Latest / The Driven Athlete / A Labrum Tear On MRI Does Not Automatically Mean Surgery | Ep 122

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A Labrum Tear On MRI Does Not Automatically Mean Surgery | Ep 122 · The Driven Athlete

• 0:00
  SPEAKER_00: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what?
• 0:06
  SPEAKER_00: This podcast is for you.
• 0:08
  SPEAKER_00: This is the Driven Athlete Podcast.
• 0:12
  SPEAKER_00: What's up, y'all?
• 0:12
  SPEAKER_00: It's your main Dr.
• 0:13
  SPEAKER_00: Kyle.
• 0:14
  SPEAKER_00: Welcome back to the Driven Athlete Podcast.
• 0:16
  SPEAKER_00: This is a super concise podcast on the shoulder in the labrum.
• 0:20
  SPEAKER_00: All right.
• 0:20
  SPEAKER_00: So labrum um issues is not uncommon by any means.
• 0:24
  SPEAKER_00: It's actually very common, especially for athletes, especially for overhead athletes.
• 0:28
  SPEAKER_00: All right.
• 0:28
  SPEAKER_00: And then think about active people, right?
• 0:30
  SPEAKER_00: That they played sports when they were a kid in high school and stuff, and then they exercise.
• 0:34
  SPEAKER_00: Labrum issues are extremely common.
• 0:37
  SPEAKER_00: Let me just share more insights in the lens in which I would approach this and my thought on thoughts on these.
• 0:42
  SPEAKER_00: All right.
• 0:44
  SPEAKER_00: So the shoulder is built for mobility.
• 0:48
  SPEAKER_00: All right.
• 0:49
  SPEAKER_00: Like it's, it's, it's very unstable, naturally unstable joint.
• 0:54
  SPEAKER_00: And the labrum is a fibrocartilaginous ring that encircles the socket component of the ball and socket joint.
• 1:02
  SPEAKER_00: All right.
• 1:03
  SPEAKER_00: So it's on the rim of what's called the glenoid, all right, of your scapula.
• 1:07
  SPEAKER_00: And that's like the socket where the humorous bone would be the ball, the head of the humerus, articulates with the glenoid.
• 1:14
  SPEAKER_00: And that's where it moves around and rolls around to be able to reach overhead and normal joint mechanics.
• 1:20
  SPEAKER_00: Okay.
• 1:21
  SPEAKER_00: The labrum is a ring of fibrocartilaginous tissue that uh goes on the perimeter rim of the glenoid that helps to deepen the socket and create more inherent passive stability.
• 1:33
  SPEAKER_00: So it's not an active stabilizer.
• 1:35
  SPEAKER_00: The active stabilizers would be like your muscles, the rotator cuff and all the surrounding musculature.
• 1:39
  SPEAKER_00: That's actually what keeps the shoulder dynamically stable.
• 1:42
  SPEAKER_00: Whereas on the labrum falls in the same category as like ligaments, where they're not a passive stabilizer.
• 1:48
  SPEAKER_00: They're, they just create passive, inherent underlying stability for the joint, but they don't help create the active stability for like active movements, exercise, sports, and stuff like that.
• 2:00
  SPEAKER_00: So it's uh if with that lens, if the labrum gets involved, and we would call involvement being like fraying over time, imagine like a rope gets frayed.
• 2:10
  SPEAKER_00: Um, if it gets a lot of uh undue stress on it repeatedly in the same area in the same way over and over and over again, it gets degraded or frayed in one particular area from all those micro trauma incidences.
• 2:23
  SPEAKER_00: All right.
• 2:24
  SPEAKER_00: So a thousands and thousands of micro and um trauma experiences on one little spot, you know, it's like death by a thousand cuts, right?
• 2:32
  SPEAKER_00: It's uh it just gets frayed over time.
• 2:34
  SPEAKER_00: And that indicates to us that if somebody has labrum involvement or fraying of the labrum, that it was inherent underlying shoulder instability with compensation movements over many, many months and years of episodes.
• 2:48
  SPEAKER_00: And that's the different though than like a traumatic shoulder injury.
• 2:52
  SPEAKER_00: Imagine somebody falls down the stairs and they like dislocate their shoulder or something, or a football hit and they dislocate their shoulder, or they slide into first at second base with an extended arm and they sublux their shoulder.
• 3:02
  SPEAKER_00: That's a traumatic event that the labrum gets overly stressed, and that can cause like a more um a traumatic labrum tear.
• 3:10
  SPEAKER_00: Okay.
• 3:11
  SPEAKER_00: Um, and that way, you know, oftentimes requires surgery.
• 3:14
  SPEAKER_00: Um, and the determining factor on labrum surgery is if it just continually feels very unstable.
• 3:21
  SPEAKER_00: There's popping, clicking, and catching in the shoulder joint with movement.
• 3:24
  SPEAKER_00: It's severely limiting their physical ability for functionality.
• 3:29
  SPEAKER_00: Um, it's not getting better.
• 3:31
  SPEAKER_00: Um, and um it pops out of place, like it just like kind of goes out and comes back really frequently with simple things like reaching the cabinet, or like if you bump into somebody, like it goes out and it goes back in again.
• 3:43
  SPEAKER_00: Those um mild or minor subluxation incidences would indicate that the labrum um is more involved, and that would warrant maybe imaging like an MRI, right?
• 3:53
  SPEAKER_00: Um, or and then course of action would be well, the functionality that you have.
• 3:58
  SPEAKER_00: Here's the determining factor for surgery.
• 3:59
  SPEAKER_00: Like, do I need labrum surgery or not?
• 4:01
  SPEAKER_00: Or rotated cuff surgery, any kind of surgery for orthopedics?
• 4:04
  SPEAKER_00: Um, the the risk-benefit ratio and the pros and cons to weigh would be what are my what's my current functional capacity right now?
• 4:15
  SPEAKER_00: And then um, is that the same or less than it would be if I were to get surgery?
• 4:22
  SPEAKER_00: And if it ends or more, like what's the outcome after surgery, most likely?
• 4:27
  SPEAKER_00: Um, is it a better functional capacity than I have right now and I'm just in pain?
• 4:31
  SPEAKER_00: Then in my opinion, surgery wouldn't be warranted.
• 4:34
  SPEAKER_00: All right.
• 4:35
  SPEAKER_00: Then I would I would manage it with conservative treatment, which would be like sports physio.
• 4:38
  SPEAKER_00: Okay.
• 4:39
  SPEAKER_00: Um but the and we have to with that being said, like we stabilize everything around it and um get the scapula to be more involved.
• 4:46
  SPEAKER_00: We can dive into that on a whole podcast by itself.
• 4:49
  SPEAKER_00: I love that stuff.
• 4:49
  SPEAKER_00: I nerd out on that stuff.
• 4:51
  SPEAKER_00: Um, but anyway, the the decision process would be like, um, is the functionality going to be better than I actually have right now or the same?
• 4:58
  SPEAKER_00: And if it's if it is the same um or and it's it's not gonna be much better, then why do surgery?
• 5:03
  SPEAKER_00: Not gonna be functionally better to begin with, unless it's debilitating and it's super painful.
• 5:07
  SPEAKER_00: You have caught catching, locking, popping, and its subluxes come frequently.
• 5:11
  SPEAKER_00: Then I'll be like, yo, maybe you need to investigate and consult with a surgeon.
• 5:14
  SPEAKER_00: Okay.
• 5:15
  SPEAKER_00: Um so that that's kind of the filter on that.
• 5:19
  SPEAKER_00: But the lens in which we perceive this of like labrum involvement, um, why did it happen in the first place?
• 5:26
  SPEAKER_00: Usually for people who didn't have a traumatic event, usually it's because of chronic micro instability, um, micro-trauma incidences that have happened over many, many episodes of their life.
• 5:38
  SPEAKER_00: Playing baseball, playing soccer, uh, playing sports, exercising, um, lifting weights, like whatever, sleeping, all those things add up, like a thousand golden BBs that end up tipping the scale to it's like, now my shoulder kind of hurts, right?
• 5:51
  SPEAKER_00: And they go to the doc and they get an image and they're like, Oh, your rope tether cuff's partially torn and you have a labrum, partial labrum tear.
• 5:57
  SPEAKER_00: And it's like, oh my gosh, I didn't know I tore it like that.
• 6:00
  SPEAKER_00: Chances are it's been that image and those um abnormalities found on imaging for the shoulder have been like that for years.
• 6:08
  SPEAKER_00: It's just now that um the straw that broke the camel's back has presented itself with symptoms, and now you're having tightness and symptoms and pain and impingement and stuff because there's a there's an inflammatory, irritated response that's happened from the shoulder from a recent thing that's been going on.
• 6:21
  SPEAKER_00: If it's like you introduced a new exercise or really bumped up your volume or you slept funny one time, a cascade of inflammatory reactions can happen, and then more irritation in the cyst in this in the joint in the area, and that's when people have symptoms, and then that's what brings them to the doc to get imaging.
• 6:36
  SPEAKER_00: This is for non-traumatic orthopedic pain.
• 6:37
  SPEAKER_00: It's shorter being specifically right now, we're talking about.
• 6:41
  SPEAKER_00: So then they have an x-ray, usually comes back negative and unremarkable, just for satisfying insurance.
• 6:46
  SPEAKER_00: And then they get it justifies to get an MRI, and then the MRI would show labrum involvement or partial rotator cuff involvement and tear.
• 6:52
  SPEAKER_00: So, um, but yeah, so that happens because of a lot of incidences over many, many episodes because of an inherently more unstable shoulder joint and the way that they've been compensating in their life for years.
• 7:02
  SPEAKER_00: So it's underlying compensation patterns and inherent and underlying shoulder instability that led to the labrum getting overwhelmed and frayed over many, many episodes.
• 7:12
  SPEAKER_00: So that's what that looks like in my opinion.
• 7:14
  SPEAKER_00: All right.
• 7:14
  SPEAKER_00: So, like the lens and how I perceive that, because we're not going to change the labrum.
• 7:17
  SPEAKER_00: I we don't do surgery.
• 7:18
  SPEAKER_00: So what are we gonna do?
• 7:19
  SPEAKER_00: If they don't want, if the patient doesn't want surgery, we don't do that.
• 7:22
  SPEAKER_00: What are we gonna do?
• 7:23
  SPEAKER_00: Well, we need to focus on the compensation patterns that led to the issue in the first place.
• 7:27
  SPEAKER_00: And chances are that those labrum involvement images with like the labor ones torn that image would have looked the same almost five years ago.
• 7:35
  SPEAKER_00: But you weren't in pain five years ago.
• 7:37
  SPEAKER_00: The pain only started like six months ago.
• 7:39
  SPEAKER_00: So the pain, the tear didn't just happen six months ago.
• 7:42
  SPEAKER_00: It's already, it was already underlying over a couple of years by this point, according to the research, right?
• 7:47
  SPEAKER_00: That's what they suggest.
• 7:49
  SPEAKER_00: Um, so is the actual structure the problem?
• 7:52
  SPEAKER_00: Because you had a labrum tear prior and you had no pain.
• 7:54
  SPEAKER_00: And now you do have pain.
• 7:56
  SPEAKER_00: It's only been six months, but the labrum tear was there prior and you had no pain then.
• 8:00
  SPEAKER_00: So the presence of a labral tear doesn't indicate or dictate pain.
• 8:03
  SPEAKER_00: So then are we gonna fix the labrum?
• 8:05
  SPEAKER_00: Because you already had a labral tear and you had no pain.
• 8:07
  SPEAKER_00: So then, like, is that the actual problem?
• 8:09
  SPEAKER_00: Is the structural abnormality actually the cause of the pain to then warrant a structural solution, which would be surgery?
• 8:16
  SPEAKER_00: In my opinion, in that case, it would be not no.
• 8:18
  SPEAKER_00: Like, so the conservative management would be the route to go in the course of action, which is identifying and fixing compensation patterns in the shoulder and then building strength and stability and resiliency over time.
• 8:29
  SPEAKER_00: And that just takes a couple of weeks.
• 8:31
  SPEAKER_00: Sorry, a handful of weeks.
• 8:33
  SPEAKER_00: All right.
• 8:33
  SPEAKER_00: Sometimes people will feel um improvements pretty quickly after three weeks.
• 8:38
  SPEAKER_00: People usually feel better after a couple of visits with us.
• 8:40
  SPEAKER_00: That's the goal.
• 8:41
  SPEAKER_00: If we identify things accurately and we incorporate the right treatment strategies accurately, all right.
• 8:46
  SPEAKER_00: Um, after a couple of sessions, they'd be like, I notice an improvement.
• 8:50
  SPEAKER_00: And the key, the number one key for anybody to get better with stuff like this is they have to stop effing it up on their own at home.
• 8:57
  SPEAKER_00: Unknowingly doing things that they don't, they didn't realize is kind of contributing to their symptoms.
• 9:01
  SPEAKER_00: And one of those is just sleeping posture and positions, and then sitting posture, prolonged positions that they're in all the time, driving posture and positions.
• 9:12
  SPEAKER_00: It's just one little golden BB that adds it to scale.
• 9:14
  SPEAKER_00: Sleeping is a little bit more than one golden BB because they're there for eight hours.
• 9:17
  SPEAKER_00: I can really set the stage for things to be irritated.
• 9:20
  SPEAKER_00: When sleeping is supposed to be there for healing and recovery, it's just your body needs that and wants that.
• 9:26
  SPEAKER_00: But the positions a person is putting themselves in is not setting up for success to be able to be able to heal and recover.
• 9:30
  SPEAKER_00: It's just adding more irritation or maintaining the same irritation at least.
• 9:34
  SPEAKER_00: So it's just positioning.
• 9:35
  SPEAKER_00: And then sitting posture, same fault, same falls in the same category, driving posture, eating posture, work uh sitting at home, watching TV posture.
• 9:44
  SPEAKER_00: Um, all those things kind of add up.
• 9:46
  SPEAKER_00: Um, and then things that they might think are be helpful, right?
• 9:48
  SPEAKER_00: Like, I'm exercising, I'm trying to work out and do stuff.
• 9:50
  SPEAKER_00: Right now, it's not you.
• 9:52
  SPEAKER_00: Your shoulder just isn't ready for that kind of stress yet and those positions and those movements and that that those resistance stresses.
• 9:59
  SPEAKER_00: So um, just modifying lifestyle right now.
• 10:03
  SPEAKER_00: And that's also what we help walk through people.
• 10:05
  SPEAKER_00: Being like, it's not getting better.
• 10:06
  SPEAKER_00: Just wake up with pain.
• 10:08
  SPEAKER_00: I'm like, let's back this up and walk through the last couple of days.
• 10:12
  SPEAKER_00: It didn't hurt when we live when you left and we saw you.
• 10:14
  SPEAKER_00: It felt good.
• 10:15
  SPEAKER_00: You actually said it felt better.
• 10:17
  SPEAKER_00: That night, what did you do?
• 10:18
  SPEAKER_00: The next morning, what did you do?
• 10:20
  SPEAKER_00: That day, what did you do?
• 10:21
  SPEAKER_00: That night, what did you do?
• 10:22
  SPEAKER_00: That next day, what did you do?
• 10:23
  SPEAKER_00: And then, because like all of a sudden, two days later, you have pain.
• 10:25
  SPEAKER_00: Things don't hurt for no reason.
• 10:27
  SPEAKER_00: Something's usually being done.
• 10:28
  SPEAKER_00: So we have to identify like, what is creating these little irritation moments right now that's not allowing it to get better?
• 10:35
  SPEAKER_00: We have to stop that.
• 10:36
  SPEAKER_00: Whatever that is, we just gotta stop.
• 10:38
  SPEAKER_00: It's like picking a scab over and over again and on a cut and be like, why is it still bleeding?
• 10:42
  SPEAKER_00: So we gotta stop picking the scab.
• 10:44
  SPEAKER_00: And those little things can um contribute to just unknowingly pick the scab and not letting things heal.
• 10:51
  SPEAKER_00: Um, so we're definitely gonna work on compensation patterns, but you have to stop effing it up on your own.
• 10:56
  SPEAKER_00: Um, and then we gotta you if with identifying compensation patterns, we have to fix uh the mobility disparities and mobility requirements.
• 11:03
  SPEAKER_00: If some things are more hypermobile and some joints are more hypo-mobile and they're stiff and not moving well, we have to mobilize and influence the hypomobile joints.
• 11:12
  SPEAKER_00: And that's gonna normalize joint mobility mechanics.
• 11:15
  SPEAKER_00: All right.
• 11:15
  SPEAKER_00: And then we can also work on soft tissue.
• 11:17
  SPEAKER_00: If there's soft tissue that's dominant and stiff and bound down and tight, we got to open those things up.
• 11:22
  SPEAKER_00: All right.
• 11:23
  SPEAKER_00: And we also have to activate and strengthen the ones that aren't recruited well enough to create more stability.
• 11:28
  SPEAKER_00: And that balances out when you call like when you heard like muscle balance, that helps out balance out the muscle recruitment patterns and strength and stability.
• 11:35
  SPEAKER_00: And then once that's established and not effing it up at home with like things that you didn't realize were hurting it or just irritating it over and over again, that's when people be like, I feel better.
• 11:43
  SPEAKER_00: Like it's actually not hurting when I do this or put a shirt on or take my shirt off, like whatever, or take take a shower and wash my hair.
• 11:49
  SPEAKER_00: Um, I'm seeing improvements.
• 11:51
  SPEAKER_00: Perfect.
• 11:51
  SPEAKER_00: Let's continue this course.
• 11:52
  SPEAKER_00: And as you get better, we're gonna make things more challenging.
• 11:54
  SPEAKER_00: Let's progress.
• 11:55
  SPEAKER_00: Because you're people like that are usually active and they want to do stuff.
• 11:58
  SPEAKER_00: They don't just want to sit down and watch TV all day.
• 12:00
  SPEAKER_00: So, like, I want to work out and do stuff.
• 12:02
  SPEAKER_00: I want to surf, I want to like play tennis, I want to exercise and do shoulder press.
• 12:06
  SPEAKER_00: Um, if they just wanted to like watch TV and just go to work, then they'd be good at that point.
• 12:11
  SPEAKER_00: Like, you're good.
• 12:12
  SPEAKER_00: You don't need to do anything else.
• 12:13
  SPEAKER_00: But usually people that come see us are like, now I want to amplify my physical capability and lifestyles and return back to like playing pickleball again because I like that, or Padel, right?
• 12:24
  SPEAKER_00: Or tennis.
• 12:25
  SPEAKER_00: Um, it's like now we can have fun.
• 12:26
  SPEAKER_00: All right, now let's do the fun stuff.
• 12:28
  SPEAKER_00: We can really strengthen and progress things purposefully.
• 12:31
  SPEAKER_00: Um, hold your hand and course correct in the meantime.
• 12:34
  SPEAKER_00: Um, and that's where we get really good results for people.
• 12:36
  SPEAKER_00: And like I said, it just takes a handful, a handful of weeks.
• 12:39
  SPEAKER_00: All right.
• 12:40
  SPEAKER_00: Um, so back to the labrum specifically.
• 12:42
  SPEAKER_00: Okay.
• 12:42
  SPEAKER_00: The labrum, um, it's it's just a passive stabilizer.
• 12:46
  SPEAKER_00: It's not really a key player.
• 12:47
  SPEAKER_00: We can't really do anything about it anyway.
• 12:49
  SPEAKER_00: Um, and it was already torn, so it's not really a major factor of like you're unless you fix your labrum, you're gonna be in pain forever.
• 12:57
  SPEAKER_00: It's actually not true.
• 12:58
  SPEAKER_00: It's according to the research.
• 12:59
  SPEAKER_00: That's what the research is finding.
• 13:01
  SPEAKER_00: All right, I'm just relaying information of people who are smarter and wiser than me and more experienced with research, and that's what they're conveying.
• 13:06
  SPEAKER_00: Um, and the reason is because people have imaging um that they have labrum tears, but they have no pain.
• 13:12
  SPEAKER_00: And then there's people that have mild labrum involvement, which is like fraying, but no tears, and they're like, excuse their pain hurts, their shoulder hurts, it's impingement.
• 13:19
  SPEAKER_00: So, like there's a disconnect between what this the image might show and what their symptoms, functionality, and prognosis might show.
• 13:24
  SPEAKER_00: So I'm just saying, um, course of action sometimes is just conservative therapy and working on like the actual compensation patterns to lead to the problem in the first place.
• 13:33
  SPEAKER_00: Um, so back to the labrum, the there's it's like a it's like an oval, all right.
• 13:37
  SPEAKER_00: Um, and the top part of the labrum is where the biceps, the long head of the biceps tendon, um anchors down to.
• 13:47
  SPEAKER_00: All right.
• 13:47
  SPEAKER_00: So the biceps anchor, that would be the top part of the labrum.
• 13:50
  SPEAKER_00: You think like a clock?
• 13:51
  SPEAKER_00: Think of like one o'clock to eleven o'clock on a clock, the very top component, and like 12 o'clock.
• 13:57
  SPEAKER_00: So um that would be the top part biceps anchor.
• 14:02
  SPEAKER_00: Um, and if that gets detached from the glenoid surface of the bone, um, they would call that like a slap tear.
• 14:09
  SPEAKER_00: And there's different types of slap slap tears, but slap meaning S L A P superior labrum, anterior to posterior.
• 14:16
  SPEAKER_00: So the superior component of labrum, anterior to posterior, directional, that just indicates that the biceps anchor and the top part of the labrum have been detached or some kind of fraying or tear.
• 14:25
  SPEAKER_00: And that would indicate overhead, uh, just superior labrum in involvement and usually some shoulder instability.
• 14:32
  SPEAKER_00: Here's the crazy thing about 80% of overhead athletes, overhead being baseball, volleyball, swimming, let's stick to baseball.
• 14:41
  SPEAKER_00: About 80% of them have some kind of a lab a slap tear involvement.
• 14:45
  SPEAKER_00: 80% of overhead athletes have some kind of a slap tear involvement, but you don't see 80% of them needing slap repair, labrum repair surgery or instabilitating shoulder pain.
• 14:57
  SPEAKER_00: So the presence of a slap tear or presence of labor tearing doesn't indicate someone's gonna be in pain forever.
• 15:02
  SPEAKER_00: It's just a passive stabilizer.
• 15:04
  SPEAKER_00: I'm just saying.
• 15:05
  SPEAKER_00: Um, and then the other component would be like a bank art.
• 15:07
  SPEAKER_00: All right, so bank art would be more like of an anterior, the middle component of the labrum, um, from like imagine like two o'clock to five o'clock.
• 15:16
  SPEAKER_00: All right.
• 15:16
  SPEAKER_00: So two o'clock to five o'clock component labrum.
• 15:19
  SPEAKER_00: Um, that would be like a bank art.
• 15:21
  SPEAKER_00: And that's the anterior part, the front part of the shoulder.
• 15:24
  SPEAKER_00: It's more unstable going in the anterior direction.
• 15:27
  SPEAKER_00: Um, so that would be it's just uh it's called bank art.
• 15:30
  SPEAKER_00: I think the doc's name that invent that discovered it and identified it.
• 15:34
  SPEAKER_00: Um, but it's because the anterior part of the shoulder is more unstable going forward than it is backwards.
• 15:39
  SPEAKER_00: So the huge majority of shoulder dislocations happen going in the forward direction.
• 15:44
  SPEAKER_00: Um, and that's traumatic, like a car accident or a football injury or like falling down the stairs, something like that.
• 15:51
  SPEAKER_00: Um, but the shoulder being more unstable in the anterior direction, it sets the kit the stage for the shoulder to compensate going anteriorly over and over and over again.
• 16:02
  SPEAKER_00: And what I mean anteriorly being like the humeral head, the head, the ball and socket joint, the ball glides more forward with overhead movement, bench press, push-ups, bull-ups.
• 16:14
  SPEAKER_00: Um, so anterior shoulder instability is what they would call that.
• 16:17
  SPEAKER_00: And sometimes with enough involvement, that's when somebody might need surgery to re-anchor the labrum back down.
• 16:22
  SPEAKER_00: Most often, though, at least the people that we see, if it's non-traumatic, it develops over time, is um the straw that broke the camel's back has finally come to a head.
• 16:30
  SPEAKER_00: Now they have symptoms because of some recent event that might have been too stressful or strenuous.
• 16:34
  SPEAKER_00: So it's just overwhelmed.
• 16:36
  SPEAKER_00: And um, often a common thing we've heard with that is somebody was driving, they'd be they'd been working out a lot, they were driving and they reached backwards to reach the rear seat of the car.
• 16:46
  SPEAKER_00: And that backwards movement um created like an anterior, an anterior movement position for their shoulder, and they had like a big shoulder pain.
• 16:55
  SPEAKER_00: And um the biceps tendon, again, is a culprit often for like the pain source.
• 17:01
  SPEAKER_00: So the biceps tendon is um very it's it has a close relationship to the shoulder joint and the rotator cuff and labrum stability, but also shoulder stability, but it's not built for that.
• 17:11
  SPEAKER_00: And it hangs on for dear life because other structures can't stabilize like it need to.
• 17:16
  SPEAKER_00: So the biceps tendon hanging on and doing way too much, and that's when it gets irritated and painful.
• 17:21
  SPEAKER_00: So oftentimes people are like, What's hurting though?
• 17:23
  SPEAKER_00: What's the painful source?
• 17:24
  SPEAKER_00: It's usually the long head of the biceps tendon and the anterior capsule of the joint itself.
• 17:29
  SPEAKER_00: Because the anterior, the capsule, the shoulder joint is very sensitive, and there's a lot of nerve endings in there, and that can be very sensitive and painful.
• 17:35
  SPEAKER_00: So it's like, what's the pain generator?
• 17:36
  SPEAKER_00: What's the tissue that's angry?
• 17:38
  SPEAKER_00: It's usually the biceps tendon, the long head of the biceps and the anterior capsule.
• 17:43
  SPEAKER_00: Um, and then um the other component with like shoulder pinching overhead, like if we reach overhead and it pinches in the front of my shoulder, I have referred pain down my arm, that's the supraspinatus.
• 17:53
  SPEAKER_00: It's usually this, the, the rotate, one of the rotator cuff muscles that's overwhelmed in the pain generator.
• 17:58
  SPEAKER_00: And the pain generators are usually the victims.
• 18:01
  SPEAKER_00: They're not the problem.
• 18:01
  SPEAKER_00: It's because they're overwhelmed and they're doing too much that that's required of them.
• 18:05
  SPEAKER_00: So we have to get support around them from other things because they're not active or the mobility is setting up for failure.
• 18:11
  SPEAKER_00: There's a lack of mobility and movement that is not allowing it to function properly.
• 18:16
  SPEAKER_00: So the superspinatus or one of the road to the cuff tendons has to overcompete with everything else that's not helping.
• 18:22
  SPEAKER_00: And the supraspinatus is going to lose every time and over a long enough time horizon.
• 18:27
  SPEAKER_00: So that's usually the pain generator.
• 18:30
  SPEAKER_00: All right.
• 18:31
  SPEAKER_00: So, moral of the story, um, the labrum is a passive stabilizer.
• 18:36
  SPEAKER_00: Um, it's not an active dynamic stabilizer.
• 18:38
  SPEAKER_00: It's a fibrocartilaginous ring that encircles the glenoid surface to deepen the socket of the ball and socket joint.
• 18:45
  SPEAKER_00: And it can get frayed over time with microcompensation movements over many, many episodes.
• 18:50
  SPEAKER_00: Enough to the point where like somebody has symptoms and it causes pain.
• 18:54
  SPEAKER_00: Um, the slap tear is with the biceps anchor attaches at the top cart part of the labrum, like 12 o'clock on the clock.
• 19:00
  SPEAKER_00: And then a bank art instability or anterior shoulder instability, bank art lesion of the labrum is the anterior middle part of the labrum, which would be like from two o'clock to five o'clock.
• 19:09
  SPEAKER_00: I think like a clock.
• 19:10
  SPEAKER_00: Um, any questions?
• 19:12
  SPEAKER_00: Um, please don't hesitate to reach out.
• 19:14
  SPEAKER_00: We love, we nerd out on this stuff.
• 19:16
  SPEAKER_00: We love helping people open their eyes and be like, I didn't know this was possible, or I didn't know what to do.
• 19:22
  SPEAKER_00: Like, I don't, what do I do next?
• 19:24
  SPEAKER_00: Right?
• 19:24
  SPEAKER_00: Is this problem solvable?
• 19:26
  SPEAKER_00: Um, we will be the first ones to refer out.
• 19:28
  SPEAKER_00: If we're like, we're not the ones, like we don't, this is not this is outside of our scope.
• 19:31
  SPEAKER_00: Like you need something else, we'll for sure refer out.
• 19:34
  SPEAKER_00: Um, but we can at least chat on the phone and point you in the right direction or give you some insights.
• 19:38
  SPEAKER_00: Um, we promise we wouldn't leave you, leave you empty handed if you were to call us and chat.
• 19:41
  SPEAKER_00: We can at least send you in the right direction and give you some some things to um to take home with you for insights.
• 19:47
  SPEAKER_00: Um, but anyway, so don't hit hesitate to reach out.
• 19:50
  SPEAKER_00: We'd love to chat more and figure out how we can help you best.
• 19:52
  SPEAKER_00: And we'll catch you all next time.