Management of Labral Tears in the Hip and Shoulder – Should surgery still be the gold standard?
The gold standard for labral tears (both in the shoulder and the hip) for treatment has been surgery for a long time. Labrums have been thought to not be able to heal on their own. However, labral surgeries have not been shown to have the best outcomes, especially when someone is having multiple surgeries on the same joint.
There are some studies that have come out that are showing that conservative management (Physical therapy) of labral tears is more indicated than surgery.
- Labral Tears are common in people with no symptoms: Studies show that 40-70% of people have labral tears on their MRIs without any symptoms at all. (https://pubmed.ncbi.nlm.nih.gov/23104610/) The fact that asymptomatic people have labral tears demonstrates that the labral tear itself may not cause the symptoms. The symptoms could be caused by instability, muscle strain, poor load tolerance due to weakness. Also, pain does not always indicate damage.
- Sham surgery is no different than surgery: Here is a strong randomized control study (https://bjsm.bmj.com/content/bjsports/51/24/1759.full.pdf ). This study looks at 3 groups of patients all that had SLAP tears in the shoulder. One group got a SLAP Repair, one group got bicep tenodesis surgery, and 1 group had a sham surgery. All groups got PT afterwards. The article shows that all groups improved significantly in terms of pain and function but there was no difference between outcomes between the surgeries or the sham surgery. Meaning — is it the labral repair that is improving patients pain/function or is it PT afterwards? Or placebo effect from surgery “Fixing” it?
- Stronger people with structural deformities have no pain; Here is a study looking at asymptomatic people with FAI hip impingement (structural deformity that can lead to labral tears at the hip) (https://pubmed.ncbi.nlm.nih.gov/30038915/) It finds that the people with the deformity but without pain had stronger hip muscles, and ROM than the people with the deformity and pain. Meaning potentially that if you strengthen and increase ROM with PT, you can take away the pain even though there is a structural deformity there without surgical intervention. Classically, this structural deformity is often treated with surgery in the hip.
Here is a case series about conservative management of hip labral tears via PT. These patients had confirmed MRI labral tears and clinical tests that confirmed labral tears. Pain, function and strength improved significantly without surgery:
In conclusion, there is still a lot more research to be done about conservative management of labral tears in the shoulder and hip. In light of this research, if you have a labral tear, talk to your MD to trial PT first to see if you can meet your functional goals without surgical intervention. If you trial PT for 8-12 weeks and still have persisting limitations and decide to get surgery, you will have maximized your ROM And strength pre-surgery and will certainly have a better outcome.If you have suffered from a labral tear in your hip or shoulder, you could benefit from Physical Therapy. Call us to set up an appointment: (617) 536-1161.