Labral Tear Evaluation (Shoulder)

[@cheriemcmurry9490]

i don’t want to be out of line and ask for “free” help but i was hoping for advice lol? i shattered the ball/humerus of my shoulder from a car accident and received 8 screws and one plate, this was Sept of 2021 and didn’t get surgery till Oct of 2021. I complained about pain, the pain wasn’t subsiding with PT or just in general as my injury aged. Finally my Dr listen to me and ordered a MRI. Turns out the there was a labrum tear but i never saw the imaging nor was it explain. He simply told me that there was a tear but nothing he felt he could do, due to the surgery i had just had. He told me to go to PT but it got to the point where it was so painful due to my lost of motion and strength DESPITE being consistent for over 6 months. Finally i just quit asking for help because i somewhat felt discriminated against because of my age. I’m 23 and was told because of my age that i shouldn’t have any issues but the dr who took the MRI said she had only saw breaks like mine on people 80 or older. My symptoms are… 1) PAIN! it’s like fireworks of pain. It’s like it sparks in my shoulder blade and explodes spreading through my whole arm to my elbow. 2) My arm is now shorter then the one without the break. 3) my elbow feels like it’s catching. I lift something heavy and it locks up for about 15 seconds. 4) when i move my arm i can feel the clicking of cartilage and muscle. Any suggestions? I also have a spinal tumor that’s can’t be operated on and that pain takes a toll on me but i deal because there is no solution. I don’t think i can keep living like this. Please 😅

[@michaelgiordano3757]

Has it gotten better ?

[@ErinM-2024]

I’ve had bicep pain for 3 years. Finally! Had a Ct arthrogram. I have a superior labral tear. My surgeon is suggesting surgery

[@hawaii197]

I just had mine back in Nov I was lucky no rotator cuff . Usually they don’t know if you need the rotator until the surgeon gets in . Sometimes they find something inside that should be repaired

[@Irish37]

Very clear, helpful demonstration of ROM and strength tests. Thank you.

[@OrthoEvalPal]

You are welcome!

[@hawordlee]

Hi Paul, Just wanted to say I'm really glad I came across your channel while studying for my physiotherapy licensing exam. Your video's really help tie things together and provides a great visual of how to flow through an assessment. You've got a supporter from Canada! Cheers

[@OrthoEvalPal]

Hey Howard, so glad to hear that. It is people like you who I made Ortho Eval Pal for. Lot's more to come. Take care!

[@supersaiyanzero386]

I left a lengthy comment but mainly thanks for the content and demo Optional read below, otherwise have a great day! Im trying to figure out what's wrong with my shoulder. I get a stabbing pain under my armpit, down to the upper lat. Unsure if it's muscle damage. Original injury was doing dips with too wide of bars so I'm thinking, not as a dr. that it may be impingement caused by compression. Because when i do chin ups, no pain. When i do pronated (pull ups) i do get a bit of pain. Im seeing ortho in a day, but ive tried many things and cant reproduce the pain on demand. It does hurt at 90 degrees flexion when holding a laptop or a heavy bottle, there's some pins and needles. When i isometric resist a resistance band supinated, initially i get a jolt of pain, but only the first set. Im hoping that strengthens the area and frees up some space as i proceed into concentric exeternal rotation- resisted Otherwise i can fully exercise. Dumbbell bicep curls do make the pain shoot, but only once...again. I do feel pain near the supraspinatus based on this anatomy book and theres an obvious shoulder click when moving arm at 90 degrees out to side (laterally) and moving my pronated hand up and down. No pain though. Odd. Also when i go for a squat (light or heavy) and brace my lats in the "low bar position" aka around upper back scap area, sometimes ill get a stabbing. First part of the injury my shoulder blade area iself hurt badly and it actually hurt to breathe for about 3 days. Needless to say i have no idea whar is going on except whatever it is, it's not bad enough to keep me from lifting entirely but i hope im not worsening the injury or problem. Anyway that's my story i know a couple medical professionals in my circle who can probably do these tests if ortho doesnt want to (going for hernia l5s1) Good video, i know you cant diagnose from a comment but thanks for showing some moves. Great skill to have, most are benign enough to practice on a friend who isnt hurt. (Eg pronated hand and raising arm to test ROM)

[@sarahdurantsmith1278]

"She has Ehler Danlos" Thank God. It's so hard to find stuff that takes this into account. It's a very specific example, but hearing and seeing it as part of the exam is reassuring in a way I don't know how to describe. Being an athletic zebra can be super confusing and frustrating

[@Drikkerbadevand]

This is me, full rom but the flexion test causes instant pain as well as the o brien palm down test. Palm up is just fine. Pain at the side of the shoulder i'd guedd at the rotator cuff insertion

[@possibility28able]

What was the treatment plan for this?

[@ThanhNguyen-te3lr]

I have the same curiosity; If possible, please share. Really really thanks a lot

[@miguelvasquez8585]

Surgery

[@miguelvasquez8585]

Therapy first

[@ChrisGarcia-ux1tk]

Yes, physical therapy to waste time and money, then surgery. Six months before you can play sports again.

[@aaron___6014]

Let it heal. Light exercise to keep blood flowing. Shoulders take awhile to heal but in my experience and my brothers they do get better.

[@lunePT]

just found this channel ... I like the idea that videos are short but explanatory.. thanks a lot...

[@OrthoEvalPal]

Glad you like them!

[@Leslie83249]

I happen to be a PTA, dealing with nagging left shoulder (dominant) pain for 15 years now. I work in SNF (8 years now), worked as a massage therapist before that (2007-2017). I have clicking, clunking, grinding with internal rotation. I last injured it 3x last year, twice at work transferring patients. I workout regularly, very active, play softball in my old age (38). Ill go months where my shoulder is okay, then have to rest and start over with rehab.I also got an MRI after the 3rd injury (this past December). Radiology report says I have a SLAP tear, bicep tenosynovitis, and low grade Infraspinatus tear. I don't remember pain in my Infraspinatus tear but have it now. I got a second opinion from ortho. I want to treat conservatively so he told me to continue with my exercises. The problem is I can't get back into my regular routine (reoccurring bicep pain). I got a cortisone shot and it didn't work. I am going back to ortho next week. When this first happened (15 years ago) my shoulder was weak and I eventually lost function. I saw ortho and had a normal X-ray. Ortho wanted to wait for an MRI, it was feeling better until it wasn't. I was in extreme pain for over a year. I couldn't afford an MRI, so I just sucked it up and carried on. I eventually got back to working out but would have pain in my bicep tendon. It has been reoccurring every year since it happened (overuse exercise and from massage).

[@OrthoEvalPal]

Hi Leslie, The proximal biceps are a huge pain generator. At this stage I would seek out an orthopedic shoulder specialist and see what they say. I've seen a lot of people with this who have had surgery and they do well. Best of luck!

[@Leslie83249]

@@OrthoEvalPal Thanks Paul. I am going back to ortho on 3/30. I’m trying to avoid surgery but… which surgical procedure are you referring to? I was offered tenodesis or tenotomy. I’d rather tenodesis for several reasons. Im very active and do not want popeye syndrome.

[@OrthoEvalPal]

@@Leslie83249 the tenodesis is a good option. It takes the “pull” off of the labrum with less deformity

[@Leslie83249]

@@OrthoEvalPal Yes exactly, but that recovery. Ouch. Lol.

[@cecigalvis2108]

Hi Paul. What if the patient has a positive O'briens, Hawkins, empty can, neer, pain at night and with overhead movement?. I find this quite challenging as everything may trigger the patient's pain in the acute phase. Thanks for your help

[@richardsharpe6150]

Paul I need help I’ve had two surgeries both were unsuccessful

[@vachibal3553]

Doctor I have pain on o Brien test with palms up with resistance and pain happens in front of shoulder but does not hurt with thumbs down 👎 position . please help me with it .

[@Ngchan2000]

i have issues in my right shoulder starting a year ago, due to some reasons I have not had any treatment on it... altough it's a bit better but it is still bothering me.... (i'm 47 years old) symptoms: At the beginning (a year ago), 1: i felt weakness on my right shoulder, i used to bench 145kg but I could only bench 120kg then and during the movement I felt like my shoulder was about to come off... i could finish couple reps but my shoulder would be so sore for days.... then i had to down it to 100kg, i could do it with better after condition, but my right shoulder would feel tired in the middle of the round. 2: when i tried to reach my left shoulder with my right hand, my right shoulder would feel so much pain 3: i just ignored the pain and did regular work-out, then my bicep, trapezius, tricep, infraspinatus were alll very sore 4: i tried to do Y raise of arms with 6kg dumbells, clearly i felt weakness on right side (my left could not 10 reps but my right could do only 4 reps) now (a year later): 1: i can now bench 120kg~125kg, but somehow I still feel some weakness on my right 2: my bicep, trapezius, tricep, infraspinatus are constantly sore... and very tight.... this has been giving me hard times.....so annoying 3: for couple of times i had to raise my hand to put something at high places... at some angle, a cramp would suddenly appear on right shoulder....now I am kinda cautious everytime I raise my right arm... 4: when I do the chest-fly machine in heavier weight...i feel my right shoulder is like a bit coming off.... 5: when I do the empty can test like in your video....weakness and cramp comes up when a downward push is applied on my right arm. sorry for long words.... would like to ask if i was like in need of a surgery.... really thanks...

[@SurvivalGames1]

i feel ya pain....not sure what exactly happend to me but i was also benching 150kg for 2 reps at my best times , but now i cant do anything cause my left shoulder , 3 months ago i did a set of cheating lateral raises with 20kg each hand, got a bit pain after this but beleived it would be healed till my next workout 4 days later but it was not , now its almost 3 months since this and it got not better...do you have some improvements ?

[@yonative3642]

Hey man I’m also a baseball player. I have been having the same problem and I am worried that I have torn something. I have done all kinds of shoulder mobility and scap exercises. The problem is that if I give it like a 2 week break I feel good and as soon as I start using it again 100 percent it starts to hurt again. Have you found anything out in the last 2 months😭

[@aminexe7426]

same but i started habing this prob after workout its feel good after 5days but if i workout again its started to hurt really bad again im only 15 man cmon now

[@supersaiyanzero386]

​​@@aminexe7426iven your age, you need to work on external rotation. AthleanX has amazing exercises and he's a physical therapist for major league baseball players (knows a lot about the shoulder!), athlete. This is a plea from a 29 year old, do those external rotation exercises he has, the lifestyle of our generations (millenial, z, alpha)naturally produces internal rotation. Good luck.

[@premkumar-nx2mv]

Sir i have done left anterior 2clk to 5clk position shoulder labrum surgery bioscrews after 11months in myself tested clunk test there is mild click feeling without pain I have doubt that my bioscrew broken think about this i couldn't sleep at night think of this doubt... But i don't have any pain doing regular rehabilitation and started low weight gym workouts... Please give us symptoms if biocomposite breaks what will be happen?.... I can do all labrum test without pain as in your video sir.. Internal rotation has mild discomfort...

[@dragon0361]

Hoping you can help me, I had surgery for a tear in my shoulder labrum from 4 oclock to 7:30 position. Its been about 11 months and my range of motion from my side (as if doing jumping jacks motion) is pretty bad. I can only raise it about halfway up without pain. Also im unable to touch my back. I feel pain running down my whole arm when tring to raise it, as if a rubberband is being stretched. Doctor justs keep giving me more pt but its not helping.

[@meorpaan9771]

Maybe you can check your body posture, I had just dislocated the 3rd time and I have a really bad posture due to hypermobility, in laymans term, I tend to slouch making the shoulders to roll forward, giving stress to the labrums, I did all the exercises in this bad posture and oh boy that hurts, after I’ve changed my posture, I could see the extreme differences.

[@liamalcalay7455]

If I having a fraying labrum can I still work out?

[@AtypicalPaul]

If you couldn't get an mri due to Pacemaker what would be your next step?

[@OrthoEvalPal]

Great question for a radiologist. Possibly a CT scan?

[@trentgibson9268]

Hey Paul, I’m almost 5 years post labrum repair and haven’t been pain free since. Pain might even be getting worse. A year post surgery I got an MRI that just showed a lot of scar tissue, but that’s all they saw. What would you recommend now that I’m 4 years past that last MRI and 5 years out from surgery but still can’t do things pain free?

[@OrthoEvalPal]

Have you had a good physical therapy evaluation? Have you had a second opinion by an orthopedic surgeon?

[@trentgibson9268]

@@OrthoEvalPal A year post op, they said I had frozen shoulder, went back to PT and still saw no improvement. Haven’t been back since. Just sucked it up and dealt w the pain.

[@Mr.Mister420]

​@@trentgibson9268 where is your pain exactly My pain is exactly at point where surgery was done

[@nikhilr2761]

​@@trentgibson9268fucked for life boi

[@codypeterson4151]

hey can you plz reach out to me i have a labrum tear problem and need help

[@timberwolvesxx7250]

hey Paul, i get shoulder pain when making the 'thumbs down' gesture ie inward rotation, any thoughts, cheers

[@lewislovegrove9393]

Hi Paul, are labral tears usually common in the absence of trauma?

[@OrthoEvalPal]

Hi Lewis, No they are not but in the case of someone with Ehler Danlos where she has had many subluxations, it could happen. Waiting for an MRI.

[@lewislovegrove9393]

@@OrthoEvalPal keep us updated 👍🏼

[@2104T34]

Ehler

[@davidkids77]

Hello Paul love your videos how is O’Brien’s sign different than the empty can test they look very similar and Obrien‘s test is specific for what?

[@OrthoEvalPal]

The O'Brien's Sign assesses labral integrity. The arm is horizontally adducted 15-20 degrees and the shoulder is flexed to 90 degrees whereas the empty can is horizontally abducted about 45 degrees and flexed about 45 degrees

[@davidkids77]

@@OrthoEvalPal ok thank you!

[@davidkids77]

Paul one more question when you supinated the arm and she had no pain what does that signify during the O’Briens test

[@OrthoEvalPal]

@@davidkids77 if thumb down is painful and palm up is not it is positive for a labral tear. Otherwise negative

[@ajax7590]

I had labrum surgery 10 years ago and recently I was feeling a little sore so my doctor was having me do stretches. During a doorway stretch I all of a sudden felt a pop sound where my scapula is and got some nerve electric feeling. My doctor has refused to give me a MRI but do you think I re-tore it and damaged the anchor sutures? My range of motion sucks and I definitely have atrophy but this also could be from guarding the shoulder. Basically I don’t really get pain on lifting my arm but I definitely don’t have good range of motion and I get random pain when trying to leave my arm straighten out at my side. The PT person is confused and thinks it might be TOS. I was thinking it could be my subscapular nerve. But my biggest fear is that it’s a re-tear

[@OrthoEvalPal]

I've never seen anyone injure themselves doing a door stretch but it is possible. There are too many unknowns to say what it is.

[@vincenzomonto9661]

hello doctor! Greetings from Italy! Is the girl in the video to be treated conservatively or does she need surgery? Is it possible to return to strength levels with good rehabilitation? I am a volleyball player and I have similar symptoms despite having nothing from MRI!

[@OrthoEvalPal]

Hi Vincenzo, she did not have surgery and did you through rehabilitation. Many people who have labral tears are able to get away with rehab alone. Unfortunately volleyball is extremely high stress for the labrum.

[@cassius_eu5970]

@@OrthoEvalPal I am a strength athlete (non-professional, just as a hobby) and do/did many overhead presses. My ortho immediately recommended me surgery 1 week after the injury happened and said that if I waited, it would be more difficult to repair. I originally wanted to try and just do PT to see if it would "fix" it. Is it true that waiting a few weeks would be bad for surgery, even though I am currently not training? I am living alone so having my arm inside an L-bandage for several weeks due to the operation would be very difficult for me.

[@navneetsankhla6745]

Guys Any updates?

[@averygugliotti8446]

Hey I get negative for every labrum test I can find but when doing arm cycles I get this out of place feeling in my sholder with lots of pain till it gets back in place. I play baseball and have been feeling sholder pain for the past 4 months.

[@yonative3642]

Hey man I’m also a baseball player. I have been having the same problem and I am worried that I have torn something. I have done all kinds of shoulder mobility and scap exercises. The problem is that if I give it like a 2 week break I feel good and as soon as I start using it again 100 percent it starts to hurt again. Have you found anything out in the last 2 months😭

[@oweeks6]

@@yonative3642 Bro do you have any info yet? I’ve just been pitching through the pain every week cause it only really hurts warming up and in the bullpen. It hurts for a few days after I pitch but then it feels decent.

[@harris_h24]

I tore my labrum 5 months ago and recently got hit blindsighted. I got an mri, and the tear got longer/lower. is it recommended that I get surgery? I turned 16 in Feb. and I play baseball for my high school. I'm a pitcher, and I know the consequences but I'm willing to take them if I can be more comfortable in day to day activities

[@bhawuksharma7349]

Hey I'm bhawuk from India can you guide me with my shoulder injury i also play basketball

[@lexiekent4697]

hey i had the surgery and i’m not going to lie it’s a hard recovery… i never made a full recovery and went back to my sport too soon and re fractured it. it been two years sense my first surgery and i have full range of motion but my muscles are super weak and become sore easily. the best option is doing pt and if it doesn’t get better, get the surgery. it’s about a 6 month recovery but pt is super beneficial. i did school online which really helped and now i use kt tape anytime i know i’m going to be working it out. i’m also a surfer and honestly my favourite workout now is swimming because it’s light on it and i’m regaining strength.. honestly i would follow the docs advice bc they go out of their ways to avoid surgery. hope this helps :)

[@sefibrou]

@@lexiekent4697 Hi, thanks for sharing. Did you had a slap tear? How did it happened? How bad was it?

[@navneetsankhla6745]

Guyss any updates

[@harris_h24]

@Navneet Sankhla it's been a year and I'm 17 now. I still haven't gotten the surgery and the pain is relatively the same. it hurts insanely bad when I throw and it hurts bad for a day after but if I'm not active then I'm fine. I have the surgery scheduled for 6 months from now

[@meorpaan9771]

Hello Doc, I have hypermobility joints and 3 dislocation(Bankart Lesion) on right and 2 on left mainly due to rugby and my just profound condition , I am now 21 and have decided to retire from rugby, I am not fond of surgery, can I know whether the shoulder labrum tear can heal on its own by time?

[@OrthoEvalPal]

Usually they don't. But if is not bothering you with daily activities then you could be fine. Many people live with labral tears but usually have to modify lifestyle. I would recommend meeting with an orthopedic surgeon now that you are done rugby. Good luck!

[@meorpaan9771]

@@OrthoEvalPal Thank you very much for the opinion Doc.

[@navneetsankhla6745]

Sir can this hill sachs happen becoz bankart tear. I have small bankart tear from 4 - 5 o clock can it lead to hill sach because my shoulder is making pop sound often can it lead to hill sachs ??

[@OrthoEvalPal]

No. not always. Many reasons why you can have noise or pop in a joint

[@navneetsankhla6745]

@@OrthoEvalPal do I require surgery for my tear ?? Or because it's small bankart lesion I can heal it by rest , physiotherapy??

[@OrthoEvalPal]

@@navneetsankhla6745 you definitely need to have an orthopedic consult and confirmation of your diagnosis. You and the orthopedist would have to make that decision.

[@arindhar3046]

97%(90%)(((((((1+2+3+4+5))))))))80%

[@workoutbasics2611]

Hello Sir, my MRI report mentions :- 1. Soft Reverse Bankart lesion seen extending from 6 to 8 o clock position; coracoid at anterior 1 o clock position. 2. Reverse Hill sach lesion seen in the anterior superior aspect of humeral head measuring 9 mm in width. Q. How do I assess that this is the true result, because in india they also fool people by performing surgery and then make money out of it? #please_reply_soon.

[@abhijeetsingh2361]

@workoutbasics2611 hii how is your shoulder now . Did you get surgery ????

[@nikhilr2761]

Old man waht happened to her mri ?

[@OrthoEvalPal]

Labral tear

[@nikhilr2761]

@@OrthoEvalPal I have the same popping and clicking painful as fuck dint have anything traumatic, what level of tear was hers ? And did she get surgery