Torn Labrum- Should I get surgery?

[Javizzle]

Hey everyone,
This is my first post on talk tennis. I am a U18 canadian tennis player. I've been to nationals and tennis definately is a big part of my life. I'm torn (no pun intended) between getting and not getting surgery for my labrum. I've had an MRI arthogram and my labrum is definately torn. The orthopedia surgeon I saw, said that even though my labrum is torn, it could be an inflamed bursa that is causing pain. And getting the labrum fixed could make my arm tighter, and subsequently, my tennis worse.

My plan after high school is to go to the states and play college tennis. Most likely division 3, because I want the emphasis to be even between school and tennis rather than div 1, which is more tennis than school.

I'd appreciate any input and/or suggestions!

Thanks

 

[OrangeOne]

Hey everyone,
This is my first post on talk tennis. I am a U18 canadian tennis player. I've been to nationals and tennis definately is a big part of my life. I'm torn (no pun intended) between getting and not getting surgery for my labrum. I've had an MRI arthogram and my labrum is definately torn. The orthopedia surgeon I saw, said that even though my labrum is torn, it could be an inflamed bursa that is causing pain. And getting the labrum fixed could make my arm tighter, and subsequently, my tennis worse.

My plan after high school is to go to the states and play college tennis. Most likely division 3, because I want the emphasis to be even between school and tennis rather than div 1, which is more tennis than school.

I'd appreciate any input and/or suggestions!

Thanks

Firstly, welcome.

Secondly, you've surely left out some of the surgeon's advice? What did he advise?

That said, remember that in all reality, a surgeon with approximately 10-12+ year's training is likely to give you somewhat better advice than you'll find here, even if you do 'luck out' and find someone who has had a similar issue, no two medical cases are likely to be the same, and no physician worth their salt will diagnose or advise over the 'net. That said, if he's not a sports-specialist maybe see if you can get a 2nd opinion from a sports-specialist!

Good luck. Remember that getting things fixed at your age is a much smaller deal than getting them fixed later on, or at least that's my humble opinion.

 

[Say Chi Sin Lo]

It really depends on how badly torn your labrum is. I had a partially torn rotator cuff and a partially torn posterior labrum, surgery fixed it and the shoulder is as strong as ever. So there's that.

But no surgery is a quick fix, you really have to put your work into the rehab. Or else, don't bother playing tennis again. I worked my butt off and followed my PT's instructions down to a T.

 

[BMC9670]

^^^ I second that. I'm 9 months post-op for a torn labrum and had to work my butt off to get to where I am now, which is about 90%, hitting full ground strokes and just working back into serving. I feel it's been worth it, but each case will be different.

I'm also curious about the advice your doctor gave you. Since the labrum is cartilage and cannot heal itself, the tear will always be there. But if it's small enough and you have no pain, you can strengthen the shoulder muscles to protect it from getting worse.

 

[Say Chi Sin Lo]

Well if the tear is a tiny one, most GOOD surgeons will opt not to operate, and rely on physical therapy to strengthen the rotator cuff instead.

 

[Javizzle]

Firstly, welcome.

Secondly, you've surely left out some of the surgeon's advice? What did he advise?

That said, remember that in all reality, a surgeon with approximately 10-12+ year's training is likely to give you somewhat better advice than you'll find here, even if you do 'luck out' and find someone who has had a similar issue, no two medical cases are likely to be the same, and no physician worth their salt will diagnose or advise over the 'net. That said, if he's not a sports-specialist maybe see if you can get a 2nd opinion from a sports-specialist!

Good luck. Remember that getting things fixed at your age is a much smaller deal than getting them fixed later on, or at least that's my humble opinion.

Well, to tell you the truth, I was kind of upset with the surgeons advice. I was quite surprised as well, considering this doctor has a good reputation. So firstly, he didn't look at the full MRI, just the one picture given on the report that showed the torn labrum. He said it could be an inflamed bursa that is giving me the pain, or the torn labrum he doesn't know. He said that he could give me a cortisone shot for the bursa if i'd like, though he doesn't even know if the bursa is inflamed or not (since i'm a 16 year old boy, i'd rather he advise me to get or not get one). So he said that if I opt to get surgery it would be about 6 months off, so he suggested trying physical training and getting stronger first, incase i didn't need it, and i wouldn't waste time. This baffles me because he said i have to take 6 months off for the physical training. So what if by that time i've done my training and start playing again, and it still bothers me. That's another 6 (at least) months off to get the surgery and back to 100% playing. So that's now 12 months.

 

[Say Chi Sin Lo]

That's another 6 (at least) months off to get the surgery and back to 100% playing. So that's now 12 months.

That's what I did on my 1st rotator cuff (yeah I've torn it twice). I was 16 when I tore it the 1st time and my surgeon at the time wasn't convinced surgery was right for me. Even though it was the size of a dime, he wanted to see if I'll bounce back from PT. Anyways, 6months later the shoulder was stronger for sure, but the tear was still there, so we had the operation. 6 months rehab, so 12months for me since i first tore it.

Tore it again (along with a partially torn posterior labrum) a couple years ago when i was 22, and I just opted for the surgery right off the bat. Like you, I didn't want to waste anytime.

 

[BMC9670]

Well, to tell you the truth, I was kind of upset with the surgeons advice. I was quite surprised as well, considering this doctor has a good reputation. So firstly, he didn't look at the full MRI, just the one picture given on the report that showed the torn labrum. He said it could be an inflamed bursa that is giving me the pain, or the torn labrum he doesn't know. He said that he could give me a cortisone shot for the bursa if i'd like, though he doesn't even know if the bursa is inflamed or not (since i'm a 16 year old boy, i'd rather he advise me to get or not get one). So he said that if I opt to get surgery it would be about 6 months off, so he suggested trying physical training and getting stronger first, incase i didn't need it, and i wouldn't waste time. This baffles me because he said i have to take 6 months off for the physical training. So what if by that time i've done my training and start playing again, and it still bothers me. That's another 6 (at least) months off to get the surgery and back to 100% playing. So that's now 12 months.

Unless the MRI shows a big tear, most doctors will start with physical therapy as surgery is really a last resort. That's a good thing. Yes, there is no guarantee PT will get you where you want to be, and surgery may be needed, but you won't know until you try. I went through 8 months of therapy before opting for surgery, so there is no quick fix.

If you're not comfortable, get another opinion from another doctor, or even two. Talk to your parents.

 

[Say Chi Sin Lo]

Unless the MRI shows a big tear, most doctors will start with physical therapy as surgery is really a last resort. That's a good thing.

Yeah you don't want a surgeon who's scalpel happy. You have to realize that the surgery itself, although it's done arthoscopically, is still a traumatic injury to the joint. Couple that with the required rest is a big blow to the shoulder. But because it was my 2nd surgery, and I knew exactly what I was getting myself into, I was prepared for the rehab that comes with it.

 

[Javizzle]

Yeah, I think i'm definitely going to get another opinion. Doctor are so flipping busy these days. My parents are doctors, so they arrange the best for me, but apparently to no avail so far. The thing is, time is of the essence for me. If I do the PT and i get stronger but it doesn't help, I would not go to an American University for my first year. And as a result, all the work i'm doing to get there will be a giant waste of time, effort and money. I was thinking about doing my first year in Canada and then transferring to the states, but i've heard it's not as easy said then done.

I do have a question. Though i'm not sure how big my tear is. Even if it is small, won't it effect me in the future? If I do go to the states for university, i don't want to be playing at 70% of my potential, i'd want to be playing my absolute best without worrying that pain will come from my shoulder when I serve. In the past 3 years almost, I haven't been playing at 100 or even 80%. And now that i've taken REAL time off, I've realized how much I need it back. (considering I can't find myself a women ha ha!) The typical, you want what you can't have syndrome.

 

[Say Chi Sin Lo]

Well if you have a tear then you have a tear, you won't be able to play. Aggressive treatment have worked for me, but might not to some other people.

Also, surgeons do weigh desires into their treatment protocol. If you're 60years old and you get live without sports, a small tear won't affect their quality of life all that much. But if you're young and you make it known to your surgeon, that you want to sustain an active lifestyle, then s/he will more likely to open you up.

This is my take on treatments. Soft tissue irritation such as tendinitis and impingement, I'll let the body take care of it. Structural damage such as tears, surgical intervention can be a good thing.

 

[FastFreddy]

If you want to still play tennis the rest of your life the answer is yes. It's just a matter of timing when you want to take a break from playing and have it. I say the sonner the better and get it over with since you want to play some college tennis.

 

[Ultra2HolyGrail]

Lots of info in this thread..
http://forum.bodybuilding.com/showthread.php?t=114453121

 

[decades]

do a lot of research before deciding.

 

[charliefedererer]

Some shoulders get better after surgery.

Some shoulders "freeze up" after surgery from the inflammation and scar tissue that builds up.

Doing the rehab after surgery is critical, but results still vary. There is no way to predict how much inflammation and scarring will occur in any one individual. All the doctor can do is tell you the results he has had for his last 100 patients, and give you the spectrum of results. He can not say with certainty where you as a lone individual will end up.

It is pretty clear he advising 6 months of rehab now to see if that takes care of the shoulder pain. At the worst, the therapy would be "pre-hab" to get the shoulder in the best possible shape to tolerte the surgery, and get you involved with a physical therapy team that could help post-op. Also his 6 month estimation would change if the shoulder get much worse, or at the end of 6 months was significantly, but not entirely better.

By the way, what type of preventative shoulder exercise program have you been doing over the last couple of years, and do you have any advice for the rest of us on how to prevent an injury?

 

[Say Chi Sin Lo]

Make sure you maintain the flexibility within the shoulder, keep doing your shoulder rotation exercises. Work out your rotator cuffs as much as the bigger shoulder muscles (deltoids etc.). You don't want imbalance within the joint, and have your deltoids etc. overwhelm the rotator cuff tendons.

 

[OldButGame]

Someone said 'no two shoulders are the same' (or something like that),...and i would agree. That having been said,...I had severe impingement and a partially torn labrum. They surgically took care of the impingement,....but left the labrum alone. Orthopedist told me it shouldnt be an issue....that the surrounding muscles should keep the shoulder 'stable' (instability of the shoulder would be a critical issue here). Long story short,.....i 'worked my *** off in physical therapy (as someone else very wisely suggested),.......and was back playing in about 4 mos. That was 2 years ago. Since that time my shoulder has only gotten better. I currently would never know i ever had a problem with it. And I have (very UNWISELY,)....been 'pushing the envelope lately,....and played every day the last 10 days, no rest....approx 2 hrs a day. I have some sore areas, but that shoulder is not one of them.

 

[Javizzle]

Thanks for all the info everybody, I'm going to get a second opinion soon. I think the truth in the matter is, for serious tennis players, playing almost comes secondary to fitness. Fitness is input, tennis is output, at the end of the day they should be even. I think I will try to really bulk up and work out a lot no matter what, because if I get the surgery, hopefully the fitter I am the more I will be able to deal with the scar tissue and inflammation. I really appreciate everyones help by the way, and i'l update my situation once I know more.
Thanks! God bless.

 

[polski]

You can play through a tear. At this point, you really can't do anything worse to it - you already need surgery. What I tell people is that if you can manage the pain to a point where it doesn't affect your life (school/work) by affecting your ability to sleep through the night - you can live with it. Once I reached the point where I couldn't sleep more than 2 hours at a time, I knew that I needed surgery.

I tore my labrum & rotator cuff in October 2007, re-aggravated it in April 2008 & finally got around to getting surgery in November 2008. I was back to light hitting in March 2009 & finally started playing full strength in July 2009 (when I turned 32 years old). By that time, my full range of motion had basically returned & I was playing the best tennis of my life.

If my injury had only been a strain or sprain, I would have shut down tennis for 2 to 3 months & just rehab'd. With a strain, you are not at a surgery need yet & it should be a goal to avoid it. Since you're at the point of a tear, screw it...just warm up well, play, ice & be smart about it.

As I said above, use sleep as your guide. If you can't sleep through the pain, that is when you get surgery.

 

[BMC9670]

You can play through a tear. At this point, you really can't do anything worse to it - you already need surgery.

To a point, but one should consult their surgeon on this. Mine told me I could hit ground strokes and do PT before surgery, but not to hit overheads or serves. He didn't want to make the tear worse as it could have meant more extensive work (more anchors and sutures) to repair the damage. This could mean more recovery time and more PT, more pain, etc, etc.

That was my experience, but again, consult the doctor before assuming you can do no more harm if your having surgery anyway.

 

[Say Chi Sin Lo]

To a point, but one should consult their surgeon on this. Mine told me I could hit ground strokes and do PT before surgery, but not to hit overheads or serves. He didn't want to make the tear worse as it could have meant more extensive work (more anchors and sutures) to repair the damage. This could mean more recovery time and more PT, more pain, etc, etc.

That was my experience, but again, consult the doctor before assuming you can do no more harm if your having surgery anyway.

But you're restricted to just groundstrokes for a reason, so why stress/agitate it even more?

 

[FiveO]

If you have access get a second and third opinion from purely sports surgeons who specialize in shoulders. I had mine repaired and it worked for me but with all the advances in surgery shoulder surgeries have probably the least assured outcome.

I still balanced mine against the inevitable. I shreded the underside of the rotator cuff and my biceps tendon was beginning to tear.

I inadvertently let it go too long having gotten use to "throwing shoulder pain" and later weakness. But by letting it go I developed the biceps tendon tear and because of that additional injury my arm had to remain in a sling, completely imobile for several weeks until the biceps tendon repair healed.

That complicated re-hab of the shoulder, per se. Regaining full range of motion in the shoulder was a bear and I happen to be blessed/cursed with a high pain threshold which complicated my surgery in the first place.

Good luck. Go to shoulder specialists and get multiple opinions.

I used a guy who had a great reputation for shoulders among some serious guys in the baseball community. In fact he did Frank Catalanotto's shoulder, at the time with the Toronto Blue Jays, the same day as mine and we ended up going to the same sports related P/T facility <ultra nice guy Frank and our surgeon>.

The choice is personal but for me, by unintentionally "putting it off" <via denial> removed whatever choice I may have had at one time, and greatly lengthened and complicated my recovery and rehabilitation.

5

 

[polski]

To a point, but one should consult their surgeon on this. Mine told me I could hit ground strokes and do PT before surgery, but not to hit overheads or serves. He didn't want to make the tear worse as it could have meant more extensive work (more anchors and sutures) to repair the damage. This could mean more recovery time and more PT, more pain, etc, etc.

That was my experience, but again, consult the doctor before assuming you can do no more harm if your having surgery anyway.

It's the labrum, not the cuff for the OP. The labrum is a small piece of cartiledge. The only way there could possibly be a recovery delay is if there is an additional injury to the cuff or bicep tendon - a seperate issue. Putting another anchor onto the labrum does not affect recovery time. One anchor or six, it's going to take 4-6 months to get full ROM and strength back. It's going to heal at a constant rate, regardless of how many anchors are sewed in. One anchor = 4 weeks in a sling. Six anchors = 4 weeks in a sling.

 

[BMC9670]

It's the labrum, not the cuff for the OP. The labrum is a small piece of cartiledge. The only way there could possibly be a recovery delay is if there is an additional injury to the cuff or bicep tendon - a seperate issue. Putting another anchor onto the labrum does not affect recovery time. One anchor or six, it's going to take 4-6 months to get full ROM and strength back. It's going to heal at a constant rate, regardless of how many anchors are sewed in. One anchor = 4 weeks in a sling. Six anchors = 4 weeks in a sling.

Again, not in my experience. I was in a sling for 6 weeks and was very stiff as more healing needed to be done before I could begin full PT. I'm not making an assumption, my OS told me not to make the tear worse as it "could" make recovery more difficult. I know others with labrum repairs and all had a little bit different experiences. They are not all the same is all I'm saying. Someone with this, or any injury for that matter, should consult the doctor before making assumptions that they can't make it any worse.

 

[BMC9670]

But you're restricted to just groundstrokes for a reason, so why stress/agitate it even more?

I simply did what he said I could, didn't push it, didn't do it if it hurt, etc. I did not play competitively before surgery and I did do PT to keep everything else in good condition going in. He wanted me to stay away from overhead motions as he said they would put stress on the injury and could further the damage, but groundstrokes would not stress it as I had done PT for 8 months and my shoulder was strong otherwise.

 

[tigerhoo]

partially torn labrum

I just had decompression/impingement surgery and "clean up" surgery for a partially torn labrum.

I had my month out post op appointment on Friday for acromin decompression/paritial labral and specifically asked about the torn labrum and got an answer that was not exactly what I would consider clear cut.

The doctor suggested that in years past torn labrum injuries had been over treated resulting in further complications. He also suggested that it common but generally a PT type regime best helps with this problem. It was a wishy washy answer imo at best, but rest and ROM exercises were reccomended.

My biggest problem is that I had a type 3 acromin that impinged the tendon, causing tendonitis and bursitis, and if left untreated would of led to a full cuff tear.

I would try the layoff and PT because it seems to be very little known about the effects of partial labral tears,and it is generally believed to be the best route for this problem, unless others exist.

 

[OldButGame]

^^^^ This was virtually the exact thing i had done,......I was really strict regarding the PT,....and i was back playing tennis 3 mos after the surgery,.......shoulder was a little tender first few times out,...gradually disappeard (tenderness),.....today it feels great,...100%,....i'd never know i had had a problem...or surgery.

 

[tigerhoo]

sorry, but 4th post on forum...

unaware, but sure there must be some type of edit function available.

Long story short, if nothing else other than a partial labral tear, then PT and strengthening training would be my first option, and surgery last result. I'm no doctor but my .02.

 

[Say Chi Sin Lo]

unaware, but sure there must be some type of edit function available.

Long story short, if nothing else other than a partial labral tear, then PT and strengthening training would be my first option, and surgery last result. I'm no doctor but my .02.

Yep, partial labrum tears are usually not repaired. At least that's what my surgeon at the time told me. But because I also had a partially torn supraspinatus, so he fixed both lesions if he's going to open me up.