MRI Results

Labrums do not/cannot heal.  Maybe he meant the bicep tear where it merges with the labrum.  2nd Ortho opinion wouldnt hurt. 

Be sure to go to an ortho that specializes in baseball shoulder injuries. Specifically baseball. The treatment is sport specific. Is there an MLB team within reasonable distance to you?  If so, consider being evaluated by the nearest MLB shoulder specialist 

I don't recall what the process has been for you and son to date.  I won't try to play doc.  Trying not to rain on your "good news" message and hope my thoughts mean nothing... BUT... 

You should search through the tons of info on past threads here regarding labrum tears.  One common path is that the docs will almost always take the conservative route first and put the player through lengthy PT, which it sounds like your player has already been through.  In too many cases, this doesn't sufficiently address the problem the player is feeling/dealing with and they end up in surgery and having lost a good deal of time toward recovery and rehab.  So, this is where I would second other posters' suggestion of 2nd opinion by a baseball specialist ortho if you can swing it and if the current guy isn't already that guy.  If he is, then your good news is sounding much better to me, anyway.

@edcoach posted:

Just got back from meeting with ortho after discussing mri results.  Biggest take away is the first thing he said is that he wouldnt run out and do surgery on anything.  Said there is old healed tears of the labrum and even the rotator cuff.  His biggest take away was a slight bicep terror but again doesnt recommend surgery.  Going with a total throwing shut down, more physical therapy, a steroid all for 6 weeks then reevaluate.  I thought this was a positive result based on what he was saying.  As always any of your input and experiences are welcome

I think this is not terrible news edcoach.   I have had both a labrum tear leading to surgery and then had my bicep tear off my labrum leading to surgery.  All I have to say is don't open up a shoulder until its absolutely necessary.  That is my experience.  I think the plan your doc came up with makes a ton of sense.   I too would get a second opinion and hope that it's the same as the first opinion.  You would be in a huge bind if the second one came back saying you have to get surgery.....  Hearing two doctors thinking rest and PT is the way to go though would be reassuring.  

This guy is the specialist for the okc dodgers AAA

@SoCal OG posted:

Labrums do not/cannot heal.  Maybe he meant the bicep tear where it merges with the labrum.  2nd Ortho opinion wouldnt hurt. 

1) To "Labrums do not/cannot heal"... that is utter nonsense. They do. If you read that report it even speaks to a healed posterior (meaning the back of) labrum tear.

2) Great news. Also wouldn't hurt to get a second opinion if you feel it's necessary. If you haven't had the corticosteroid yet, you may want to ask the doctor what the number needed to treat* is, and the pros/cons. If everyone is on board with that then splendid. Always want to empower the patients and give them as much information as possible so they can make the best decision for them.

But anyway, best of luck, like I said before on the other thread. Hope all goes well.

*Number needed to treat is basically how many people would need to get the injection to get better more than a placebo injection (typically saline or a local anesthetic). So for instance, if he said 5, that would mean you'd have a 1 in 5 chance to get better beyond what a placebo would give you. Then you'd want to know how long that would last and again, pros/cons.

@XFactor posted:

1) To "Labrums do not/cannot heal"... that is utter nonsense. They do. If you read that report it even speaks to a healed posterior (meaning the back of) labrum tear.

2) Great news. Also wouldn't hurt to get a second opinion if you feel it's necessary. If you haven't had the corticosteroid yet, you may want to ask the doctor what the number needed to treat* is, and the pros/cons. If everyone is on board with that then splendid. Always want to empower the patients and give them as much information as possible so they can make the best decision for them.

But anyway, best of luck, like I said before on the other thread. Hope all goes well.

 

*Number needed to treat is basically how many people would need to get the injection to get better more than a placebo injection (typically saline or a local anesthetic). So for instance, if he said 5, that would mean you'd have a 1 in 5 chance to get better beyond what a placebo would give you. Then you'd want to know how long that would last and again, pros/cons.

Having had a son go through this process, I can tell you that labrums do not heal by themselves.  The labrum is basically cartilage, it does not heal or grow back.  Putting it simply the labrum helps holds the shoulder ball in its socket.  PT strengthens all the surrounding muscles & tendons to help the shoulder stay in its socket, thereby compensating for the labrum not doing its job.

Do all labrum tears require surgery, absolutely not.  But if you have a tear, you will have a tear forever unless surgically corrected. 

 Edit:  I also meant to say that this was my understanding after having been through the process.  Could I be wrong?  Sure...but thats why you take what you read on the internet with a grain of salt and do your own due diligence and get multiple opinions from the real docs.

Thx guys I appreciate all your experiences. He was given a prescription for methylprednisone i think its called

Update: son had shoulder injury and after rest and pills and pt wasn't having much improvement. Today went and got 2nd opinion. The ortho gave injection and said this is step 1. He said step 2 if step 1 doesn't work would probably be arthroscopic surgery but is hopeful with the injection. The first ortho never did an injection and kept saying rest...rest...thx to all who suggested a 2nd opinion!

@edcoach posted:

Update: son had shoulder injury and after rest and pills and pt wasn't having much improvement. Today went and got 2nd opinion. The ortho gave injection and said this is step 1. He said step 2 if step 1 doesn't work would probably be arthroscopic surgery but is hopeful with the injection. The first ortho never did an injection and kept saying rest...rest...thx to all who suggested a 2nd opinion!

Really hope it works out for him.  Surgery sucks.  But to be honest, I think injections just temporarily mask the underlying issue.  If he has had rest and gone through PT and still has the same issue I think surgery may be needed.  Having said that I am no Dr, just someone that has gone through this...and every shoulder injury is different.  So as you have already done, get multiple opinions and listen to the docs

My son went through rest & PT and was able to play again at a fairly high level but then the pain came back and he was absolutely unable to play.  Turns out the tear got worse from the time we first saw Dr and had MRI's.  Ended up having 4 anchors put in.  He was able to semi play about 6-7 months after surgery and was not truly fully healed until about 1 yr.  And if you asked my son he is not 100%, probably never will be.  He estimates that he is 90% of where he was before.

Socalog where was the tear? Labrum? My son's is strain of biceps tendon and some very small tears in the shoulder...this doctor was talking about a scope but never anchors etc.  Praying its not that it sounds like your son was a fighter!

@edcoach posted:

Socalog where was the tear? Labrum? My son's is strain of biceps tendon and some very small tears in the shoulder...this doctor was talking about a scope but never anchors etc.  Praying its not that it sounds like your son was a fighter!

My son's shoulder issue came back during his first live pitch at fall practice.  He managed his way through it but his pain was back at midsummer levels.  He went back to another 6 weeks PT which just finished.  He's about to start his throwing routine to have arm ready for a return to school in Jan (will start in 1.5 weeks as per team plan).   I am not sure he adequately warmed up shoulder/arm before fall due to tight timeline from PT to practice.  If his shoulder acts up again I am certain it will mean the knife... Good luck with your son.

Thx GMJ best of luck to your son as well. What's up with these shoulders?

GMJ did your son ever get injection?

@edcoach posted:

Socalog where was the tear? Labrum? My son's is strain of biceps tendon and some very small tears in the shoulder...this doctor was talking about a scope but never anchors etc.  Praying its not that it sounds like your son was a fighter!

Yes, it was a labrum tear.  Anchors are used in labrum (and other) surgeries.  Basically drill a hole into the bone to attach the labrum back to the shoulder.  

Hopefully, your sons is not as bad.  The bicep tendon does connect to the labrum though.  That is one of the areas labrums can tear also.  Maybe a simple scope is needed to just clean up the torn/shredded areas.  

Im sure the Doc knows what he is doing.

@edcoach posted:

GMJ did your son ever get injection?

No injections of any kind.   I asked about Cortisone at our second opinion and the Doc said she would not recommend at that time.   Given where we are regarding determining the next steps I do not thing we would go to any type of injection.  Having mostly rested and PT for almost 6 months, if the issue comes back I would think its more serious, ie: not inflammation.   We will see though.  My son is 100% committed to PT and targeted workouts, he needs to get more serious on arm care and throwing routines. 

Gmj i agree about the arm care. A few years ago I bought the bands but I guess he thought it was a suggestion as they were never used. Hopefully the pt has drilled it in his head otherwise.

SocalOG I remember when I was a sr in 1988 I got a cortisone shot and my shoulder was like new for awhile. I had a diagnosis of tendinitis. You said 9 months til throwing again and 12 months til 100%??

@edcoach posted:

Gmj i agree about the arm care. A few years ago I bought the bands but I guess he thought it was a suggestion as they were never used. Hopefully the pt has drilled it in his head otherwise.

SocalOG I remember when I was a sr in 1988 I got a cortisone shot and my shoulder was like new for awhile. I had a diagnosis of tendinitis. You said 9 months til throwing again and 12 months til 100%??

Injured shoulder was non throwing arm (left).  Throwing arm is even tougher obviously.  He was able to start playing again at about 6-7 months after surgery and according to son was not 100% until almost 1 year.  And as I mentioned, his 100% is now roughly 90% of what he was.  He still has issues/discomfort with certain overhead stretches/lifts which he avoids now.  

did it effect him lifting weights or swinging a bat?

Before or after?  Before surgery he couldn't lift anything.  He probably started lifting again maybe 9 months after surgery.  He was doing small stuff during PT.

Before....mine has been lifting as normal although nothing over head and throws just said he can't throw 100% without pain. Still hasn't tested it out after the injection

@edcoach posted:

Before....mine has been lifting as normal although nothing over head and throws just said he can't throw 100% without pain. Still hasn't tested it out after the injection

Did he stop lifting during the rest & PT stage?  

Just listened to the Cressey podcast ep. 77. Lots of great info on this topic

@SoCal OG posted:

Did he stop lifting during the rest & PT stage?  

no he didnt SoCal....just didnt do anything overhead....was also with the pt during the shutdown..