barely has time to pay attention to you, you might be doing the wrong movements and the wrong exercises. Actually, she had gone somewhere and they were stretching her and stretching her. They overstretched her.
In a labral tear type of injury, to be overstretched can, one, cause more pain, which defeats the whole purpose, right, of avoiding the surgery. And two, it’s, you know, it can cause more damage. The damage is just gonna make you feel like conservative treatment doesn’t work, but you can actually do it in a way that’s very gentle, pain-free and give you the results that you want. So, just like anything else I talk about, how do you determine if conservative treatment is working for you? One, you have a plan with your therapist, right? They understand what they need to do. You understand what you need to do based on the plan that’s set in place. So, I usually can tell when I work with my patients, a labrum tear is, by week two, I should see some progress. By week three, I should see some progress. And by week four, not only am I seeing progress, but I can…not only am I seeing progress, but I can keep the progress.
So, with the labral tear, it’s a really important…you can reduce the pain, or you can reduce the symptoms, but can you keep it, right? So, labral tears can be a little bit trickier than rotator cuff tears potentially. But depending on its size, you can completely avoid it. Where is it when you can’t avoid it? Well, I had a client, whoof, actually a friend of mine years ago, 8, no, it’s like probably almost 10 years ago when I first opened my practice. He got in a car accident and just has a huge labral tear and then tore two of his rotator cuff muscles. And I was like, “Dude, you need to have surgery. Like, you have a big labral tear.” And he just decided he didn’t wanna do it, right? And one of the things that I do with my patients, I discuss the consequences of your decision, because there’s always consequences. These are, you know, the decision is a personal decision. But what I wanna help you do in videos like this is to help you feel more comfortable and more confident about your decisions, right? If you have really big tear, you know, talk to your therapist about what’s possible and can you actually avoid it? Because you’ll see whether you can or can’t, relatively fast, right? But if you have a really small tear in your labrum, it’s totally possible to avoid the surgery and have great results.
The client that I’m talking about, she couldn’t have surgery until almost like next year, right? So, she had to live with her “shoulder pain” until she can have the surgery a year from now. And I was like, if you can’t “have surgery” right now, why not give yourself a chance to fully, you know, try conservative therapy and see if it can work, right? And we created a plan, and I said at week two, at week four, at week six, these are the things that I’m looking for. From time and time again, what are the things that I’m looking for so we can see results? Labral tears, you do not want to overstretch. If someone is overstretching you, speak up, right? I want to empower you to, you know… We ask a lot of questions when we’re working with them because with the labral tear, you want to stiffen and then slowly but surely gain the movement with the strength.
But we were able to essentially avoid surgery. We’re able to reduce the pain within week on week, on week, right? By four weeks, we didn’t have, you know, I think the pain that went from like a 10, it was down to a 1 or 2 with activity, right? With activity. And then slowly but surely, she was able to fully regain her full, full motion, right, and strength. And when she came to us, she could barely lift her arm. She couldn’t work. And she worked in…she’s a general contractor and she does, you know, a lot of heavier work. So, within, you know, three months, she was able to actually go back to a lot of the types of work that she required to do. She was remodeling bathrooms and kitchens and stuff like that. And she was able to do it.
Seeking the Right Type of Therapy
So, it is possible, it just requires the right type of therapy. So, the right type of therapy that can help you avoid the surgery is creating a plan with your therapist to say, you know, what does it need to look like? What should you look for based on how severe you are? Every person that I work with, even if they’re the same shoulder injury, labral tear, each person presents slight differences in their body type, differences in their activity level, differences in how they sleep, differences in their past medical history, right? Different prior injuries that affect the shoulder. Their level of commitment can be different. So, some people are like…she was honest. She was like, “I’m doing my exercises as you prescribed.” You know, she wants to make sure she’s doing it correct. And then some people just are like, “I’m too busy. I need more time, I need more help.”
You know, so your level of commitment will determine how slow or fast you go. And there’s no right or wrong, and you shouldn’t feel bad about it. It’s just…the question here is, can you avoid the surgery? And the answer is yes, it’s possible for you to avoid it, and here are the things that you should be looking for, right? You should be able to see results week on week, and you wanna talk with your therapist to make sure that they are, you know, working with you to create that plan, keep that plan, and talk to you about what works and what doesn’t work. Because our progress just depends on where you’re at. So, it’s not a cookie-cutter plan. If you are going somewhere and all they’re doing is putting a hot pack, doing ESEM and ultrasound on you, and putting you from one exercise to another without paying attention to the order in which you do your exercises and your form, it makes a really big difference.
All right. One of the things that I always talk about is when you’re trying to fix a particular problem, the movements and the things that you do take a lot more intention. The movements, you focus a lot more on form. If you’re looking at exercises and you see them online on YouTube, yes, you’re seeing really buff fit people doing them. They’re doing them correctly. You don’t know if they’re feeling pain. Because some of these people look good, but they don’t feel good, right? And they do big, bold movements, but that’s not where you might be at if you are rehabbing a labral tear and trying to avoid surgery. You can progress to that at some point, but you might not be there today. So, it requires a certain amount of progress.
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Conclusion
If you are someone who’s suffering from a shoulder injury, a labral tear, and you want to know, can I actually avoid the surgery? I would really highly recommend you go and work with a trusted occupational therapist or physical therapist, someone who specializes in shoulder injuries, like a certified hand therapist. If you’re in the local Miami area, my name is Hoang Tran and my team and I can help you determine, you know, how severe is your tear and can you avoid surgery. The clinic is Hands-On Therapy Services, and I’ll include the link below so you can take a look and grab one of our free guides if that’s where you need to get started.
I hope this helps you feel more comfortable and more confident about the decisions that you need to make regarding how to really fully take care of your shoulders so you can live a very active and full life with no pain. It’s totally possible for you. If you like videos like this and this has really helped you, please like and consider sharing it with someone that you might know who’s going through some of similar shoulder problems.
About Hoang Tran – an expert in physical & occupational therapy
Hoang Tran is a Miami certified hand therapist , the owner of Hands-on Therapy Services and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!).
The aim of her occupational therapy practice is to bring patients back to full functionality, without pills, injections or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care.
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