Posterior Labral Tear?

Hi all,

Has anyone here dealt with a posterior-inferior labrum tear and/or a posterior slap tear? The "posterior" (back) aspect is confusing me since it seems that anterior (front) slap tears are more common in climbers. To add to my confusion, my pain is actually in the front of my shoulder as well as in the back of my shoulder blade....but not directly behind the shoulder joint where I would think a posterior tear would hurt.  

Has anyone else had a similar diagnosis with anything to share? Has anyone had success with PT for a posterior tear? Anything exercises to avoid or that help?

I saw a doctor twice already, but he didn't provide me with the information I was looking for. PT is next.

Hey Beth,

I had a posterior inferior tear - basically the opposite of a SLAP tear. My pain aligned with yours. Do you know the severity of yours? Mine was originally pretty mine, 7-9. However, when I tore mine I tore off a chunk of cartilage that got stuck in the perfect spot to cause me to dislocate/relocate my shoulder ~5x a day, and as a result I had to get surgery. By the time I got surgery, my tear had escalated to a 4-11 or 4-10 or something - basically it had gotten a lot worse due to all of the dislocations and relocations. My Dr originally said that if I hadn't also torn off that chunk of cartilage that was causing problems, that he would have just recommended PT for me instead of surgery. Just a note, I have the same scars J mentioned in his comment, two on front and one on back (though they're barely visible anymore even though I'm only 6 months post-op).

I saw your other posts about looking for a PT - seems like you're in the front range. I went to Western Orthopedic with Dr. Hatzidakis for my surgery/diagnosis, and he really was excellent. My healing process has been remarkably fast (though I'll be honest and say I've been heavily accelerating the prescribed recovery for sure). I work with Kevin over at Climb Clinic as a PT and he's been excellent. To give you an idea, I was told 6 months post surgery before I'd even be doing easy climbing again originally. I'm 6 months post surgery and projecting the hardest routes I've ever touched. I definitely still get some shoulder soreness and have a bit more to work on with relation to ROM and mobility but overall I'm in a pretty great place, especially in comparison to my first prognosis and I highly recommend both.

Also, just a note, here's how my medical industry brother described the difference between our tear and his SLAP tear: "Basically the opposite of what I had. I had a superior anterior tear (up and forward) yours is posterior inferior (down and backwards)". I think the difference in pain is generally SLAP on top and Inferior/Posterior on the bottom but I honestly have no idea - I can just commiserate that it blows. Hopefully you can get away with just doing PT.

Hey Tal, thanks for the response! I am on the front range, so thanks for the recommendations too!

It's also my understanding that the posterior-inferior tear is back and down. Most climbers I've talked to have had anterior superior tears (up and forward), so I'm wondering if mine was even caused by climbing or possibly an old injury. Luckily, I've never dislocated or felt like I was coming close.

Unfortunately, my radiology report doesn't specify the severity or the exact position (i.e. 7-9). It's rather vague....it says, "There is irregularity and likely nondisplaced tearing in the posterior inferior labrum. There is a shallow cleft in the posterior undersurface of the base of the biceps anchor that could represent a small SLAP lesion." From think report, I didn't think it actually sounded too bad, and I was pretty hopeful that the doctor wouldn't recommend surgery. However, the doctor read me the report and told me I needed surgery. I was pretty abrupt and shocking because like I said, it didn't sound that bad. I kept asking the doc how severe it looked, and he just kept telling me "it's torn." To be honest, I don't think he looked at my images himself and instead just read me the radiology report.

I could get a second opinion, but ultimately surgery is not an option for me right now because I have some larger health issues that need to take priority. So no matter how 'bad' my shoulder might be, the next step has to be PT for me.

Do you think your tear was caused from climbing? I'm skeptical that mine was, since it seems the majority of these types of tears are caused from a blow or impact to the shoulder.

Beth Y wrote:

Hey Tal, thanks for the response! I am on the front range, so thanks for the recommendations too!

It's also my understanding that the posterior-inferior tear is back and down. Most climbers I've talked to have had anterior superior tears (up and forward), so I'm wondering if mine was even caused by climbing or possibly an old injury. Luckily, I've never dislocated or felt like I was coming close.

Unfortunately, my radiology report doesn't specify the severity or the exact position (i.e. 7-9). It's rather vague....it says, "There is irregularity and likely nondisplaced tearing in the posterior inferior labrum. There is a shallow cleft in the posterior undersurface of the base of the biceps anchor that could represent a small SLAP lesion." From think report, I didn't think it actually sounded too bad, and I was pretty hopeful that the doctor wouldn't recommend surgery. However, the doctor read me the report and told me I needed surgery. I was pretty abrupt and shocking because like I said, it didn't sound that bad. I kept asking the doc how severe it looked, and he just kept telling me "it's torn." To be honest, I don't think he looked at my images himself and instead just read me the radiology report.

I could get a second opinion, but ultimately surgery is not an option for me right now because I have some larger health issues that need to take priority. So no matter how 'bad' my shoulder might be, the next step has to be PT for me.

Do you think your tear was caused from climbing? I'm skeptical that mine was, since it seems the majority of these types of tears are caused from a blow or impact to the shoulder.

Hard to say exactly what may have caused your injury - I can tell you that mine 100% happened while climbing (it was a very abrupt tearing sound and sensation while I was on a climb that I came down from and went to the ER for thinking that I had tore my rotator cuff. 0/10, do not recommend - that shit sucks and stays in your mind for a long time). That being said, there's a pretty good chance I had either partially tore it from other activities which led to a full tear, or was just weak from running too hard for too long and it finally just tore through.

From everything I've heard and what my Dr told to me, I think you're correct in just pursuing PT first. If you're not feeling better in a few months, then maybe surgery will be the long term answer. If your radiology report didn't give a severity/position, I'd assume it's a pretty minor tear and more responsible doctors would recommend PT over surgery in that case regardless. What every medical professional told me is that unless it's catastrophically torn, you're a professional athlete, or you're a lot older in age, you're almost always going to be recommended PT over surgery, at least at first.

Tal M wrote:

Hard to say exactly what may have caused your injury - I can tell you that mine 100% happened while climbing (it was a very abrupt tearing sound and sensation while I was on a climb that I came down from and went to the ER for thinking that I had tore my rotator cuff. 0/10, do not recommend - that shit sucks and stays in your mind for a long time). That being said, there's a pretty good chance I had either partially tore it from other activities which led to a full tear, or was just weak from running too hard for too long and it finally just tore through.

From everything I've heard and what my Dr told to me, I think you're correct in just pursuing PT first. If you're not feeling better in a few months, then maybe surgery will be the long term answer. If your radiology report didn't give a severity/position, I'd assume it's a pretty minor tear and more responsible doctors would recommend PT over surgery in that case regardless. What every medical professional told me is that unless it's catastrophically torn, you're a professional athlete, or you're a lot older in age, you're almost always going to be recommended PT over surgery, at least at first.

That sounds rough, but glad you're recovered and climbing harder now! Thanks for sharing!

Tal M wrote:

... I work with Kevin over at Climb Clinic as a PT and he's been excellent. 

+1 for Kevin at Climb Clinic.  Totally different problem (strained finger tendon sheath) but he was able to rapidly diagnose and get me on a rehab program that hugely improved in 6 weeks what I had been waiting for 6 months to get better on its own.  And all of this was via telemedicine over Zoom!