The Back Pain Doctor
The labrum is a rim of strong fibrous tissue around the edge of the shoulder socket. It deepens the socket by roughly half, helps hold the joint stable, and anchors several shoulder ligaments as well as the long head of the biceps tendon. Tears are described by where they sit — SLAP tears at the top where the biceps attaches, Bankart lesions at the front-lower socket after a dislocation, and posterior tears at the back. They follow either a distinct injury — a fall onto an outstretched arm, a forceful pull or overhead reach, or a dislocation — or gradual wear from repeated overhead activity.
Assessment focuses on the history and a careful examination of shoulder movement, strength and stability, using positional tests to reproduce symptoms. The neck is checked too, since a pinched nerve there can mimic shoulder pain. X-rays do not show the labrum but exclude arthritis and fracture. MRI shows the soft tissue far better, and an MR arthrogram — contrast injected into the joint before the scan — is sometimes needed. Because labral fraying is common in shoulders that do not hurt from middle age onward, imaging is most useful when the result will change what happens next.
First-line care is usually non-surgical: settling the pain with simple analgesia or a short course of anti-inflammatory medication, modifying aggravating overhead load, and a physiotherapy program restoring capsule flexibility and rotator cuff strength — typically over three to six months. Surgery, most often arthroscopic, is considered when pain persists despite that program or when the shoulder is unstable, and involves either trimming the torn tissue, repairing it with sutures, or addressing the biceps attachment. Recovery after surgery is gradual, with a sling for two to six weeks and sport-specific work usually from around three months.
The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.
This is the starting point for most musculoskeletal conditions.
The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.
Evidence is condition-specific; it is not a universal pain treatment.
Shockwave is best framed as an adjunct where the diagnosis fits. It is generally more established for selected tendon and plantar heel pain presentations than for many joint or nerve conditions.
Read moreEvidence varies substantially by condition, tissue and preparation method.
PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.
Read moreBest used for specific inflammatory or irritable pain generators, usually for short-term relief.
An injection may help when a joint, bursa, tendon sheath or other defined structure is driving symptoms. It is not a cure and needs to be weighed against risks, recurrence and the need for rehabilitation.
Read moreClinical evidence is still developing and guideline support is limited.
EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.
Read moreEvidence is condition-specific and generally less established than exercise-based care.
Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.
Read moreMost relevant when focal myofascial pain is a clear contributor.
Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.
Read moreRelevant only when the history and examination support nerve irritation or entrapment.
Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.
Read moreThis is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
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Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
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