A 27-Year-Old Thrower with Failed Labral Repair

Abstract

Overhead athletes with suspected labral injuries must be evaluated for the presence or absence of the clinically significant labral injury (CSLI), an anatomic labral injury that can be related to the clinical symptoms. This term is a more functional description of the pathoanatomy and can guide more precise treatment than the term superior labrum anterior to posterior. Surgical treatment of the labral injury should address all of the pathoanatomy without damage or restriction of the normal anatomy. This case illustrates pitfalls in treatment that may occur if these principles are not followed and how revision treatment can improve outcomes.

The original diagnosis of the labral injury focused only on the “superior” injured and guided treatment which failed to restore the normal anatomy and produced further disability. Detailed physical exam and imaging revealed the posterior component of the injury and determined that the biceps was not a factor in the dysfunction. Revision arthroscopic treatment addressed the posterior labral pathoanatomy and resulted in stable and acceptable functional outcomes for overhead activities. It did not include a biceps tenodesis, since the physical exam and arthroscopic evaluation did not indicate biceps pathology. Understanding the roles of the labrum in normal shoulder function and how the CSLI affects shoulder dysfunction can lead to improved evaluation and treatment methods.