Medical imaging is a technology that has saved countless lives through its ability to allow healthcare professionals to see the structures beneath the skin. But what about the additional information it also captures, such as the bulging disks and tears that might not be painful but now are known?
Whenever a new student mentions that have a tear or bulge at XYZ in their body, my follow up question is always “are you in pain?”. Sometimes, the answer is yes. But often times, the answer is no.
When we know that there is structural damage beneath the skin, is surgery the only option?
Lateral (side) view of the shoulder showing the glenoid labrum (marked “glenoid ligament”)
A 2016 study from the Orthopaedic Journal of Sports Medicine did shoulder MRIs on 53 adults without shoulder pain who were between 45 & 60 years of age. Participants had no history of surgery or injury to either shoulder and the shoulder that was imaged was randomly selected. They found that a labral tear (the cartilage that lines the socket of the ball and socket joint) occurred more than half of the time in both males and females. Remember that all participants were PAIN FREE at the time of imaging.
So what does this mean for you? Just because your scan says you have a tear, doesn’t mean that surgery is your only option. Pain is a very complicated beast, and while it often follows structural damage, like a labral tear, it can also precede damage. Finding a tear in a joint does not mean that repairing the structural damage will fix everything – in fact, the invasiveness of surgery may (read definitely will) cause a host of other issues, from scarring and the negative effects of downtime that will certainly be a bigger issue during recovery.
While the structural damage may not heal, learning to stabilize the joint through corrective exercise and lessening the soft tissue tension from guarding can help stave off pain or avoid it entirely. This fix is not a quick fix, but neither is surgery – an informed decision is much better than a rash one!
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