Torn Labrum, Torn rotator cuff

[dr jim]

Doc, do they not rebuild the attackment in BCgroove during slap-surgery?

I suspect one important point to remember about the G-H joint is that while the glenoid capsule, which is formed by the rotator cuff muscles "wraping around" the humerus provides MOBILITY, the labrum ensures STABILITY.

This is an extremely important function since only 20-30% of the humerus is in contact with BONE, something must keep it there and that is the function of the labrum.

Thus absent a fully functional labrum, which tightly pulls the humerus over the bony glenoid, subluxation can become an everyday occurrence to varying degrees, depending upon the SLAP GRADE.

Indeed SLAP tears allow for even greater translation of the humerus superiorly worsening impingement remarkably which is why the SLAP and the A-H outlet MUST BE repaired simultaneously for an optimal outcome. And conversely for the same reason, the BT transfer may be delayed in NON-THROWERS.

'Tthrowers" are somewhat different because they typically develop a SLAP tear by literally pulling the BT off the labrum. This is one instance in which both surgeries, BT transfer and a SLAP repair, may be performed simultaneously. However since the forcers generated by the biceps itself in throwers is less than 5% many simply don't miss the diminished strength especially after "retraining" is completed.

Regs
jim

 

[kjetil1234]

Thanks for that, doc. Surely though, the rotator cuff is responsible for keeping the humeral head stable and centrated in the glenoid fossa during motion, keeping the primary movers from pulling the humeral head out of axis, and not just the labrum. Or did I misunderstand?

 

[dr jim]

Thanks for that, doc. Surely though, the rotator cuff is responsible for keeping the humeral head stable and centrated in the glenoid fossa during motion, keeping the primary movers from pulling the humeral head out of axis, and not just the labrum. Or did I misunderstand?

Sure but WITHOUT the labrum and its attachments the mobility would be excessive especially to loaded resistance. Want some evidence ask anyone who has an ISOLATED SLAP tear. The joint simply feels "unstable", because the translation-motion allowed by the RC muscles becomes excessive.

It's akin to the knee itself while the muscular attachments provide mobility the ligaments provide the stability. Want some evidence ask anyone who has had a torn ACL.

BUT no doubt for a fully functional joint both stability and mobility are mandatory and I'm NOT suggesting the knee or RTC muscles are not knee or shoulder respectively stabilizers at all, but rather referring to their primary function.

jim

 

[kjetil1234]

Sure but WITHOUT the labrum and its attachments the mobility would be excessive especially to loaded resistance. Want some evidence ask anyone who has an ISOLATED SLAP tear. The joint simply feels "unstable", because the translation-motion allowed by the RC muscles becomes excessive.

It's akin to the knee itself while the muscular attachments provide mobility the ligaments provide the stability. Want some evidence ask anyone who has had a torn ACL.

BUT no doubt for a fully functional joint both stability and mobility are mandatory.

jim

Definitely believe you doc! Just wanted an explanation for my personal educational purpose.

Thanks again!

 

[dr jim]

Sure but WITHOUT the labrum and its attachments the mobility would be excessive especially to loaded resistance. Want some evidence ask anyone who has an ISOLATED SLAP tear. The joint simply feels "unstable", because the translation-motion allowed by the RC muscles becomes excessive.

It's akin to the knee itself while the muscular attachments provide mobility the ligaments provide the stability. Want some evidence ask anyone who has had a torn ACL.

BUT no doubt for a fully functional joint both stability and mobility are mandatory and I'm NOT suggesting the knee or RTC muscles are not knee or shoulder respectively stabilizers at all, but rather referring to their primary function.

jim

The fact is often if impingement syndrome is left untreated the end result is a Supraspinatus tear, which most certainly can destabilize the joint. This generates forces which stresses the labrum such that a SLAP tear may occur. So of course the RCM also provide stability to the shoulder joint, as does the knee musculature.

Ok I'm done splitting these hairs, lol

Regs
JIM

 

[kjetil1234]

The fact is often if impingement syndrome is left untreated the end result is a Supraspinatus tear, which most certainly can destabilize the joint. This generates forces which stresses the labrum such that a SLAP tear may occur. So of course the RCM also provide stability to the shoulder joint.

Ok I'm done splitting these hairs, lol

Regs
JIM

Definitely agree with you doc. I see lagging external and internal rotators quite often in my clients, aswell as inability to posteriorly tilt the scapula and lock it in that position (serratus anterior inhibited). Impingement and elevation of the humeral head in the GF will inevitably cause damage.

Thanks again for the clarifications !

 

[BR1217]

An Arthrogram? Interesting because the information obtained does NOT reveal WHY the fraying is occurring.

Whatever!

This is what I would suggest you consider AND ask your surgeon about.

Have the Acromio-Humeral outlet decompressed and what is probably a SLAP lesion repaired.

If A-H impingement is the etiology of your fraying, which it likely is, then the fraying and pain will be effectively treated. However if an abnormality of the BC grove is causative then only partial relief would be noted.

Why partial relief? Because the primary cause of impingement pain is the humerus scraping underneath the A-H which frays the Supraspinatus tendon AND the Biceps tendon in some folk.

Personally based on the info you have provided (Thx) I believe the tendon transfer should be delayed pending the outcome of your decompression. The disadvantage of course is you COULD need two surgeries but I think that's a small price to pay considering risk of reduced strength, ESPECIALLY in BB where the literature is fully inadequate, IME.

Understand what and WHY of my suggestion mate?

Regs
Jim

Sorry Doc, I had an MRI and xrays prior to having the Arthrogram.

 

[BR1217]

An Arthrogram? Interesting because the information obtained does NOT reveal WHY the fraying is occurring.

Whatever!

This is what I would suggest you consider AND ask your surgeon about.

Have the Acromio-Humeral outlet decompressed and what is probably a SLAP lesion repaired.

If A-H impingement is the etiology of your fraying, which it likely is, then the fraying and pain will be effectively treated. However if an abnormality of the BC grove is causative then only partial relief would be noted.

Why partial relief? Because the primary cause of impingement pain is the humerus scraping underneath the A-H which frays the Supraspinatus tendon AND the Biceps tendon in some folk.

Personally based on the info you have provided (Thx) I believe the tendon transfer should be delayed pending the outcome of your decompression. The disadvantage of course is you COULD need two surgeries but I think that's a small price to pay considering risk of reduced strength, ESPECIALLY in BB where the literature is fully inadequate, IME.

Understand what and WHY of my suggestion mate?

Regs
Jim

I understand the idea you are conveying. I will research this some more. Thanks for all your time Doc! I really appreciate it!

 

[BR1217]

Sure but WITHOUT the labrum and its attachments the mobility would be excessive especially to loaded resistance. Want some evidence ask anyone who has an ISOLATED SLAP tear. The joint simply feels "unstable", because the translation-motion allowed by the RC muscles becomes excessive.

It's akin to the knee itself while the muscular attachments provide mobility the ligaments provide the stability. Want some evidence ask anyone who has had a torn ACL.

BUT no doubt for a fully functional joint both stability and mobility are mandatory and I'm NOT suggesting the knee or RTC muscles are not knee or shoulder respectively stabilizers at all, but rather referring to their primary function.

jim

Is this the reason that I feel like my shoulder is "moving" around while doing heavy pressing movements? Last time I benched I felt like my shoulder almost gave out completely. Felt like it "slipped" and all my strength was gone. That was two weeks ago and I have not done any free weight movements since.

 

[kjetil1234]

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.

 

[BR1217]

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.

It is only on the heavy pressing movements, flat bench in particular. The shoulder has been so bad lately that I have a hard time raising my arm to the side when putting on deodorant. Its almost like something is preventing it from moving in that direction. I can still raise my arm if I keep it tight to my body and lift it straight up then out. Any movement like barbell rows for the shoulders is completely out of the question at this point. I cant even complete this motion without any weight. All of my other lifts are becoming painful though, pulls, legs. I have to do pulling exercises with my arm tight to my side with a neutral grip though. I only do pull ups with neutral grip and arms are shoulder width, nothing wider than shoulders, nothing without a neutral grip. Squats hurt my shoulder like crazy. Anyway thanks for the info! Appreciate it!

 

[kjetil1234]

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.