Is fraying of the shoulder labrum typically treated with surgical repair?

Management of Shoulder Labrum Fraying

Fraying of the shoulder labrum typically does not require surgical repair and should be managed conservatively with physical therapy and pain management strategies. 1, 2

Understanding Labrum Fraying vs. Tears

• Labrum fraying: Represents early degenerative changes or minor damage to the labral tissue
• Full tears: More significant damage that may involve detachment from the glenoid

Evidence-Based Treatment Algorithm

First-Line Treatment: Conservative Management

For labral fraying without instability or complete tears:

1. Physical therapy program (6-8 weeks) 2

   • Rotator cuff strengthening exercises
   • Scapular stabilization exercises
   • Range of motion exercises
   • Manual therapy techniques

2. Pain management 2

   • NSAIDs
   • Activity modification
   • Ice/heat therapy

When to Consider Surgery

Surgical intervention is generally NOT indicated for simple labral fraying. According to AAOS guidelines, surgery should be considered only in specific circumstances:

• Symptomatic full-thickness tears (not fraying) 1
• Failed conservative treatment (minimum 6-8 weeks) 2, 3
• Significant functional limitation despite therapy
• Evidence of instability

Important Considerations

Patient Factors That Influence Management

• Age: Younger patients (<40 years) with traumatic tears may benefit more from repair than older patients with degenerative changes 4, 5
• Activity level: Overhead athletes have different considerations than non-athletes 6
• Symptom severity: Asymptomatic labral fraying should not be surgically treated 1

Rehabilitation Success Rates

• Patients who complete a full rehabilitation program for SLAP lesions show a 78% return-to-play rate 3
• Successful rehabilitation typically requires approximately 20 physical therapy sessions 3

Common Pitfalls to Avoid

1. Overtreatment: The percentage of SLAP repairs reported is approximately three times higher than supported by literature 5
2. Inadequate conservative trial: Many patients improve with proper rehabilitation but may be referred for surgery prematurely 3
3. Misdiagnosis: Normal variants and degenerative changes can be misinterpreted as pathologic SLAP lesions 4

Follow-up Recommendations

• Initial follow-up at 1-2 weeks to assess response to treatment 2
• Clinical reassessment at 6 weeks 2
• Consider advanced imaging (MRI) only if no improvement after 6 weeks of therapy 2

Remember that the primary indication for surgical intervention is significant pain with functional limitation that fails to respond to appropriate conservative management, not simply the presence of labral fraying on imaging 1.