Shoulder Labrum Tears

For this week’s blog, I wanted to go over a study that although it is now 8 years old, I still consider it very important. 

For this study they wanted to look at how frequently tears in the shoulder labrum are seen in people who have no pain, no clinical exam findings and no injury history. 

This study came to fruition as the rate of shoulder surgeries was increasing especially in middle aged individuals. At the same time, the quality of imaging was also been increasing. This led the researchers to start to wonder, what changes are part of the natural aging process and what changes are pathologic. It is well documented that with time, joints undergo a series of changes. With time we see thinner cartilage, bone remodeling in the joint space and bone spurs, tendons and ligaments losing elasticity and joint spaces narrowing. These are all normal changes, they occur in everyone and aren’t painful or an indicator for surgery. 

The study enrolled 51 men and women aged 45-60. A clinical exam was done and the patients rated their shoulder pain on a scale. Any individual who rated any pain higher than 0 was excluded. These individuals then had MRI’s done on their shoulders which were then read by a radiologist. They surprisingly found that at least 50% of the individuals had a tear in their shoulder labrum on the top side. 

Now I consider this a very important finding for a couple reasons. First off, if someone does have shoulder pain and they get an MRI and they have a labral tear, we can no longer definitely say that this is the cause of your pain and if we fix it you will be pain free. The only time we can say that is in the presence of a previously clean image (that was relatively recent) or in cases of trauma. So the question then must be asked, so what should that individual do. This is where clinical exams and functional exams are important. If someone has shoulder pain, we first must clean up all other functional deficits so we can definitively say that nothing else is the pain driver. Only then could we confidently consider something that is a normal change with aging to be the pain driver. 

So what does all of this mean for the average individual? This means that if you see a labrum tear on an image, don’t worry about it, it is not an indicator of pain for the rest of your life or something that you have to operate on. It is simply a normal change with the ever marching progression of father time.  

Schwartzberg R, Reuss BL, Burkhart BG, Butterfield M, Wu JY, McLean KW. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. Orthop J Sports Med. 2016 Jan 5;4(1):2325967115623212. doi: 10.1177/2325967115623212. PMID: 26779556; PMCID: PMC4710128.