Dr. Amit Sahasrabudhe 2014-04-01 00:25:50
Posterior Labral Tear From A Car Accident? The labrum is a ring of cartilage that surrounds the socket (glenoid) of the shoulder joint. Its job is to deepen the socket, serving as a bumper to prevent the ball (humeral head) from shifting or dislocating. Tears of the labrum are common, especially the anterior (front) and superior (top) labrum. Posterior labral tears are less common, but sometimes seen in athletes in a condition called internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder. Additionally, certain dislocations, falls, sports and repetitive overhead sports can cause a posterior labral tear. Similar to a SLAP tear, a posterior labral tear can be ignored if asymptomatic. Diagnosis is made by history and physical exam. MRI with dye injected into the shoulder is 90 percent accurate to help confirm the diagnosis. Case Study Forty-year-old right hand dominant male presents with left shoulder pain after being involved in a motor vehicle accident, as the restrained passenger. His vehicle was rear-ended at high speed, causing his car to hit a stationary object in front. He denies any previous left shoulder pain, injuries or surgery. He complains of pain in the posterior aspect of the left shoulder, along with a feeling of catching when trying to do a pushup. His MRI shows a posterior labral tear. Question: Was the tear caused by his motor vehicle accident? Answer: It depends. Under typical circumstances – i.e., in the absence of significant trauma – it is more likely than not that the presence of a posterior labral tear is due to age-related degenerative changes. However in this situation, it was revealed that he used his left arm to brace the impact, placing his left hand on the dashboard. The impact drove his left arm back into his shoulder. Two of the tests we conduct in the office to indicate the presence of (or at least concern for) a posterior labral tear are the jerk test and posterior apprehension test. With the posterior apprehension test, the arm is adducted and flexed. The examiner pushes posteriorly; apprehension with this maneuver indicates a positive exam. This, in fact, is the mechanism of injury described by the individual. This maneuver conducted at low energy is unlikely to create enough force to tear a labrum. If, however, the maneuver were to be a high energy incident – such as the high speed vehicle accident, then it could cause a tear. This individual, having failed conservative management, underwent arthroscopic surgery to repair the labrum and has done well from the surgery. Dr. Amit Sahasrabudhe is a board certified orthopedic surgeon specializing in sports medicine surgery and fracture care at the Arizona Sports Medicine Center (www.asmcmd.com). Dr. Amit is one of the team physicians for the Arizona Cardinals, Phoenix Coyotes, Colorado Rockies, and Chicago Cubs. He also takes care of several local area high schools. In addition to taking care of athletes and their families, his practice focuses on independent medical examinations for worker’s compensation cases as well as personal injury. He currently holds active medical licenses in Arizona and New Mexico. For more information or to get in touch with Dr. Sahasrabudhe, please feel free to call ExamWorks at (866) 800-4637.
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