Labrum and Infraspinatous Tear - no pain after cortisone and full range of motion

[Jen68]

I have been diagnosed with a labral tear and a tear in the infraspinatous. I had/have pain down the bicep muscle, in the elbow and at times in the forearm. I was given my first round of cortisone and it only lasted one day. 30 days later I was given my second shot, this time in the posterior shoulder and after a few days the pain had subsided and I have full motion of the arm. I do have pain under the arm and in the back of the shoulder only when I put pressure on those specific spots. My question now is do I still need surgery if I don't have anymore pain? How long does the cortisone last and will the pain come back or will the tears be able to start repairing themselves? My MRI also shows 3 bone spurs - one very very large on the top of the acromion that has to be taken down via an open incision it is too large and too close to the top of the shoulder.

My main question is that even though I am feeling good now should I still proceed with the surgery or wait until the symptoms/pain return.:confused:

[mtomaino]

Thanks for your question. First--visit this link to read more about treatment of an assymtomatic cuff tear, which is what you are describing:
http://www.rearmyourself.com/article/The%20Asymptomatic-Rotator%20Cuff%20Tear-Should%20this%20be%20repaired

In general, a cortisone shot may last anywhere between a day or many weeks. This then affords one the opportunity to rehab the cuff muscles in order to appreciate long-term relief. A labral tear is by definition inside the joint, so in the absence of a large cuff tear, I would not expect a subacromial cortisone shot to have any effect on pain that may be related to a torn labrum--the point being that perhaps the labral tear is something that was overinterpreted on the MRI, and not a root cause of your previous symtoms. However, if the labral tear is more consistent with degeneration od the superior labral attachment--secondary to Impingement, then this can be addressed when and if it starts to bother again, as part of an arthroscopic procedure, with either biceps tenotomy, tenodesis, or simply labral debridement. I would not recommend repair, as this may not take away all of your pain.

No matter how large a spur---an arthroscopic resection ("acromioplasty") is always possible if one has the necessary expertise in shoulder arthroscopy.

Bottom line----as long as you are feeling better, you are burning no bridges in holding off on surgery so long as you are not experiencing weakness, which would imply a larger tear.
Please let me know if you have any additional questions.

[Jen68]

Thank you for the quick response. I should have mentioned that there is a marked decrease in strength in my right arm - most noticable when lifting say a gallon of milk out to the front and more so if I try to lift anything to the side - very little strength. My pain is more of a dull ache deep in the arm and towards the back. It is coming up on 4 weeks since the cortisone shot and I am starting to get all the symptoms and pain back. Most notable pain is when I lay down at night. In addition to the the pain and weakness I also have grinding, snapping and a loose feeling when I use my arm in a larger range of motion.

I am a 42 year old woman, I am active but not in any particular sport on a regular basis. I ski, run, swim and play soccer with my kids. My work is 90% on the computer and I do find that I get pain/ache when I am using the mouse alot and it runs down my arm to my elbow.

If I will eventually need surgery and not having it now will just buy me time I would rather have it sooner than later. I was just hoping that there was a non-surgical option that would last me indefinitely but that is not looking good. I am going to get a second opinion since I don't want to have any open surgery if I don't have to. Thanks again for the reply and the information on this page.

[mtomaino]

If you have gone through PT and your exam is suggestive of "Impingement"---which seems to be the case, then I agree with your plan---including searching out someone who has the expertise to evaluate and treat your problem arthroscopically. Good luck!

[Risj7]

Hi there! I too have nearly the same condition as you have described (and am also the same age). One additional symptom that I am experiencing is tingling down my arm and what seems like 'fatigue'. That is, I seem to lose the strength in my grip, or it feels more difficult to make a fist.

I have an appt. to see an OS on Monday, and will find out if she recommends surgery. I have heard that the surgery itself is not an issue, but that the rehab is long and slow. I have 5 kids and do not have the time (nor luxury) to skip work and "rest" my arm. I guess, I'll just have to be patient and wait til Monday before I begin further research. Thanks for posting this. I think it's odd that our symptoms/age/activity/work level are so similar.

[mtomaino]

Let me know his/her thoughts after your appt. Happy to provide my opinion regarding options---both nonoperative and operative.