Shoulder Pain: Labral Tears vs. Frozen Shoulder

Shoulder issues (labral tear of the shoulder joint)

Hello Doctor: Last June, I had a motorcycle accident and fell, using my right hand to break the fall.
At the time, it hurt a little, but I didn't pay much attention to it.
One or two months later, I started experiencing deep pain in my right hand.
When I extended my hand to grab something, it felt like an electric shock.
I began acupuncture treatment with traditional Chinese medicine and also did exercises at home.
The pain was mostly at night while sleeping; during the day, my hand felt normal and did not hurt.
Later, while exercising, I extended my hand and rotated it ten times, which caused significant pain, so I stopped.
After that, my right hand felt different.
I experienced sharp pain below my right shoulder, and sometimes I felt soreness or tingling even when I wasn't moving my hand.
Initially, my hand felt weak, and I had difficulty opening and closing doors or taking off my clothes.
I went to see a doctor who performed an ultrasound and MRI.
The doctor only mentioned a tear and advised me to undergo rehabilitation and strength training, suggesting surgery if that didn't work.
I underwent three months of rehabilitation and exercises in the rehabilitation department, followed by ten sessions of prolotherapy, but the results were not good.
A friend referred me back to the original hospital, where I saw two different doctors (the first doctor who performed the MRI was Dr.
A).
Dr.
B first examined my hand, checking its range of motion up, back, and side to side, and tested my arm strength.
Then he reviewed my MRI report and told me I had frozen shoulder.
I mentioned that the rehabilitation doctor at the same hospital said I had a labral tear.
Dr.
B said that MRI findings are only a reference; doctors must also consider the patient's condition and their clinical experience.
He believed my labrum was merely thinned out.
He advised me to do exercises at home.
Dr.
C only listened to my symptoms without examining my hand.
After reviewing the report, he stated that I had a labral tear, but my pain was caused by adhesive capsulitis (frozen shoulder).
He said that since I am 50 years old, surgery was not necessary.
If I were younger, he would recommend surgery.
He also mentioned that some of his patients with labral tears still dance the "土風舞" (a traditional dance).
During this time, I also consulted traditional Chinese medicine, received manual therapy, and took herbal medicine.
My hand feels stronger, but I still experience pain and soreness, particularly a sharp pain in the lower front of my right shoulder.
Sometimes the soreness extends to the back of my arm and even to the upper part of my hand.
When the prolotherapy was ineffective, I considered surgery, but the rehabilitation doctor told me that even after surgery, there is no guarantee I would return to my original condition.
I asked if, after surgery and diligent rehabilitation, it might still not work, and he said that was possible.
Everyone promotes the benefits of arthroscopy, but the thought of not returning to my original state makes me very hesitant about surgery.
Dr.
C said that since I am 50 and not an athlete, surgery might not be necessary.
Will not having surgery lead to any long-term consequences? I sincerely hope you can help me, and thank you for taking the time to respond.

Xūyào bāngzhù de rén, 50~59 year old female. Ask Date: 2017/04/12

Dr. Hong Ximing reply Orthopedics

The shoulder joint has a wide range of motion and complex tendons, making it prone to tendon injuries during physical activity.
Typically, diagnosis relies on magnetic resonance imaging (MRI), and in some cases, arthroscopy may be necessary for treatment.
Rehabilitation is also a crucial component of recovery, while surgery is considered a last resort.
To restore the shoulder to its original condition, it depends on the location of the injury, the mechanism of injury, and the subsequent rehabilitation treatment.
Wishing for a speedy recovery.

Reply Date: 2017/04/12

More Info

Shoulder pain can be a complex issue, particularly when distinguishing between conditions such as labral tears and frozen shoulder (adhesive capsulitis). Both conditions can present with overlapping symptoms, but they have different underlying causes and treatment approaches.

Labral Tears: The labrum is a ring of cartilage that surrounds the shoulder socket, providing stability to the joint. A labral tear often occurs due to trauma, such as a fall or a sudden pull on the arm, which aligns with your history of falling off your motorcycle. Symptoms of a labral tear can include deep shoulder pain, a sensation of catching or locking in the shoulder, and weakness in the arm. Pain may worsen with specific movements, especially those that involve overhead activities or lifting.

Frozen Shoulder: On the other hand, frozen shoulder is characterized by stiffness and pain in the shoulder joint, which can develop gradually and often without a clear injury. It typically progresses through three stages: the freezing stage (painful but with limited range of motion), the frozen stage (stiffness with less pain), and the thawing stage (gradual return of motion). The pain in frozen shoulder is usually more diffuse and can be felt in the shoulder and upper arm, often worsening at night or with inactivity.

Given your symptoms, including the deep pain, weakness, and the specific location of your discomfort, it is essential to consider both conditions. The fact that you have undergone multiple imaging studies and consultations with different physicians is a positive step in understanding your condition. However, the conflicting opinions regarding whether you have a labral tear or frozen shoulder can be frustrating.

Treatment Options:
1. Physical Therapy: Regardless of the diagnosis, physical therapy is often a cornerstone of treatment for both conditions. A tailored rehabilitation program focusing on range of motion, strengthening, and functional exercises can be beneficial. It seems you have already engaged in rehabilitation, which is excellent.

2. Injections: Corticosteroid injections can help reduce inflammation and pain in both conditions, potentially allowing for improved mobility and participation in physical therapy.

3. Surgery: Surgical intervention, such as arthroscopy, may be considered if conservative treatments fail. However, as you mentioned, surgery does not guarantee a return to pre-injury function, especially in older adults or those who are not athletes. The decision to proceed with surgery should be made after thorough discussions with your orthopedic surgeon, weighing the potential benefits against the risks and your personal goals.

4. Alternative Therapies: You mentioned trying acupuncture and traditional Chinese medicine, which can provide relief for some individuals. Continuing with these therapies may complement your treatment plan.

Long-term Outlook: It is crucial to have realistic expectations regarding recovery. Many individuals with labral tears or frozen shoulder can achieve significant improvement with conservative management, but complete resolution of symptoms may take time. The key is to remain engaged in your rehabilitation and communicate openly with your healthcare providers about your progress and any concerns.

In conclusion, while both labral tears and frozen shoulder can cause significant shoulder pain, the treatment approach may vary. It is essential to continue working closely with your healthcare team to determine the best course of action for your specific situation. If you feel uncertain about the recommendations, seeking a second opinion from a shoulder specialist may provide further clarity and confidence in your treatment plan.

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