Does surgery for shoulder labrum tears work? - Upright Health

Does surgery for shoulder labrum tears work?

If you have shoulder pain and someone has told you that it’s coming from a labral tear, you may feel like your only option is surgery. After all, if something in your shoulder is torn, how could you possibly be able to do anything to fix it besides having surgery? You can’t possibly go in yourself to fix that tear!

But what are the odds of shoulder labrum surgery success? 

While surgeons may suggest that shoulder surgery is often extremely successful, it’s important to look a little more into the details in research. As with many orthopedic surgeries, initial reports of great success may not play out in the long run.

In addition, what is considered success for a surgeon may not be the same for you as someone with shoulder pain.

In another article, we’ve looked at whether or not labral tears should even be blamed for shoulder pain. If you haven’t read that one, you can check it out here.

You can also check out this video on the topic.

Now let’s talk about surgery for shoulder labral tears.

Is surgery for labral tears the obvious solution?

First of all, what you should know that the research on surgery for shoulder labral tears doesn’t provide crystal clear answers for how to approach labral tears surgically. There is no obvious, clear answer about which surgical procedure does the best for specific shoulder problems.

systematic review from 2016 looked at 26 research articles on the surgical treatment of SLAP lesions (superior labral tear from anterior to posterior). The study was looking for “best practices” for surgery for SLAP tears based on overlap from the other studies.

The review found many studies did not include enough details on the actual repairs, criteria for determining if repairs were complete, and the actual details of postoperative rehabilitation.

Basically, there wasn’t enough information in these studies to be able to make meaningful comparisons and conclusions. If, for example, one surgical study performed a repair one way and another study reported it another way - and neither of them told us exactly what they did! - we can’t tell whether one method is better than the other.

From the abstract: “These findings may be some of the factors responsible for the variability in treatment outcomes and suggest that efforts could be directed toward consistency in documenting and reporting surgical indications, surgical techniques, surgical endpoints, and efficacious rehabilitation programs” (Kibler 2016).

Keeping in mind that there are different ways of approaching shoulder labral repairs, let's take a look at some studies that look at the actual efficacy of surgery to repair labral tears.

How effective are surgeries for shoulder labrum tears in the long term?

The long-term results for shoulder surgery don't seem to be reliably good.

A large review (Provencher et al 2013) prospectively examined 225 patients with type 2 SLAP tears. After a follow-up at an average of 40.4 months, 179 patients completed the study.

They looked at the range of motion of the shoulder. After shoulder surgery, the range of motion actually became worse for many patients! Flexion and external rotation both decreased by 5 degrees and abduction decreased by 15 degrees on average.

After shoulder surgery, the range of motion actually became worse for many patients! Flexion and external rotation both decreased by 5 degrees and abduction decreased by 15 degrees on average.

The researchers also measured results using the American Shoulder Elbow Score. The mean preoperative score of the ASES was 65. Following surgery, it was 88. Sounds like a significant difference, right? But let’s look at the ASES a little closer.

If you look at the questions, they are heavily weighted toward very basic activities of daily living, with only two questions looking at return to work and leisure. 

Of these patients, 36.8% met failure criteria - as defined by an ASES score below 70, requiring a revision surgery, or an inability to return to sports and work. So one-third of people "failed," the average patient lost range of motion, and the score for "success" did not heavily value the ability to return to work or leisure activities. 

But don't some studies show high rates of shoulder labrum surgery success?

Sure! But those results aren't always an accurate reflection of your satisfaction.

Another group of researchers looked at results five years after SLAP repair. They included 107 patients in this study and used the Rowe score to measure results. This study noted improvements from a score of 62.8 preoperatively to 92.1 at follow-up. 13.1% of patients continued to suffer from postoperative stiffness and pain despite these reported improvements (Schroder et al 2012).

To really understand what's going on here, let's look closer at the Rowe Score.

If you check out the Rowe Score scoring system, there are only 3 sections: stability, motion, and function. Within each section there are only 4 choices that drastically affect the scoring, so it is not too difficult to reach a big difference with a very subtle improvement.

For example, having a score of 90 (as in this study) can indicate you still have limitation of function and range of motion AND continued discomfort as long as your shoulder does not subluxate. To be even more clear, with a score of 90, you could still have only 75% of normal external and internal rotation and elevation ability. You could still have "mild or minimal" discomfort.  

In this study, the surgery could have fixed the stability of the arm but NOT the function and motion and STILL showed a very "positive" outcome!

In this study, the surgery could have fixed the stability of the arm but NOT the function and motion and STILL showed a very "positive" outcome!

How does surgery do for shoulder pain relief?

In 2008, a group of 33 patients had arthroscopic surgery for their SLAP lesions and were assessed before and after surgery using the disabilities of the arm, shoulder, and hand (DASH) scale. They found that 63% of the patients with SLAP lesions had a 10 point reduction in their DASH score (Lim et al 2008).

Again, we need to look closely at these numbers. First, it's important to note that less than two-thirds had a 10 point reduction in their DASH score. Second, we need to understand what that score improvement means for the 63% that had a "successful" result. 

The DASH is a 30-item disability/symptom scale, scored 0 (no disability) to 100, and looks at topics from frequency of pain to the ability to perform household duties. While 10 is a Minimally Clinically Important Difference, the results of the surgery in this study just squeak by at 10 points.

A 10 point reduction, unfortunately, is not a gigantic improvement. If you play with the actual score calculator, you can see how easy it is to add 10 points. For many, a variation of 10 points could happen without surgery on a weekly basis! 

A 10 point reduction, unfortunately, is not a gigantic improvement. If you play with the actual score calculator, you can see how easy it is to add 10 points. For many, a variation of 10 points could happen without surgery on a weekly basis! 

If you look at question 22, you can see one example of how a small improvement has outsized results in the score calculation: "During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups?"

You can answer "Extremely, Quite a bit, Moderately, Slightly, Not at all." 

If a patient had the surgery and the answer went from the worst case of "extremely" down to "quite a bit," the score instantly improved by 25 points. 

Keep in mind that going from "extremely" to "quite a bit" for most people is probably not a significant improvement in a person's quality of life. And yet that change actually results in MORE than 10 points of improvement. Again, the positive spin on this study was that 63% of the patients had a 10 point improvement - an improvement that for the average patient would not be much cause for celebration. 

One weakness of this study is the relatively small sample size. However, if the shoulder surgery is supposed to truly help people, one would hope to see significant improvement in a larger proportion of this small group.

The Summary on Surgery for Shoulder Labrum Tears

When looking at the research on surgery for labral tears of the shoulder, it's important to read the evidence closely. Long term studies show that surgery for shoulder labral tears are not simple "slam dunk" solutions.

Even the studies that support surgery for shoulder labral tears show a very modest benefit when you look closely at how success is being measured. And often success is measured using criteria that don't accurately account for people's desires to feel AND move better! 

One of the reasons why we encourage our clients to think outside the "orthopedic surgery" box is that these kinds of results and research appear to be quite common. This exact pattern has occurred already in medical history with back pain and back surgery and knee pain and knee surgery.

Research is now catching up to hip and shoulder issues.

As trainers and movement coaches, we are intensely interested in how people train the muscles that control movement to help people move and feel better (simple!). Movement is ultimately what needs to be improved - so focus on the organs that help you move - muscles!

By working with muscles gradually and safely, we believe people can drastically improve their pain levels, confidence, and quality of life. 

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About the Author

Matt Hsu is a trainer and orthopedic massage therapist. He fought a long battle with chronic pain all over his body and won. He blends the principles he learned in his journey, empirical observations with clients, and relevant research to help others get their lives back.