Study of Superior Labral Tears Shows Needs for Judgment in Treating the Condition

Study of Superior Labral Tears Shows Needs  for Judgment in Treating the Condition Blog  Shoulder Pain Labral Tear

The number of superior labral surgical procedures in the United States has increased in the last decade. However, this increase may be somewhat due to the greater use of MRI imaging in diagnosing this type of injury. A recent study also shows the need for displaying caution when treating a labral tear in the shoulder.

The Basics of a Superior Labral Tear

A superior labral tear is an injury affecting the labrum, which is the area of cartilage surrounding the socket of the shoulder joint. First identified in the 1980s, the condition was largely considered a sports injury found primarily in baseball players. Previous studies, in fact, concentrated on this specific group of athletes but largely ignored the rest of the population.

In addition to throwing a baseball, falls and heavy lifting can precipitate a labral tear in the shoulder. The symptoms of this type of injury include shoulder pain and popping sounds emanating from the affected area.

The Results of the Latest Study

The study was conducted on 53 men and women aged 45 to 60 years, none of whom had experienced either shoulder surgery or an injury to the area. The participants were subjected to physical examinations and MRI imaging. In order to assure objectivity, two of the musculoskeletal radiologists who conducted the imaging were unaware of the purpose of the study.

Respectively, the doctors found indications of a labral tear in the shoulder in 55 and 72 percent of the participants. No statistical differences were found based on the issues of age or sex, or whether the individual had a history of physical labor or participated for at least a year in sports that involved overhead throwing.

Treating Injuries and Related Shoulder Pain

The study to determine the prevalence of superior labral tears shows the need for using careful judgment when considering treatment options. In trying to avoid unnecessary procedures, doctors should realize that such injuries may be normal in middle-aged men and women.

Medications or the use of hot or cold treatments are known to be useful in dealing with shoulder pain associated with such injuries. Although surgery is sometimes required, shoulder physical therapy may suffice in many other cases. This type of treatment will emphasize the strengthening of tendons and muscles in the area for the purpose of reducing shoulder pain.

In using such noninvasive procedures as shoulder physical therapy, the doctor or therapist can teach their patients certain exercises, possibly allowing the sufferers of superior labral tears to treat themselves.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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