Damian Williams Tears Labrum

Updated and cleaned up. This is a part of a larger series on Sports Injuries – Paragon

From Wolf at the Daily News:

If Arkansas quarterback Mitch Mustain transfers to USC this summer, he will have participated in just one less practice than his teammate, wide receiver Damian Williams, who became a Trojan in January.

That's because an MRI exam revealed Williams suffered a torn labrum in his shoulder in USC's first spring practice and he will undergo surgery next week. He will be sidelined at least three months.

Williams originally injured his shoulder at Arkansas last season and aggravated the injury during his first practice last week.

While no injury is ever good this is best time to get it identified and surgically repaired. It's a relatively simple surgery but the rehab time is brutal so better to have it fixed now then to have it torn during the season where he would have been lost for the season for sure.

The team USC Team Doctors from the Kerlan-Jobe Orthopedic Clinic in Los Angeles will probably be the group to perform the surgery, This is a good group of docs and I have had the pleasure of working with about 6 or 7 surgeons who have done their fellowship work there over the past 8-9 years.

From Wolf at the Daily News:

If Arkansas quarterback Mitch Mustain transfers to USC this summer, he will have participated in just one less practice than his teammate, wide receiver Damian Williams, who became a Trojan in January.

That's because an MRI exam revealed Williams suffered a torn labrum in his shoulder in USC's first spring practice and he will undergo surgery next week. He will be sidelined at least three months.

Williams originally injured his shoulder at Arkansas last season and aggravated the injury during his first practice last week.

While no injury is ever good this is best time to get it identified and surgically repaired. It's a relatively simple surgery but the rehab time is brutal so better to have it fixed now then to have it torn during the season where he would have been lost for the season for sure.

The team USC Team Doctors from the Kerlan-Jobe Orthopedic Clinic in Los Angeles will probably be the group to perform the surgery, This is a good group of docs and I have had the pleasure of working with about 6 or 7 surgeons who have done their fellowship work there over the past 8-9 years.

The Labral Tear (Shoulder)

The Shoulder or Glenohumeral joint, is considered by some a ball and socket joint. It is comprised of the Humerus (ball/shaft) and the Glenoid (socket). While there are some similarities to that of the hip, a traditional ball and socket joint, the shoulder joint is more shallow than the hip and has more of a gliding type of range of motion, as it is the most mobile joint in the body . Because the joint is shallow, the glenoid is essentially flat, it is inherently more unstable than the hip so the shoulder relies on the soft tissue structures around it to achieve stability. The glenoid has a rim, or cuff, of tissue around it called the labrum. This helps keep the head of the humerus in place essentially making the socket "deeper". It also acts as a bumper to limit eccessive motion of the humerus.

The labrum can be torn because of a direct fall or blow to the arm resulting in abnormal movement of the humerus. It can also be caused by repetitive trauma of the greater tuberosity and rotator cuff on the posterior aspect or back of the labrum. This is termed internal impingement, the pinching of the soft tissue, and is most commonly seen in baseball, swimming and tennis athletes whose arms are frequently in overhead positions.

The most common patterns of labral tears are:
  • SLAP Tears - A SLAP tear is a type of labral tear most commonly seen in overhead throwing athletes such as baseball players and tennis players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder.
  • Bankart Lesions - A Bankart lesion is a labral tear that occurs when a shoulder dislocates. When the shoulder comes out of joint, the labrum is torn, and makes the shoulder more susceptible to future dislocations.
  • Posterior Labral Tears - 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.

Slap Tears

Non-operative Treatment for Labral Tears

There are probably a large number of untreated labral tears that heal spontaneously since the labrum has a rich blood supply that helps the healing process (except in the anterior and superior locations).

Physical therapy is helpful for certain cases such as internal impingement, in which the rotator cuff rubs the posterior labrum. Physical therapy options include:

  • changing the throwing mechanism.
  • strengthening muscles that externally rotate the shoulder.
  • stretching the posterior capsule with the help of a physical therapist.
Operative Treatment for Labral Tears

Tears that need treatment are usually seen in the chronic stage when spontaneous healing has not occurred. Tears of the biceps tendon anchor are unlikely to heal without treatment because the biceps constantly pulls on the labrum.

Chronic tears may require surgery if patients are unwilling or unable to modify their activities sufficiently to allow for healing and comfort. Surgery should be considered if:

  • pain is unresponsive to anti-inflammatory medications such as ibuprofen, rest, and activity modification.
  • the labrum has not healed after an acute injury.
The arthroscope allows direct visualization and evaluation of the entire shoulder joint. Using this small instrument, the orthopaedic surgeon first examines the labrum and all attachment sites for instability requiring repair. Once other disorders are treated or ruled out, the labral injury is addressed.

Arthroscopic treatment is the standard of practice for most labral injuries not associated with instability. The majority of these can be treated with simple debridement (removal of abnormal, damaged, or excess tissue). This procedure will eliminate flaps that may impinge the movement of the humerus on the glenoid and/or remove any unstable portion of the labrum.

Certain painful and unstable SLAP tears, in which the biceps is detached, need special attention. If the biceps tendon anchor is no longer firmly attached to the glenoid, it must be re-attached to the bone. The surgeon uses suture anchors and /or arthroscopic knot tying techniques to repair the torn labrum of younger patients.

It is often safer for older individuals to have a debridement of the labrum and a biceps tenodesis. A tenodesis is a procedure in which the biceps is repaired to the bone outside the glenohumeral joint to relieve pain, yet allow it to retain some strength and function. This procedure can be a good choice for older patients because the blood supply to the labrum diminishes with age, making the healing process more difficult. The decision to perform a tenodesis repair should be made by the doctor and patient together, after a thorough discussion of the surgical options and the healing process.

What types of complications can occur?

Complications associated with surgery for labral tears are few:

  • The risk of infection in arthroscopic procedures is extremely low and can be a complication of any surgical procedure.
  • Stiffness after surgery is unlikely since debridement allows early arm movement. Physical therapy will usually relieve stiffness resulting from the sling that is needed for four or more weeks for labral repairs.
  • Failure of healing can occur due to technique, biology, or the patient's unwillingness to follow post-operative instructions and the prescribed rehabilitation program.

Here is a great write up by Dr. Russell Warren at the Hospital for Special Surgery (HSS) in NYC on Shoulder Arthroscopy that will help give an overview of the procedure. There are also some great images that you can click on in this article that show the procedure.

Images and treatment information taken from the Steadman-Hawkins Clinic in Vail, Colorado.

These are some intra-operative images of the procedure:


Images take from the website of Daniel C. Wnorowski, MD Syracuse, NY

Here is short video from YouTube outlining the procedure:

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