Glenoid Labral Tears
In this article Ross Hauser, MD discusses alternatives to surgery for glenoid labral tears including Stem Cell Therapy, Platelet Rich Plasma Therapy and Stem Cell Therapy.
The shoulder’s broad range of motion leaves it susceptible to a broad range of injury injury. As with all joints, there are various stabilizing structures and one of the most important soft tissue stabilizing structures of the shoulder is the glenoid labrum. Injury to the glenoid labrum results in instability, dislocation and pain.
Glenoid Shoulder labral tear tests and diagnosis
Shoulder labral tears can develop from a traumatic injury, such as a dislocation, fall onto an outstretched hand, or blunt force to the joint. If you suffer an injury with enough force to tear the labrum, it is highly likely that you will also tear or strain other tissues around the shoulder as well (i.e. ligaments or tendons that surround the joint). This is especially true of the biceps tendon that attaches directly to the labrum. Labral tears can also develop over time from repetitive motions, such as in throwing athletes or manual laborers.
One challenge with a glenoid labrum tear is that it is difficult to diagnose.
MRIs and arthrography have proven unreliable and many studies have shown that arthroscopy is both sensitive and specific when diagnosing labral tears and injuries. Although arthroscopy can diagnose a labral tear, it is not the best treatment for it. In fact, controversy surrounds arthroscopic treatment for labral lesions since clear, evidence-based guidelines for surgical repair are lacking.1
Further, studies have shown short-term success with shoulder arthroscopy but long-term results have been associated with continued pain, instability, and decreased function over time.2-5
Some physicians choose to treat suspected labral tears with conservative treatments such as NSAIDS, physical therapy exercises and cortisone injections. Some, however, skip all conservative treatment when symptoms of a labral tear show up and go straight for surgery. During arthroscopic treatment, the damaged portion of the labrum may be removed or debrided, and/or the labrum may be reattached to the glenoid. Following surgery, patients wear a sling for four to six weeks and then proceed with exercises to regain motion and flexibility in the shoulder.
Prolotherapy for glenoid labral tears
The problem with the arthroscopic treatment previously mentioned is that it involves removal of tissue. The glenoid labrum is the one of the most important soft tissue stabilizing structures of the shoulder. So when removed, the shoulder becomes less stable and more susceptible to further injury. An alternative to arthroscopy would be Prolotherapy, a regenerative injection technique that stimulates the healing of soft tissue. Prolotherapy injections aim to initiate or recreate the inflammatory stage of the healing process. It triggers a cascade of anabolic events and stimulates the new growth of cells. In short, it stimulates healing and indirectly rebuilds depleted tissues.
In our recently published research Prolotherapy for Glenoid Labrum Tear, we talk about our experiences in treating patients with shoulder pain.
In summary we note that:
- Tears of the glenoid labrum are a common cause of shoulder instability and a frequent finding in patients with shoulder pain.
- Management of these patients typically involves an attempt to avoid surgery through conservative treatment, but these treatments are lacking at promoting labral healing.
- Regenerative injection therapies, including Prolotherapy, have shown promise in the treatment of several musculoskeletal disorders, but have not
- Patients following Prolotherapy treatment reported highly significant improvements with respect to pain, stiffness, range of motion, crunching, exercise and need for medication.
- Patients reported complete relief of 69% of recorded symptoms. One patient reported worsening of some symptoms.
Labral tear treatment
Prolotherapy for glenoid labral tears involves multiple injections of dextrose-based solution to the various ligament and tendon attachments around the shoulder. As mentioned previously, those that suffer a labral tear often damage surrounding tissues in the process. Comprehensive Prolotherapy to all of the adjacent structures stimulates the immune system, through the natural inflammatory cascade, to repair the weakened tissues. It can be thought of like “spot welding” for an unstable shoulder joint.
Other Prolotherapy solutions
We can also use cellular Prolotherapy as a more aggressive approach to stimulate healing. Commonly, this involves the concentration of healing cells from the blood, known as Platelet Rich Plasma (PRP Prolotherapy). In our office, this combined approach of PRP and traditional dextrose Prolotherapy has shown great results as an alternative to surgery for labral tears in the shoulder. Because the labrum has such a poor blood supply on its own, PRP Prolotherapy is a way to bring healing cells directly to the labrum. Stem Cell therapy using bone marrow or adipose (fat) tissue may also be used in more complicated cases. These are then injected into the joint to heal musculoskeletal injuries. In addition to injecting dextrose solutions to the surrounding ligaments and tendons, cellular Prolotherapy works well for glenoid labral tear repair.
- Bedi, A., Allen, A.A. Superior labral lesions anterior to posterior—evaluation and arthroscopic management. Clinics in Sports Medicine. 2008;27:607-630.
- Cordasco, F.A., Steinmann, S., Flatow E.L., Bigliani, L.U. Athroscopic treatment of glenoid labral tears. American Journal of Sports Medicine. 1993;21(3):425-430.
- Katz, L.M., Hsu, S., Miller, S., Richmond, J.C., Khetia, E., Kohli, N., Curtis, S. Poor outcomes after SLAP repair: descriptive analysis and prognosis. The Journal of Arthroscopic and Related Surgery. 2009;25(8):849-855.
- Green, MR, Christensen, KP. Arthroscopic Bankart procedure: two-to five-year follow-up with clinical correlation to severity of glenoid labral lesion. American Journal of Sports Medicine. 1995;23(3):276-281.
- Kartus, C., Kartus, J., Matis, N., Forstner, R., Resch, H. Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. The Journal of Bone and Joint Surgery (American). 2007;89:1442-1448.