Labrum Surgery vs Physical Therapy

I fell mountain biking in early August onto an outstretched left arm and recently learned I have a 2:00-6:00 posterior labrum tear. I’ve met with an orthopedic doctor and surgeon and it seems I have two options right now:

  1. Surgery and be back to full strength in 4-6 months
  2. PT and build enough muscular strength to get by:
    2a. Complete 6-8 weeks of PT and then have surgery with a “pre-habbed” shoulder

My dilemma is I am a competitive(to me) cross country skier, and love gravel, mtb, and road biking, so my off season is only a few weeks in the spring and fall. I think I’d have to choose to recover in winter or summer.

Question: How many of you have torn labrums? How have you continued your life habits? Surgery? PT? Constant discomfort? Other? Would a surgery at age 37 put me at risk to need another surgery down the line?

I tore my labrum 20 years ago. I went to a highly rated orthopedic surgeon (who did much of the work on local pro hockey players). I tried to get surgery and he talked me out of it saying it wasn’t a guarantee to full recovery (again, 20 years ago tech and procedures). I attempted PT but never achieved full recovery. There are still many exercises that utilize my shoulder movement that cause great discomfort and still have a hard time sleeping with my right arm over my head. At this point, I really wish I would have pushed harder for the surgery.

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@miesemer, thanks for sharing your story. I can only imagine technology and procedures have advanced in the last 20 years. Maybe 1 point for surgery?

It seems that labrum tears are so unique. I have a friend who went 14 years before getting surgery(but now has a stable shoulder), another who did PT and has been able to classic ski marathon distances competitively the past two season.

At the end of the day, I don’t want to feel limited by shoulder strength goofing around with my kids, mountain biking, or skiing.

Get the surgery…I’ve had shoulder surgery on both shoulders (because I’m kind of a knucklehead). Before the surgeries my shoulders felt weak and unstable. Sure I have some discomfort here and there, but within 12 weeks of surgery I was back to doing normal activities (including light weight lifting).

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I find mine affects me most while doing my strength exercises, especially things like crab walks, rolling planks, renegade rows, standing press, or military press. I don’t have issues riding/racing my bike. I keep trying to ease back into the exercises above but find I easily reinjure it which then results in sleepless nights with an aching shoulder.

The news of someone getting successful surgery after 14 years gives me a glimmer of hope.

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I’ll start with the conclusions and you can scroll down to my story if interested.

Always try PT first, cheaper and (obv) less invasive. Every situation is different and clearly people cant simply rehab certain tears, i.e. ACL, rotator cuff. Most people think surgery is like a magic bullet and they’ll be all fixed up afterwards. The reality is, you’re going to have to do a ton of PT post-op anyway, after going under the knife. Even then, you may not be 100%.

I tore my hip labrum last year lugging firewood from my woodshed to the back door. Slipped on some snow and landed in a lunge position directly on my right knee, classic. MRI confirmed tear. My wife is a PT and she prescribed me some exercises which I’ve incorporated into my daily 20 minute lunchtime mobility routine. I’m probably 99 % at this point. Racing XC and cyclocross competitively. Just one guy’s story. Good luck.

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N+1 Hip labral tear here…4 years ago was in constant pain, could barely ride my bike and was told I needed surgery by sports dr, physiotherapist and of course orthopaedic surgeon…however, I finally opted to try eliminating muscle tension I had, improve function and strengthen the hip…all pain went within a few months and never went back to the surgeon. I have a martial arts friend who took a similar approach to fix his shoulder.

Of course every case must be treated on its own merits and perhaps your shoulder is much worse but I would certainly look at PT/non invasive treatment first, if nothing else it will serve as good pre-hab before an op and accelerate recovery

Good luck

the labrum is basically an O-ring of cartilage that helps give stability to the joint. Best example I ever saw was a surgeon giving a lecture on stage at a sports medicine symposium. He pulls out a toilet plunger, points to the wooden handle and says “this is your humerus”; then he points to the rubber plunger part and says “this is your labrum”. He jams the thing against the wall and it sticks there quite nicely. Pulls it off with a “thwuuuuuuck” sound, takes some shears and makes a cut in the plunger. Says “this is a torn labrum”, sticks it to the wall, lets go, and said plunger drops to the ground. Bottom line, the labrum provides stability to the humeral head. It’s a “static stabilizer”, meaning it doesn’t contract/relax, change with training etc. You also have “dynamic stabilizers”, namely the four rotator cuff muscles, as well as about 17 muscles that attach to your scapula, which is the true anchor for anything you do with your upper extremity. So…if the static restraint is broken, work the hell out of the dynamic restraints. Worse case, option 2a, you go into surgery strong and bounce back quicker. That said, the rehab is a long haul, with return to sport probably at the 9-12 month mark

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My husband tore his labrum in April 2020 after a bike crash, and initially was diagnosed with a dislocation since they only did an x-ray at first visit. After a month, he still didn’t have full range of motion (couldn’t lift arm above parallel), so he met with an ortho, had an MRI, and was diagnosed with a torn labrum. He had surgery and rehabbed in PT for ~2.5 months. He was back to normal roughly 3 months post surgery, and it was a 1:30-5:00 tear. He’s not testing the shoulder as much as a competitive XC skier would, but he was effectively crippled before surgery.

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@miesemer, one of my biking friends tore his labrum and waited 14 years for surgery. Sounds kind of like you where he was able to generally get by, but eventually, it was wearing while biking, so he finally got it fixed. This was about three years ago. He said it was a long recovery, but now he’s feeling stable again.

@AustinPT, thanks for the explanation. Before my crash, I wasn’t able to recall from my HS anatomy class what a labrum does exactly, and now feel much more knowledgeable, and in awe of how the shoulder works.
I also think 2a is the route to head right now.
Being the rare breed of nordic skier, biker and NBA fan, I read a pre-season article about three NBA players that had labrum surgery in June, and are hoping to get back to playing by late November, December. I realized those guys have a far superior medical team helping them get back to action than I do, so that helped me realize six months might be pushing it.

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