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ubu
Jan 22, 2009, 12:12 AM
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About 1.5 years ago I managed to get a moderate SLAP tear in my right shoulder labrum from a mountain bike fiasco. My orthopedic doc suggested I try to build up the muscle through physical therapy in the hope that I could compensate for any instabilities. Well, after a couple months of PT I felt like new and went back to my routine.
Flash forward to this past Monday. I was climbing at the gym and blew a hold. I must have overcompensated, because I felt a dull pain in my shoulder coming off the hold. I had been having some slight discomfort for the past week (I thought from sleeping on the arm wrong) and initially wrote it off as nothing. I had increased discomfort while sleeping Mon night, and last night my shoulder felt just like it did after the initial SLAP injury: waking up every 5 min with a nasty ache that just wouldn't go away no matter how I adjusted things. I get a little "pop" when lifting my arm above shoulder height and from the feel of things today, I'm pretty sure I've managed to munge the same SLAP tear again. Overall motion is not really limited, and the pain isn't bad during the day, but things don't feel quite as stable as they should.
So...I guess I'm going back to my orthopedist. In the meantime I'm curious if anyone has experience with this scenario, i.e. trying to rehabilitate a moderate SLAP tear with PT only, no surgery. Am I likely facing some arthroscopic joy in my future, or is there hope for a non-surgical recovery?
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onceahardman
Jan 22, 2009, 6:50 PM
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Hi ubu...
It's a tough call...glenoid labrum (SLAP= Superior Labrum from Anterior to Posterior) doesn't heal very well, being avascular (no blood supply). As you have found, though, sometimes you can improve the stability to a satisfactory degree through intensive rotator cuff strengthening.
You need to continue keeping your cuff strong, though. Forever.
Many people (I'm not saying YOU) make the mistake of stopping cuff strengthening once they return to full function. When you do that, eventually, your cuff strength will revert to it's previous level.
You may well have increased the size of your SLAP lesion. Or maybe just "angry'd it up" a bit. ( no offense to angry).
Little is lost by trying a few weeks of cuff strengthening. It's generally better to go into surgery strong, rather than weak. You may well find that it improves again, and that you can forestall surgery, again. You won't know unless you try.
BTW, I get asked sometimes if a SLAP repair can tear again. Of course it can. If you apply the same force to the same tissue, you usually get a similar result.
The purpose of the labrum is to deepen the socket and improve joint surface congruity between the ball and socket. When it's torn, you lose some stability.
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ubu
Jan 22, 2009, 7:40 PM
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Many, many thanks for the input. I admit to being guilty of not focusing on keeping my rotator cuff strong after PT. In fact my therapist didn't give specific home exercises for this...in retrospect this seems strange and I should have pushed to get the right program to keep the cuff strong.
I'm keeping my fingers crossed that I just aggravated the tear a bit. The pain is not as bad I recall from the original injury, and range of motion seems ok -- just weak/unstable for some movements, particularly when lowering the arm from above the shoulder.
I'm stuck on travel this week but will be going back to the PT on Monday for advice on a strengthening program -- hopefully one I can do at home. Regardless I see your point: the best I can hope for is keeping the cuff strong to postpone things, hopefully indefinitely, i.e. long enough that I won't care about the instability/weakness any more...
...or until dilithium-powered robotic shoulder joints are perfected...
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bella
Mar 7, 2009, 2:42 AM
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I also recently found out I have a SLAP tear. I found out from an MRI report. I'm curious about experiences people may have had with either PT only, surgery only, or both. I'm not sure I want to get surgery at this point. Are there any success stories from this type of injury? My doc told me I will never be 100% but I don't want to believe that.
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ubu
Mar 7, 2009, 4:18 AM
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bella wrote: I also recently found out I have a SLAP tear. I found out from an MRI report. I'm curious about experiences people may have had with either PT only, surgery only, or both. I'm not sure I want to get surgery at this point. Are there any success stories from this type of injury? My doc told me I will never be 100% but I don't want to believe that.
All I can do is update you on my experience. My first SLAP injury was from a well-defined trauma that caused so much pain I was unable to sleep more than 2-3 hrs/night for the first couple weeks. After the SLAP diagnosis my orthopaedist told me the common perception is that very few people recover without surgery, but that this is not the case; it's likely that many people rush (or get rushed) into surgery without needing it. In my case a month of PT was enough to get me back to what felt like 100%, or close to it.
My recent re-injury (6 weeks now) was 1.5 yrs after the original. At first I thought it wouldn't be too bad, but the pain just wouldn't go away with PT. So I stopped PT last week, and lo and behold, now I feel much better after 5 days of pure rest. I am optimistic about getting back on the rocks by late April. 100%? I have no idea, but considering how well things went the first time I am optimistic. Of course the real lesson for me is that (as oneahardman noted) it is imperative to keep the rotator cuff muscle set as strong as possible. I fully expect to be doing the appropriate excercises daily for the rest of my active life. A small price to pay for avoiding the knife, imo, and with good collateral benefits.
Of course this is just from my own experience, but my recommendation is to try PT, rest if the pain is recurrent, and see how far you can push it. You can always have surgery, but once you go down that path there's no return. I'm sure the pros here can tell you better and more relevant info. Keep in mind that SLAPs are not at all uncommon, indeed most people over 40 have some degree of damage to their shoulder joint labrum, so it's not the end of the world if your tear is not severe.
Good luck! I'd be interested to hear how things turn out for you.
(This post was edited by ubu on Mar 7, 2009, 12:13 PM)
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bella
Mar 7, 2009, 4:47 PM
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Thanks so much for the reply, it gives me hope to talk to others who have resumed climbing.
My doc is a surgeon and of course surgery is the only option we discussed on my first visit. I've never had surgery before and I am hoping I don't have to now. With that said if it needs to be done then I will do it. Climbing is obviously the most important thing, whatever gets me back to climbing is what I will do.
I only have an MRI report at this point to give me insight into what is going on. I am going back to see the doc this Wednesday and hope to have a bigger picture idea at that point. I would like to try PT first and see how that goes. However, I am worried since I waited so long to get this checked, I may have made it worse. Hueco was my objective for the past few months and now I have no trip to focus on and it seems like perfect timing to deal with it.
I will definitely keep you posted on how things go for me.
Please keep me posted on your shoulder as well.
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ubu
Mar 7, 2009, 5:05 PM
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I was fortunate to find a shoulder specialist who advocates conservative treatment first. Ask your orthopaedist about the severity of the tear, and the lesion type as well, and ask for his opinion on how similar cases do taking a conservative approach. Regardless, don't go into surgery lightly. Check out some of the horror stories on slaptear.com about poor surgical outcomes.
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bella
Mar 7, 2009, 5:12 PM
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Those are some good suggestions. I'm almost afraid to check out the horror stories. I'm not in the most positive place about this right now, so i'll wait on that :) I just have so many questions and know so little about all of this that I am a wreck about it right now. This is what I know so far:
IMPRESSION:
1. SLAP tear with extension into biceps tendon (type IV SLAP tear) and
associated paralabral cyst.
2. Rotator cuff tendinopathy without evidence of tear.
3. Anatomy that can predispose to subacromial impingement.
4. Subacromial/subdeltoid bursitis.
I am hoping to see my shoulder specialist on Wed and get idea of what he thinks then get a second opinion.
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ubu
Oct 19, 2009, 6:19 PM
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Just a quick update. After about 7 months of PT and at-home rotator cuff exercises, today was my first day climbing again. Just some nice & easy gym routes to ease back into things. I still have some impingement that limits what I can do, but overall I am happy to report that my shoulder feels great! About 3 months ago my orthopedist had started pushing for surgery. I declined since every week there was slight improvement, and I thought it best to just keep chugging along. This turned out to be a good choice in my case.
Now I'm thinking about trying massage therapy to reduce the impingement issues, but I can live with the current state of affairs if nothing helps.
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lizardontherocks
Oct 20, 2009, 3:18 AM
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I had a slap II tear two years ago and have had similar experiences as you. I took 3 months off from climbing, did PT and strengthening exercises and resumed climbing. A year later, I re-injured my shoulder and did the same treatment. So far, I have had good results. My doc said to test the shoulder climbing before surgery and I have climbed now for about a year and a half with great results. The key seems to be moderation and listening to my body. I am careful on severely overhanging routes and try to use my feet better, and I climb more slab, or vertical to slightly overhanging routes. Friends do let friends climb slab. I usually climb 2 days and rest 2 or more if necessary. I try to limit reaching on severely outstretched arms, especially to the sides. Another thing that has greatly helped me is the mental side of healing. When I was first injured, I was severely depressed and seemed to obsess on the injury and not climbing. When I finally accepted that this injury is now a part of me, I started to get much better. I let go and just accepted it. Healing is a matter of time, but it is also a matter of opportunity. Maybe there is something to learn in the situation. Slowing down can be allright, at least you can still climb. Also, the more I have climbed, the stronger I have become, as my other muscles have compensated for the injury, similar to yours. Just don't overdo it. Moderation, rest and acceptance. These are the keys.
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eastvillage
Oct 20, 2009, 4:28 AM
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My experience is similar to what others have said.
I tore my labrum 2 years ago at the Gunks on a 5.6. (which I was forcing and not climbing smoothly.
MRI and Ortho said I did not want to have shoulder surgery - very long and painful recovery. PT for 3 months then it seemed to get better but I did not try any really overhanging stuff.
Fast forward to this spring and an unfortunate chain of events led my injured side to become a "frozen shoulder" with pain and very limited movement. New MRI confirmed no add'l tear.
Then I had to go through very painful PT of strecthing right into the pain and limitation. Owie! After 3 months range of motion returned and it feels pretty good.
I know I will be doing cuff and back strengthening exercises for EVER.
The good news is that I'm in Boulder this week till 10-22 and looking for partners for the Flatirons.
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ubu
Oct 20, 2009, 10:56 AM
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lizardontherocks wrote: I had a slap II tear two years ago and have had similar experiences as you. I took 3 months off from climbing, did PT and strengthening exercises and resumed climbing. A year later, I re-injured my shoulder and did the same treatment. So far, I have had good results. My doc said to test the shoulder climbing before surgery and I have climbed now for about a year and a half with great results. The key seems to be moderation and listening to my body. I am careful on severely overhanging routes and try to use my feet better, and I climb more slab, or vertical to slightly overhanging routes. Friends do let friends climb slab. I usually climb 2 days and rest 2 or more if necessary. I try to limit reaching on severely outstretched arms, especially to the sides. Another thing that has greatly helped me is the mental side of healing. When I was first injured, I was severely depressed and seemed to obsess on the injury and not climbing. When I finally accepted that this injury is now a part of me, I started to get much better. I let go and just accepted it. Healing is a matter of time, but it is also a matter of opportunity. Maybe there is something to learn in the situation. Slowing down can be allright, at least you can still climb. Also, the more I have climbed, the stronger I have become, as my other muscles have compensated for the injury, similar to yours. Just don't overdo it. Moderation, rest and acceptance. These are the keys.
Yup, agreed on all points, particularly acceptance. I was very bummed over the first few months. Ok, more like the first 6 months, especially after the ortho told me PT wasn't working and it was time to consider surgery. One of the more therapeutic things for me was reading several of the more serious injuries reports, seeing how people pulled through, and realizing that a bit of dysfunction in the shoulder is really a very minor thing. I plan to take it very slow and focus on being exquisitely deliberate in all of my movements, recognizing that there are some new limitations on what my right arm can do. I can live with that.
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ubu
Oct 20, 2009, 11:02 AM
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eastvillage wrote: I know I will be doing cuff and back strengthening exercises for EVER.
Sucks, huh? But in a way I've come to enjoy this. My RC is stronger that ever, which feels great on its own, and the stretching/strengthening routine forces me to think about other aspects of my health that used to go ignored.
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