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Ask Dr. Rick – May 2011

May 16, 2011

Glenoid Labrum Tears

Glenoid labrum tears are generally associated with overhand athletes. These may be throwers as in pitchers or quarterbacks, and could be swimmers, javelin throwers or tennis players. Activities that create stress and repetitive activities overhead predispose the shoulder to break down at the glenoid labrum and alterations in mechanics of throwing motion.

These injuries occur when the underlying pathology is tightness in the posterior/inferior capsule or covering of the joint which causes the shoulder to alter its position overloading what is known as the SLAP (superior labrum anterior/posterior) area and the labrum tears. The glenoid labrum is a structure that attaches the biceps tendon to the shoulder joint and creates pain in the cocking phase of throwing.

When the labrum tears and the biceps tendon is pulled off of the bone, this causes pain and can overload the back part of the rotator cuff creating what is called internal impingement. Initially the athlete will just lose velocity and have no pain. A decrease in velocity is followed by soreness and discomfort in the shoulder and ultimately inability to continue to throw.

Care and treatment for this problem initially is stretching of the posterior/inferior capsule, strengthening of the posterior shoulder and improvement in the biomechanics of the shoulder. Ultimately if it does not improve with physical therapy, a MRI and subsequent arthroscopic surgery becomes inevitable. The success rate of this surgical procedure in throwers is approximately 85% and one can anticipate a full return to throwing activities.

Ask Dr. Rick

“Dear Dr. Rick: I am a dancer and have had pain in the back part of my hip for approximately six months. The pain occurs mostly during extreme motions while I am dancing. Can you please help?”
– Linda L., Chesterfield, MO


Dear Linda: Thank you for your question. The common problem with dancers is their hyperflexibility and repeated stress. Commonly they have problems in the sacroiliac joint as well as biomechanical overload of the pelvis. You will probably need an x-ray and possibly a MRI of your SI joint and low back, but this should be addressed aggressively and will not improve with rest and may threaten your dancing career. Be aggressive with your treatment and get this resolved early. Thank you for your question.

“Dear Dr. Rick: When I wake up in the morning I have tingling and numbness in my hand and once I start to shake it, it improves. Do you have any idea what this could be?”
– Allen R., Florissant, MO


Dear Allen: Thank you very much for your question. Last month we talked about carpal tunnel syndrome and it seems that this may be a typical case of carpal tunnel syndrome. I would go to a medical store and buy a wrist splint and wear it at night when you sleep and see if this helps. If this does not help you need to consult your physician and progress with your treatment. Good luck.

Pearl for the Month of April: As the weather starts to improve, progress your outdoor activities slowly and be very careful of repetitive overload until you have gotten back into reasonable shape.

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