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Is surgery the right choice for a torn labrum?

A baseball coach holds the shoulder of his pitcher. Nicholas Sgaglione, MD, details New York Yankee Miguel Andujar's experience and highlights how to recover from a torn labrum, including surgery.

Rest, inflammation reduction and muscle strengthening can prolong playing time for weekend warriors and professionals alike, but labrum surgery might be the right answer for athletes like New York Yankee Miguel Andujar

While the New York Yankees don’t seem to be fazed yet by the unprecedented rash of injuries that have plagued the opening of this season, they are sure to feel the long-term absence of Miguel Andujar at some point.

The 2018 American League Rookie of the Year runner-up partially tore his labrum after diving back to third base on March 31. Opting to strengthen the muscles around the labrum rather than undergo season-ending surgery, it quickly became clear the 25-year-old third baseman would need an alternate plan.

In nine games since the injury, his production flat-lined, hitting just .088 with no home runs and no RBI.

Something was off. And Mr. Andujar soon opted for right shoulder labrum surgery, signaling the end of his season — the right move for the promising Yankee to fully maximize his potential. Mr. Andujar is already recovering and should be ready for spring training next year.

This is a common story for numerous athletes who suffer shoulder tears. And while labrum surgery is usually the final option, it also may be their best bet.

What is a torn labrum?

A torn labrum — or torn cartilage of the shoulder — typically occurs after outstretching your arm or falling on the upper extremity. The shoulder is the most mobile joint in your body and most potentially unstable joint, too. It’s at more risk than any other joint for excessive translations and extreme positioning.

The shoulder’s anatomy is not ball-and-cup like other joints. Instead, it works more like a golf ball on a tee. The shoulder joint is balanced via soft tissue, labrum (cartilage) and overlying muscles, such as the rotator cuff.

When you fall, like Mr. Andujar did during his dive, the shoulder joint is abnormally subjected to extreme positioning and the subsequent forced trauma tears the tissues, including the labrum.

Playing through pain

These injuries are never black and white, but you want to explore your options before having surgery. That includes rest and muscle strengthening.

In Mr. Andujar’s case, the Yankees exhausted all options before labral repair. If you try something and feel better, it’s a home run. If you are in the grey zone, your ability to return to the field could be worth the risk.

One of the issues with baseball players and other throwers is ongoing stress caused by years of repetitive high-stress motion. Mr. Andujar, for example, could’ve had small tearing before the dive caused more damage. This is called repetitive micro trauma, which is very common among baseball players and similar to the stress that can contribute to ulnar collateral injuries in the elbow (before Tommy John surgery is needed).

What should you do?

Incidence is high in today’s active world. And like Mr. Andujar’s injury, some falls can’t be avoided.

If you suffer from this injury, treatments are completely predicated on whether the labrum is injured, irritated or partially or completely torn. Options can be conservative (rest, anti-inflammatory agents, cortisone and biologic injections) or you can have surgery.

Surgery is an option for those with complete tears and those who can no longer withstand the symptoms caused by the injury.

Surgical options

Labrum surgery is usually performed arthroscopically to minimize invasiveness. For professional athletes, formal repair is almost always season-ending because of the long recovery period that includes immobilization in a sling followed by months of physical therapy.

In general, it can take six to nine months to recover. Approaches include:

  • SLAP repair: Using shoulder arthroscopy, this minimally invasive technique repairs the area of the labrum that anchors the long head of the biceps tendon.
  • Bankart repair: Bankart lesions include torn ligaments from the front of the socket. The Bankart labral repair surgery reattaches the torn labrum to the shoulder socket rim.
  • Posterior labral repair: This reattaches the area of the labrum that is located on the back portion of the shoulder joint.

Nicholas Sgaglione, MD, is professor and chair of the Department of Orthopedic Surgery at Northwell Health and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is also the senior vice president and executive director of the Northwell Health Orthopaedic Institute. Dr. Sgaglione is a team physician for Hofstra University, the United States Merchant Marine Academy and the New York Lizards Major League Lacrosse team.

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