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Old 10-26-2008, 12:16 PM   #1
Davis Hart
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Labral tear and recovery

For years I have experienced shoulder pain on and off. The pain has always felt like extreme soreness of the front deltoid, more in the right than the left shoulder. I only felt it after certain shoulder workouts, such as the Crossfit press/push press/jerk triplet, but not consistently. For a long time, I just lived with it.

Last April, after tearing a callus doing a long pullup workout, I decided to try parallette HSPUs for the first time. I went deep for a number of reps, and felt fine the rest of the day. The next day, the pain was back a bit stronger than ever before. I laid of pushing exercises for months, continuing to do pull-ups, cleans, kettlebell swings, and deadlifts pain-free. By July, I was just starting to get back to HSPUs and dips.

At that time, after changing jobs and activating new health insurance, I decided it was time to have the condition checked out. The PT got me started on the standard prescription of mobility exercises, ultrasound, etc. He banned me from any shoulder exercise. In August, I had an MRI, and the diagnosis was:

1. Small tear of the anterior labrum
2. Bone marrow edema in the posterior humeral head in association with truncation of the posterior labrum (may be consistent with chronic posterior impingement)
3. Stripping of the anterior capsule
4. Small amount of bursitis

The ortho and I agreed that surgery would be premature (I donít want it anyway).

I have started to get back into shoulder work, primarily in terms of pushups. However, my shoulder now pops and clicks a lot more than ever before (especially pull-ups, of which I done maybe 20 since July). I have also found it much more sensitive and prone to pain. As I think Crossfitters can understand, this is very frustrating because I donít feel like Iíve made any progress in my recovery, and I fear that I will never get back to the level I was at. Moreover, the fact that I was doing HSPUs before I started seeing the PT only adds insult to injury (pardon the pun).
So I have a few questions for the community:

1. How aggressive should I be in ramping up exercises (specifically, slow and methodical ramping, or ramp as fast as the soreness/pain are not present)?
2. Other than stretching the shoulder capsule and rotator cuff exercises, any other things I should be doing?
Thanks!
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Old 10-27-2008, 03:17 PM   #2
Scott Jones
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Re: Labral tear and recovery

Davis,

The PT mention bothers me. Sorry about that. Clearly, this individual was not an orthopedic or sports board certified specialist or he/she would not have thrown this "shotgun" approach at you.

There is a lot here, and it will definitely take some expertise to work through it if you want to go the conservative route.

I will say up front that while I'm about as opposed to the surgical route as you can get, for your level of athletecism you may end up finding that the surgical route is ultimately the best way to go.

You have to first be most concerned with recovering a full ROM that is pain free.

Based on your MRI, you've likely had varying levels of inflammatory processes for quite some time. The clicking and popping is likely joint degeneration (osteo-arthritis, which we all have to some degree - it's just wear and tear over time) as a result of the injuries as your body tried to heal itself. The popping and clicking may be nothing but that. Is the popping and clicking pain free? If so, proceed with caution. If you have periods of joint "catching" followed by clicking and popping with pain (and even feelings of joint swelling) then it's probably a result of damaged soft tissue in the joint, and you should go talk it over again with your orthopedic surgeon.

I will say the chronic posterior impingement is a huge red flag for me. If you do have this, then you also have some type of underlying and fundamental biomechanical movement dysfunction that may be the ultimate culprit for all this. If this is the case, you will definitely need a good sports/ortho PT to prescribe exercises that address this movement dysfunction. If you do end up having surgery, the movement dysfunction may just end up chewing away at the repair.

Hope that helps,
Scott
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Old 10-28-2008, 07:28 AM   #3
Davis Hart
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Re: Labral tear and recovery

Scott - Thanks for your reply, it was incredibly helpful. I don't have training in the field which makes it hard to judge the quality of the PT. He has said that the stretches and exercises are chosen/designed to increase ROM (particularly internal rotation) and strengthen the muscles around the joint. So far, he seems to be pleased that swelling in the long head of the biceps tendon is decreasing. Otherwise, I keep doing the exercises (which he has been varying) and stretches.

The popping I feel is rarely associated with pain, either during or after. I suppose that the healing of the last few months combined with avoidance of a variety of shoulder movements I used to do may have created new pops and clicks. I have and will continue to proceed with caution.

Thanks for your comment about the posterior impingement, which gave me great pause. The possibility that the root cause of all of this is not necessarily the tear, but a fundamental biomechanical issue, both frustrates me because no one has mentioned it before and also gives me some hope that I can gain more clarity on how to go forward. I think the next step is to take the diagnosis to a different ortho who is willing to talk to me for more than 5 minutes about it. I will try to contact local sports professionals (crossfit affiliate, oly coaches, etc.) to get recommendations.

Thanks again, Scott.
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Old 10-29-2008, 12:23 PM   #4
Scott Jones
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Re: Labral tear and recovery

I think pursuing the posterior impingement might be a good idea.

Try to find someone (it will take some work) who works with overhead athletes (baseball, volleyball, etc).

The easiest way to do this is call a local high-school/university (preferably university) with a good baseball or volleyball program and ask them what orthos and PTs they send their athletes to.

Good luck,
Scott
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Old 02-03-2009, 08:06 PM   #5
Jared Hendee
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Re: Labral tear and recovery

Reading this thread to find out about labral tears but I will recomend that you try getting Rolfed for treatment of biomech issues. Rolfing has really helped me.
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Old 02-05-2009, 12:47 PM   #6
Davis Hart
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Re: Labral tear and recovery

Thanks, Jared. Going to see a ortho next week who works with a baseball team and likely sees these types of injuries often. Will certainly look into rolfing as well as trigger point, etc. once I get his opinion.
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Old 02-05-2009, 01:10 PM   #7
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Re: Labral tear and recovery

Quote:
Originally Posted by Davis Hart View Post
Thanks, Jared. Going to see a ortho next week who works with a baseball team and likely sees these types of injuries often. Will certainly look into rolfing as well as trigger point, etc. once I get his opinion.
How is your scapular mobility (elevation, protraction, retraction, depression)?

If the scapulae aren't moving that well that can definitely lead to some impingement especially with chronic inflammation.

Also, I would get your internal and external rotation movement checked. If you have some deficiencies there it would indicate certain problems. For example, in throwing sports such as baseball pitches often have impaired mobility especially in internal rotation in their throwing arm. This limit of ROM can lead to tight muscles and imbalance and thus to pain and injury.

A good PT/ortho should be able to evaluate these things... so hopefully that one you know that does the baseball team will be able to help ya.
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Old 02-21-2009, 03:11 PM   #8
Davis Hart
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Re: Labral tear and recovery

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Originally Posted by Steven Low View Post
How is your scapular mobility (elevation, protraction, retraction, depression)?

If the scapulae aren't moving that well that can definitely lead to some impingement especially with chronic inflammation.

Also, I would get your internal and external rotation movement checked.

Thanks everyone for your thoughts and recommendations. Steve, I *think* mobility is OK. No PT/ortho has suggested otherwise, and my scapulae move quite a bit for the rehab exercise. Elevation might be the worst of them all, but that could be from traps weakened by nearly a year without significant overhead work. Any tips on how to check mobility or references that will help me understand "normal" mobility?

I saw the ortho last week, and he gave me a slightly different diagnosis than the first: a SLAP tear. I don't know how to check if he is right, but he reviewed the MRIs and did a slew of diagnostics, including comparing right shoulder (injured) to left (healthy). We could both see the differences in ROM, flexibility, and pain resulting from palpitation. He recommended surgery if I want it to get better. I will probably get around to the surgery in the fall as I want to be outside and active this summer, even if that means less/light OH work.

Of course, my knee has been hurting for a few weeks now after a 5RM PR squat. My injury rate is beginning to bother me, and I am now tweaking the diet by adding fish oil for omega3, and trying to consume more fats.

Thanks again everyone.
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