Torn Labrum

Doctor Marc Darrow, M.D., J.D.

Discussions from our Radio Show:

Caller: I have a tear in my labrum, I had surgery a few years ago and I am still getting a lot of pain there and I am desperate to avoid another surgery.

Dr. Darrow: Often times a torn labrum will show up on an MRI, but it will not be the reason for someone’s pain, something else maybe causing the pain.

The labrum is a little lip on the inside of the glenoid (the socket in the shoulder blade) which the ball of the humerus (the upper arm bone) goes in, the labrum is the soft tissue that helps hold the ball in the socket and very often it gets torn, I see them all the time.

We had a patient, he was a lacrosse player that use to fly in from the east coast once every couple of weeks. Initially he could barely move his arm, I saw his MRI, it was the worse MRI I had ever seen.

We did Prolotherapy injections to the proliferate or growth new tissue in the area and we tried to heal it up that way. After about three times he was back to playing Lacrosse again.

The thing is he probably STILL has a torn labrum but that was not the cause of his pain. My point is that you cannot look at an MRI to decide to do surgery, you have to find where the pain is coming from, the best way I think of doing that is a diagnostic injection of lidocaine to see if it can numb up the area, and if it can numb it and then put some dextrose with it then we know that the proliferent is going with the numbing agent. I think there is very good hope for you even with the torn labrum can heal you up. A future discussion will focus on a rotator cuff tear and other similiar injuries.

Partially Torn Rotator Cuff

Doctor Marc Darrow, M.D., J.D.

Discussions from our Radio Show:

Caller: I have been suffering with a partial torn rotator cuff and a bit of bursitis and tendonitis, it has lasted about four months. I have been going to physical therapy for about a month and it has not gotten any better.

Dr. Darrow: Prolotherapy works really well on those types of syndromes in the shoulder, but a consultation is needed, however, it is the kind of thing that is very simple to heal in most cases.

Caller: My physical therapists say and I read that rotator cuffs take a long time to heal.

Dr. Darrow: I do not find that to be the case, Prolotherapy is something that is very unique, very simple, very easy to do. You would come in and get an injection in your shoulder, at at least on point, maybe more depending on what we find.

By doing these injections we would stimulate your immune system to create a little bit of inflammation and you would walk out of the clinic right then, you would not have any down time, you may feel a little bit stiff, maybe not.

Maybe for your situation it may take four treatments the bursitis, tendonitis, tendinosis, to clear up. Based on percentages that I am aware of, it sounds like you have an 80-90% chance of improve.

Caller: Is this different than a cortisone shot?

Dr. Darrow: I would not do a cortisone injection for a person like you. If someone was in such distressed pain, I may consider doing a cortisone injection but it is not the best way, it does not heal these things and it is not the first line work that we do, Prolotherapy is because it is stimulating or proliferating new tissue growth and it is a healing technique I think you will find very good.

Chronic Shoulder Instability Syndrome

Dr. Marc Darrow, M.D., J.D.

Chronic shoulder instability syndrome results from trauma caused by subluxations, dislocations, from less detectable micro-trauma caused by repetitive strain on the tissues, or from congenitally loose shoulder joints. Recurrent pain or tenderness in the shoulder joint and weakness in the arm are two of the more common symptoms, but severe examples include patients whose shoulders pop in and out of joint. Frequent shoulder dislocations stretch the brachial plexus, the nerves that run from the neck down the arm. This process can cause permanent nerve damage, pain, and loss of use of the arm.

Shoulder Dislocations

Sometimes the bones in the shoulder joint slip out of normal alignment or are forced out by injury-subluxation and dislocation. For those individuals who suffer from chronic shoulder instability, dislocations may occur frequently. This occurs because first dislocations usually require a significant amount of force as in anterior dislocations, in which the anterior static shoulder stabilizers are stretched or torn away from the bone. Approximately 95% of shoulder dislocations are this type and typically occur when a person falls on their outstretched hand, or sustains a downward motion blow to the shoulder.

Until recently it was common in cases of dislocation to immobilize the shoulder for long periods of time. But studies showed that while immobilization helped alleviate the pain of such injuries, it also contributed to a general weakening of the ligaments and predominance of adhesive capsulitis.

In one alarming study of 245 patients who had suffered a combined 247 shoulder dislocations, about half of those treated with immobilization had recurring dislocations within the 10 year period of the study. The problem was much greater in the study’s younger people (teens and twenties). This is one of the few situations where older folks have an advantage, because their connective tissue are less elastic, the risk of dislocation is less likely.

Surgery for shoulder separations can be effective for some but as always, surgery should be considered a last option because of issues of complications, down time (immobilization), and for the “weekend warrior,” or professional athlete, a weakening of the shoulder through the removal of and damaging of other connective tissue in the surgical process.

Shoulder Arthritis
There are many types of arthritis, but most often in the shoulder, it is triggered by an initial trauma. It can also involve “wear and tear” of the tissues of the joint, causing inflammation, swelling and pain. Often people will react by instinctively limiting their shoulder movements in order to lessen the pain. This can lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in yet further pain and restriction of motion. In the worst cases, adhesive capsulitis occurs and the arm can not be moved.

Referred Pain
The musculature of the shoulder area is fertile ground for trigger points, as is evidenced by the prevalence of a “stiff neck” and referred pain radiating anteriorly, laterally or posteriorly from all three of the major scalene muscles into the arms, chest or vertebrae. Trigger points from the trapezius muscles can refer pain to the head and down the arms.

Okay, You Know About The Problems and Pain, Now What?
A proper diagnosis of shoulder pain is essential to determine the root cause of the problem and the proper method of treatment. Because many shoulder conditions are caused by specific activities, a detailed medical history is an invaluable tool. A physical examination should also include screening for physical abnormalities—swelling, deformity, muscle weakness, and tender areas—and observing the range of shoulder motion—how far and in which directions the arm can be moved.
Since it’s been proven to strengthen the connective tissues, and has the benefit of over fifty years of testing to back it, Prolotherapy is arguably one of the best choices of treatment in cases of dislocation, rotator cuff tendonitis, muscle tissue impingement or recurring instability.

Shoulder Arthritis

Because the shoulder does not usually bear our body weights (unless we do an extraordinary amount of chin-ups or even push-ups) it is not subject to the type of damage that causes osteoarthritis (bone-on-bone type degeneration) that occurs in the hips and knees.

Arthritis to the shoulder is usually triggered by an injury such as a dislocation or separation that has not healed properly. In these cases or even in the cases of past surgical intervention, connection soft tissues–the ligaments, tendons, and cartilage, have not completely healed or have become overstretched (ligament and tendon laxity).

This causes an excessive amount of “play” in the joint resulting in the previously mentioned chronic shoulder instability. When bones rub against bones or against soft tissue, inflammation, swelling and pain occurs. Over time, painful bone spurs may form and a surgical consult called for.

Often people will react by instinctively limiting their shoulder movements in order to lessen the pain. This can lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in yet further pain and restriction of motion. In the worst cases, adhesive capsulitis may occur.

Shoulder Impingement Syndrome or Rotator Cuff Impingement

Dr. Marc Darrow, M.D., J.D.

Shoulder impingement syndrome involves one or a combination of problems: inflammation and/or swelling of the bursa located just over the rotator cuff, inflammation of the rotator cuff tendons (tendonitis), or calcium deposits in tendons—called calcific tendonitis, (caused by wear and tear or injury). The main problem is usually that the acromium or a bone spur puts pressure on the supraspinatus tendon. This type of injury usually occurs as a result of wear and tear. Typically in athletes whose sport requires repetitive overhead movements such as serving in tennis, swimming, strength training or weight lifting, and golfing. This injury is also seen frequently in baseball pitchers and basketball players, where a great deal of overhead arm motion is required.

The symptoms include pain from the shoulder to the elbow, especially when the arm is raised above the head, reduced arm strength and range of motion without pain. A future article will deal with rotator cuff tear in more detail.

Because inflammation is present, a patient will usually be told to immobilize the area to prevent further irritation and inflammation, and be prescribed anti-inflammatory medications and perhaps a cortisone injection. Treatments whose side effects and long-term effect on injured joints have been well documented.

Shoulder Pain

Dr. Marc Darrow, M.D., J.D.

The shoulder is really a combination of several joints, combined in such a way by an intricate arrangement of muscles and tendons, that provides the arm a wide range of motion, flexibility and stability.

The rotator cuff is a group of four shoulder muscles that surround the top of the upper arm bone, the humerus, and holds it in the shoulder joint. These muscles are responsible for moving the arm in various directions, and unlike the massive deltoid muscle of the upper arm, are smaller and generally more vulnerable to injury. The four muscles and tendons of the rotator cuff are the supraspinatus, infraspinatus, teres minor, and subscapularis. It is the supraspinatus that is most commonly inflamed or torn.

The supraspinatus, and the rest of the shoulder, because they are built and expected to allow a remarkable array of motion, frequently are subjected to injuries, causing problems of instability or impingement of soft tissue and in pain. The pain may be constant, or may occur only when the shoulder is moved. In any case, any shoulder pain that persists more than a few days should be diagnosed and treated as necessary.

Shoulder Inflammation- Bursitis

In the shoulder this is often an inflammation of the tendons as a result of the wearing process that takes place over a period of time. It can also occur from an unusual, awkward movement or fall.

Sometimes, excessive use or injury of the shoulder leads to inflammation and swelling of a bursa, a condition known as bursitis. Bursas are fluid filled sacs located around the body and joints. They lessen the friction caused by movement of the shoulder. Bursitis often occurs in association with rotator cuff tendinitis.
A future article will deal with v issues in much more detail. Symptoms of shoulder bursitis include mild to severe pain, limiting the use of the shoulder. In extreme cases the joint stiffens into a condition known as “frozen shoulder,” also referred to by doctors as adhesive capsulitis.

Chronic Shoulder Instability Syndrome

Chronic shoulder instability syndrome results from trauma caused by subluxations, dislocations, from less detectable micro-trauma caused by repetitive strain on the tissues, or from congenitally loose shoulder joints. Recurrent pain or tenderness in the shoulder joint and weakness in the arm are two of the more common symptoms, but severe examples include patients whose shoulders pop in and out of joint. Frequent shoulder dislocations stretch the brachial plexus, the nerves that run from the neck down the arm. This process can cause permanent nerve damage, pain, and loss of use of the arm.

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