What else have you been doing to your shoulder?
✓ Member
Labral Tear: Decision Time
Male, 37, ~196 lbs.
In late January 2018, I noticed pain in the bottom ~3rd of heavy pressing movements – bench, press, and dips – which gradually worsened over the following month. I can no longer perform any heavy pressing movements, but pullups (supine grip) seem to positively affect the area. I just went over the MRI findings with the ortho this morning, and here is the diagnosis:
“Findings: The components of the coracoacrimonial arch reveal mild-to-moderate acromioclavicular joint arthropathy without significant narrowing of the supraspinatus outlet.
There is supraspinatus and infraspinatus tendinosis with mild partial tearing along the articular surface of the anterior fibers of the infraspinatus.
Mild partial tearing and partial delamination affects the subscapularis.
The long head of the biceps tendon reveals tendinosis with partial tearing/sprain.
The osseous glenoid is intact. There is posterior superior labral degeneration and fraying, which may include subtle incomplete tearing. There is a small joint effusion with a small amount of fluid in the subacromial-subdeltoid bursa.”
A few issues going on, but the big one appears to be the (possible?) posterior labral tear, which makes sense to me considering the symptoms. Now I have to decide whether to try some sort of rehab, or just bite the bullet and schedule the surgery. Hoping for some opinions/thoughts on this, and I'd also welcome any comments on the diagnosis.
Thanks!
TMPHBITEU
What else have you been doing to your shoulder?
Starting Strength Coach
What about "degeneration, fraying, and may include subtle, incomplete tearing" of the posterior labrum...1) sounds like it matches your symptoms at the bottom 3rd of the movements?...
2) sounds amenable to surgery...and 3) what about this all sounds like rehab would be beneficial?
✓ Member
Prior to onset of symptoms: Benching, pressing, and activities required to maintain a heavily-wooded 5 acre parcel (tree trimming, wood splitting, chainsaw use - sometimes overhead - line trimming, etc.).Originally Posted by Mark Rippetoe
Since symptom onset: I've tried benching, pressing, and dips, and the rain lately has precluded me from any yardwork. I can bench or press with ~50% of my 5RM, slowly, still with slight pain, so I've dropped those altogether. I've still been squatting (during which I experience pain, but it is tolerable), deadlifting and doing pullups. Ibuprofen did not seem to help, and I have not tried icing.
The affected shoulder is my left, and I'm right-handed. I don't think that I do anything unusual with the shoulder, and there was no specific acute injury that I can think of. I have experienced some left elbow tendinosis from squatting in the past, and for as long as I can remember, I've had some heavy knots underneath my left scapula - which may or may not be related.
1) My understanding (which is a little lacking, I admit), is that the head of the humerus has a tendency to want to slip out of the joint when labral tears are present. Since the "possible" tear is posterior, it seems likely to me that during a heavy bench or dip, the humerus wants to slip in the direction of the load. This may not explain the pain during pressing however, and this all assumes that a tear is actually present.
2) Well, it doesn't. The findings are not exactly satisfactory - to me, at least. "May include...." doesn't inspire a lot of confidence, but I have very little experience in these things. I plan on getting a second opinion.
3) I have read anecdotes (here and elsewhere) about others successfully training around these types of injuries, or apparently strengthening the surrounding musculature enough to lessen or eliminate the pain. I know the injury is not going to heal on its own, but I wonder if there is something else I can try.
TMPHBITEU
I'd get a second opinion on the MRI. If you have a labral tear, it needs to be fixed.
✓ Member
Will do - Thank you, Mark.
Starting Strength Coach
When someone performs a bench / press / dip, the bottom of the movement causes the humeral head to translate anteriorly. Someone who has a significant anterior / superior - anterior labral tear will have significant issues with the bottom part of the bench / dip / press. If a posterior labral tear is the issue, lockout in the bench press will cause discrete feelings of instability. An improperly performed bench press or dip will cause exceptional pain at a ragged AC joint. The other individual responding to this post will likely tell you that AC joint pain is mind numbing.....mind numbing to the point people will opt in for a surgery to excise the distal end of the clavicle to reduce the pain.
The thing that worries me most about a MRI reading such as the one posted would be the diffuse nature of the tendinopathy. I would, in theory, believe this individual would benefit more from coaching, because diffuse tendinopathy is almost certainly caused from training with less than optimal programming / technique. When the entire cuff is involved, something just isn't right. If it were my shoulder, I would think my money sectioned out for a second opinion would be better spent on a coach. Tendinopathy is a wicked creature. Tendinopathy is best treated with eccentric loading, when pain reduction is the most important outcome, but concentric loading will allow the muscle to get stronger. The wild thing about heavy lifting is: it uses both a pronounced eccentric and concentric component. I routinely train people out of tendinopathy pain with proper technique and a linearly progessing loading program. It hurts like hell for about 6 weeks, and no one has ever enjoyed training through a tendinopathy but that increased nociceptive neural tissue is not going to go away on its own.
I will disagree with Rip on the necessity of having a labral tear fixed.....with the qualification that a labral tear that is causing mechanical symptoms / instability is involved, it needs to be repaired swiftly. Most of us north of the age of 30, walk around all day every day with minor tears in our glenohumeral labrum and we are none the wiser. Opting in for surgery for a minor tear of a labrum without mechanical symptoms is almost certainly not going to achieve the ends you wish. Not all labral tears are of the same monumentous scale as Rip's previous labral tear was. In this case, someone with this MRI reading may get a bit more clarity from a MR Arthrogram of their shoulder, but I happen to be of the belief that a theoretical patient with these MRI findings would essentially be "ghost hunting" to pursue additional advanced imaging. I think a more useful course of action in a case similar to this would be to opt in for a diagnostic CSI in the AC Joint and subacromial bursa and to seek the services of a good strength coach.
✓ Member
This is very interesting, and has changed the way I look at the findings. It is worth noting that the ortho completely skipped over the tendinosis, and directly zeroed in on the possible partial tear. He wanted to schedule a surgical repair on the spot. Thank you, Will.
I spent a lot of time over the weekend recording and examining my bench/press form from different angles, and saw some things that surprised me. Lesson learned: just because a bench or press feels OK, does not mean that it is. An experienced eye on me certainly couldn't hurt, but I may have to carefully plan for the distance and cost. I'm thinking I may get verified, and post some form checks in the meantime.
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