Torn Labrum, Torn rotator cuff

[BR1217]

Mate, please post a pic of your torso so I can see your posture, if you want some more evaluations. Leave the shirt off. Take one from the side and one that shows the back relaxed (need to see position of the scapula when relaxed)

This really sounds like frozen shoulder due to rotator cuff and scapularstabilizer-inhibition to me, but it's hard to say without actually being with you in person.

I will take pics this evening and post. Would this be in addition to the torn labrum and torn rotator cuff I have or an effect from the torn labrum/torn rotator cuff?

 

[kjetil1234]

I will take pics this evening and post. Would this be in addition to the torn labrum and torn rotator cuff I have or an effect from the torn labrum/torn rotator cuff?

I'm sorry, I was under the impression that you already had surgery and that the SLAP tear was fixed. I see now that you still have an issue with a loose tendon in the bicipital groove.
Well, as doc said, it's likely the cause of the slap in the first place. When the humeral head is allowed to elevate in the glenoid fossa, the bicep's attachment to the labrum may tear and the labrum with it. The impingement is likely the cause of this.

Doc also stated that it's difficult to successfully operate and reattatch the tendon to the bicipital groove because it will grow in a faulty manner. Now, tendinosis (degeneration) of the tendon is due to constant friction as a result of impingement (humerus scarping on the acromion). Getting the humerus back in axis will solve this and the tendon will heal up in time (though it'll still be loose, if the transverse ligament that holds it in place has been ripped (if I got your information correctly)). Painkillers (NSAIDS) however, will ruin the natural inflammation of the tendon and stop the healing process!!!

If the labrum is already healed up, the first priority will be to have the humeral head in axis at all times. Meaning perfectly balanced rotator cuff, adequate mobility and a functioning scapula.

 

[dr jim]

I'm sorry, I was under the impression that you already had surgery and that the SLAP tear was fixed. I see now that you still have an issue with a loose tendon in the bicipital groove.
Well, as doc said, it's likely the cause of the slap in the first place. When the humeral head is allowed to elevate in the glenoid fossa, the bicep's attachment to the labrum may tear and the labrum with it. The impingement is likely the cause of this.

Doc also stated that it's difficult to successfully operate and reattatch the tendon to the bicipital groove because it will grow in a faulty manner. Now, tendinosis (degeneration) of the tendon is due to constant friction as a result of impingement (humerus scarping on the acromion). Getting the humerus back in axis will solve this and the tendon will heal up in time (though it'll still be loose, if the transverse ligament that holds it in place has been ripped (if I got your information correctly)). Painkillers (NSAIDS) however, will ruin the natural inflammation of the tendon and stop the healing process!!!

If the labrum is already healed up, the first priority will be to have the humeral head in axis at all times. Meaning perfectly balanced rotator cuff, adequate mobility and a functioning scapula.

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It's really difficult for me, and I've no doubt the OP, to understand what exactly you believe is the most APPROPRIATE course for the OP at this juncture?

I mean it's clear your not reading the entire thread from beginning to end and are now requesting total body "torso" pics, what's the point in one sentence or less?.

What are you suggesting is the best therapy, or are you implying you must "see" TID members for a final analysis? I hope not!

Jim

 

[dr jim]

If it's only on the heavy movements then I doubt it. Get the labrum checked out. If it's intact, you should look at the rotator cuff activation (you should start that right away if you're not in pain).
Hope this helps.

"Rotator cuff activation" now what is that exactly?

 

[kjetil1234]

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It's really difficult for me, and I've no doubt the OP, to understand what exactly you believe is the most APPROPRIATE course for the OP at this juncture?

I mean it's clear your not reading the entire thread from beginning to end and are now requesting total body "torso" pics, what's the point in one sentence or less?.

What are you suggesting is the best therapy, or are you implying you must "see" TID members for a final analysis? I hope not!

Jim

Hi Jim,

Yes, I write in many threads and sometimes I forget details. My point for the pics was, because I'm not able to palpate, to look for any sign of dysfunction: scapular winging, rhomboid dominance, lazy shoulder, pec minor dominance, excessive internal rotation, poor thoracic mobility or posture, etc.

Sometimes it will help a lot to look at the patients posture to determine if your thoughts are correct or not. In real life you got certain tools at your disposal, and on the internet not. Gotta make the best of it, right?

My advice for OP was solely tips to keep the humerus centrated in GF, nothing else. I wasn't disputing any of your information.

Rtc activation I consider two things, the actual muscle strength (manual muscle testing) and how the muscles fire during movement. For example, a strong serratus anterior still sometimes behaves dysfunction ally, when it releases the scapula early in eccentric shoulder flexion movements and allow it to depress. Or gluteus medius allowing the TFL to substitute.

My point: could be a strength issue, could be a motor control issue. Both will have to be assessed for a better diagnosis. If, say, the teres major or lats are substituting for a dysfunctional subscap for example, it won't matter if it's strong or not when it's not being activated in the movement. That's why I always teach my clients (especially the ones in pain) to lock their shoulderblades in.

Again, I haven't disputed any of your posts. Rather, I really enjoyed reading them and I learned some new things. I also referred to your posts in my explanation that you quoted. So I hope I didn't step on your feet or anything like that, doc.

This is my hobby by the way, I am here to learn and contribute, not to challenge or argue with anyone. So I hope my posts were perceived as just that.

Best regards to you doc,
Kjetil

 

[dr jim]

Hi Jim,

Yes, I write in many threads and sometimes I forget details. My point for the pics was, because I'm not able to palpate, to look for any sign of dysfunction: scapular winging, rhomboid dominance, lazy shoulder, pec minor dominance, excessive internal rotation, poor thoracic mobility or posture, etc.


Sometimes it will help a lot to look at the patients posture to determine if your thoughts are correct or not. In real life you got certain tools at your disposal, and on the internet not. Gotta make the best of it, right?

My advice for OP was solely tips to keep the humerus centrated in GF, nothing else. I wasn't disputing any of your information.

Rtc activation I consider two things, the actual muscle strength (manual muscle testing) and how the muscles fire during movement. For example, a strong serratus anterior still sometimes behaves dysfunction ally, when it releases the scapula early in eccentric shoulder flexion movements and allow it to depress. Or gluteus medius allowing the TFL to substitute.

My point: could be a strength issue, could be a motor control issue. Both will have to be assessed for a better diagnosis. If, say, the teres major or lats are substituting for a dysfunctional subscap for example, it won't matter if it's strong or not when it's not being activated in the movement. That's why I always teach my clients (especially the ones in pain) to lock their shoulderblades in.

Again, I haven't disputed any of your posts. Rather, I really enjoyed reading them and I learned some new things. I also referred to your posts in my explanation that you quoted. So I hope I didn't step on your feet or anything like that, doc.

This is my hobby by the way, I am here to learn and contribute, not to challenge or argue with anyone. So I hope my posts were perceived as just that.

Best regards to you doc,
Kjetil

Dysfunctional scapular winging, rhomboid dominance, rotary slippage, or fascial dys-synergy, who cares at this point because the OP has a labral and RTC tear proven by an MRI. Those conditions MANDATE surgery for a functional outcome in any athlete. Are you suggesting otherwise?

I mean if your implying your "pics" will modify the OPs therapy now or in the future it would be great if you could post scientific studies which support such methods..

Finally understand although you may consider advising others about medical therapeutics on forums "your hobby" some may take your suggestions much more seriously believing you have some form specialized educational training!

To that end, because you have mentioned your "practice" (or are you eluding to some "hobby") on several occasions, it would be most helpful if you would post your educational background as any professional would have done from the outset .

Regs
Jim

 

[kjetil1234]

Dysfunctional scapular winging, rhomboid dominance, rotary slippage, or fascial dys-synergy, who cares at this point because the OP has a labral and RTC tear proven by an MRI. Those conditions MANDATE surgery for a functional outcome in any athlete. Are you suggesting otherwise?

I mean if your implying your "pics" will modify the OPs therapy now or in the future it would be great if you could post scientific studies which support such methods..

Finally understand although you may consider advising others about medical therapeutics on forums "your hobby" some may take your suggestions much more seriously believing you have some form specialized educational training!

To that end, because you have mentioned your "practice" (or are you eluding to some "hobby") on several occasions, it would be most helpful if you would post your educational background as any professional would have done from the outset .

Regs
Jim

No, I agree with you.
Some confusion on my behalf, as I thought OP already had the surgery but was still in pain due to a misaligned tendon. I see now that there was another username who had the surgery done and not OP...

This forum doesn't show any avatars (from tapatalk), so I guess that's why I got it mixed up.

The pics were just for getting an idea of the OP's alignment, as I'm obviously not able to perform any tests on him. Which I still consider important btw, as muscular stabilization of the humeral head will be most important avoid being reinjured. Do you disagree?

Proper GH and scapular articulation will reduce wear and tear.

I'm a personal trainer, not a medical professional. Sensing a bit of hostility from you doc? I don't see any reason for it, nor do I appreciate it.

Either way, have a nice day.

 

[muddog69]

I had that done. Put a plate in my shoulder and reattached my bicep in April. Back to lifting now....Not up to full strength but making good gains. The surgery wasn't too bad... used my meds and was good to go. I actually tore off the front of my rotator along with the bicep tendon.