Shoulder Labrum Surgery No Better Than a Sham Procedure

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shoulder labrum surgery side effects

Yikes, this has been a terrible decade for elective orthopedic surgery. For years studies have come out and pummeled the world’s most common elective surgeries, such as knee “cleanups” and meniscus procedures showing that neither can beat the outcome of a sham or fake surgery. This last year has also been awful as recent research demonstrated that knee replacement wasn’t cost effective in most patients. Now, based on a new study, we can add shoulder labrum surgery to that list of procedures that can’t seem to beat a placebo.

What Is the Shoulder Labrum?

The shoulder labrum is the lip around the socket of the shoulder joint. It’s a fibrous piece similar to a knee meniscus or its cousin in the hip. It can become torn, like the meniscus in the knee. When a patient reports chronic shoulder pain and an MRI finds a tear, then surgery to “fix” the damage is usually undertaken.

Labrum tears, also called labral tears come in many different flavors. The most common naming system breaks them into types I–IV. This new paper focuses on type II, which is where part of the labrum has pulled away from its attachment to the bone portion of the socket. In this case, there’s usually a small gap between the two structures.

Also, the new research focuses on a type of labral tear known as a SLAP lesion. This injury is a problem with the labrum where the biceps tendon attaches to the structure. This issue is at the top front part of the shoulder socket.

shoulder labrum surgery

Biceps tenodesis is yet another way to deal with a labral tear where the biceps attaches to the labrum (SLAP tear). In this case, instead of trying to repair the labral tear, the surgeon detaches the biceps from the upper lip of the socket and reattaches it to the humerus arm bone. The shoulder labral surgery side effects are even greater in this surgery as it is a bigger procedure than an isolated labral-tear repair because you’re permanently changing the biomechanics of the biceps muscle.

Shoulder Labrum Surgery Side Effects

One of the common shoulder labrum surgery side effects, re-tearing of the labrum, is completely avoidable. Why? The cause of the torn labrum is rarely determined. Hidden shoulder instability is almost always missed by surgeons as rather than extensive exams, surgical decisions are based on MRI. Given that your shoulder has the greatest range of motion than any joint in your body, it requires millisecond tuned timing of a series of tendons and muscles to keep it in the right position in the joint. When one of these has become lax due to a prior long forgotten fall or other injury, the ball of the humerous is not kept where it needs to be and knocks into the labrum continually, as demonstrated in the short video below. One weight lift, or one reach, or one hang done with both arms can spontaneously result in a torn labrum in the shoulder with hidden shoulder instability.

Other shoulder labrum surgery side effects result from changing the biomechanics of the shoulder. As mentioned earlier, the shoulder is an incredibly complex joint that literally requires an incredible level of precise timing. Making surgical structural changes to that system can create permanent issues.

The healing and rehab from shoulder surgery is very long and very intense. A “cushion” shoulder brace is required for months, and the atrophy resulting from this prolonged immobilization creates yet another of the most common shoulder labrum surgery side effects.  Add to these surgical risk and trauma and avoiding the surgery all together becomes the clearly better option.

The New Research

The research was double-blinded and sham-controlled, meaning that neither the assessor nor the patient knew in which arm of the trial they were entered. The 118 surgical candidates (with a mean age of 40 years) were diagnosed with an isolated type-II SLAP lesion. The patients were randomly assigned by a study coordinator to either receive labral-repair surgery (40 patients), biceps tenodesis (39 patients), or sham (fake) surgery (39 patients).

The results? There was no difference in outcome in any of the three groups! Meaning the two invasive surgeries to “repair” the labrum at the biceps attachment or to reroute the biceps were no better than the fake surgery where no surgery was performed! Ouch!

Orthopedic Surgery as a Specialty Is Coming Apart at the Seams

So we can now add the most common shoulder labral surgery to the growing list of invasive surgical procedures that have bit the outcomes dust once compared to placebo procedures or physical therapy:

You can also likely add in knee replacement for most patients based on a recent study and analysis that showed that it wasn’t cost effective.

The upshot?  As Queen Elizabeth II once said, it has been an “annus horribilis” for orthopedic surgeons. Why are the most commonly performed orthopedic surgeries no better than placebo or sham surgeries? These procedures didn’t begin with any research showing they worked. They were simply added to a growing list of procedures that were invented because we could accomplish them, not because we should. Does this mean shoulder labral tear surgery will end? Very unlikely. In my experience, it takes about a decade and at least one or two more studies to finally put a stake in the heart of an ineffective surgery.

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14 thoughts on “Shoulder Labrum Surgery No Better Than a Sham Procedure

  1. Sam

    Interesting! Would you please provide the link to the new study?

    1. Chris Centeno Post author

      Sorry, snoozed the link this am, it’s in there now…

  2. Sharon Figler

    My husband had shoulder surgery for labrum tear 6 months after having cataract surgery. He was given steroids and Fluoroquinolone antibiotic drops after the eye surgery. The shoulder surgery didn’t work. He had PRP injected at the Centeno-Schultz clinic. It worked perfectly!

    1. Regenexx Team Post author


      Really wonderful news! it is such an important and unnecessary issue. So thnakful we could help!

  3. Lucy Li

    Read the paper you cited with conclusion that labral repair is no better than sham. Is it possible that even the sham surgery has a therapeutic value due to the following activities that’s also carried out: 1 acute trauma from surgery 2 long term immobilization 3 physical therapy after immobilization ? A few control groups should be included to rule out those, as well as a group of no treatment.

    1. Chris Centeno Post author

      Lucy, the whole point of a sham surgery study is to treat ensure that the serious risks caused by the surgery actually produce effects. If the immobilization and rehab produce effects, we can do that without surgery and save the morbidity and side effects of the surgery. The same thing with the concept of injury to cause healing, that can also be done without the surgery with far fewer side effects.

  4. Hazel Scott

    What if you are a senior in high school quarterback.?also a basketball star and also plays golf?

    1. Regenexx Team Post author

      Congrats – great accomplishments! There is a drastic difference in rehab time and return to play between shoulder labrum surgery and the non-surgical Regenexx procedures using the patients own stem cells and platelets that we do. Please see: and If you would like to see if you would be a Candidate, please submit the Candidate form, or call 855 622 7838.

  5. Jason

    What success has your procedure had on SLAP tears in overhand throwers? Is there any clinical based evidence you can share that supports stem cell injection over PT or surgery?

  6. Jason

    I understand that there is no published data. My question is more along the lines of what clinical-evidence is there that PRP or stem cells repairs the cartilage in the labrum? Does Regenexx have before and after MRI’s or any type of evidence that supports that the stem cells actually repair the cartilage associated with the labrum?
    (I also posted on another page, so sorry in advance for the duplicate posts)

    1. Chris Centeno, MD Post author

      The problem is not the labrum, but the capsular instability. Clinically, we see these shoulders go from unstable on exam to stable.

  7. Robert

    Also I’m the guy who just posted. Can you please take my last name off of that comment. Didn’t realize it was going to post it up there like that. Thanks in advance

    1. Chris Centeno, MD Post author

      Yes, we have treated many dislocating shoulders with PRP and stem cells.

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