Shoulder labrum tears are common injuries involving the shoulder joint which can be a source of pain, as well as difficulty in performing certain activities. The labrum is a thick, cup-shaped piece of fibrocartilage which lines and reinforces the shoulder socket, giving the joint more stability to stay in place.
The function of the labrum is to:
- Deepen the shoulder socket: Because the shoulder socket is shallow, the cuff of cartilage attached to its rim forms a cup to hold the end of the arm bone (humerus) in place.
- Serve as an attachment area for other tissues: Ligaments and tendons that connect the shoulder to other arm structures and keep the shoulder joint together are attached to the labrum.
Injury or trauma to the shoulder joint can cause the labrum to become torn which can be a contributor to shoulder dislocation. The labrum can tear:
- Along the edge
- At the area where the biceps tendon attaches
- Completely off the bone
Causes and Types of Shoulder Labrum Tears
The labrum may be torn due to an acute injury or may become frayed or torn over time without the patient realizing the damage.
Common causes of labral tears include:
- Fall or direct blow to the arm that results in abnormal movement of the humerus
- Wear and tear due to the aging process
- Repetitive trauma, typically as a result of excessive overhead arm movements like pitching a ball
The most common types of labral tears are:
- SLAPtear (Superior Labral Anterior to Posterior tear): Often seen in athletes who use their arms repetitively in a throwing motion such as pitchers or tennis players, SLAP tears occur at the upper (superior) part of the labrum from the front (anterior) to the back (posterior). SLAP tears can be extremely painful, especially if the attached biceps tendon is ruptured. While SLAP tears are usually the result of a sports injury, they may also be cause by falling on an outstretched arm or a forceful lift.
- Bankart tear: This labral tear occurs when the shoulder becomes dislocated. Once the labrum is torn, the shoulder becomes much more susceptible to future dislocations.
- Posterior labral tear: This labral tear often occurs in conjunction with internal shoulderimpingement, a condition in which the labrum and rotator cuffare pinched together near the back of the shoulder.
Symptoms of a labral tear depend on the type, severity, and location of the injury, as well as if instability is involved. Labral tear symptoms can include:
- Loss of strength
- Pain at the top or front of the shoulder, especially during specific activities
- Aching deep inside the shoulder joint
- Decreased range of motion
- Catching or popping sensation when the shoulder is rotated
- Palpating the shoulder cannot duplicate the specific pain
- Feeling of instability in the shoulder
Diagnosing Labral Tears
Labral tears can be difficult to diagnose due to the deep location of the affected cartilage, the various areas that may be torn, and because labrum tears can present differently in different patients. Your orthopedic specialistwill start with a physical examination to identify any instability or problems with range of motion, as well as take a careful history of the injury’s progression.
Simple x-rays cannot detect labral tears but may be utilized to rule out other conditions such as osteoarthritis,shoulder impingement, or bone fractures. The best tests for diagnosing damage to the labrum involve an arthrogram (injection of a special enhancing dye along with x-rays) followed by either an MRI (magnetic resonance imaging) or CT (computed tomography) scan.
If these diagnostic tests are unable to get a reliable picture due to the complexity of the injury’s location, your orthopedic surgeonmay recommend arthroscopy of the shoulder for a definitive diagnosis. Diagnostic shoulder arthroscopyis an outpatient procedure performed under general anesthetic, and any damage found during the procedure would typically be repaired simultaneously.
Treating Shoulder Labrum Tears
The orthopedic experts at OSMI Ft. Worth recommend conservative non-surgical treatment of labral tears whenever possible. A frayed labrum may present little or no symptoms and require no treatment. Because the labrum has a rich blood supply, it can often heal on its own with adequate rest.
Other non-surgical treatments for labral tears include:
- Anti-inflammatory medication to reduce pain and swelling
- Physical therapyto strengthen the surrounding muscles and improve shoulder mechanics
- Cortisone injection
- For athletes, modifying repetitive external rotations
For labral tears that are chronic, severe, or unresponsive to conservative treatments, arthroscopic shoulder surgery is usually recommended. During arthroscopic shoulder surgery, your surgeon may debride (trim) or reattach the torn labrum depending on the size and location of the damage. Tears that involve instability (subluxation or dislocation) typically require reattachment during surgery.
Length of recovery from labrum surgery depends on the type and severity of the tear. You will likely be in a sling for several (usually 4-6) weeks followed by several more weeks of physical therapy.
If you are experiencing shoulder pain and would like an evaluation by the orthopedic team at OSMI, please contact our office for an appointment.
Our goal at the Orthopedic and Sports Medicine Institute (OSMI) is to provide our patients quality, cutting-edge orthopedic treatments, both surgical and non-surgical. If you have questions about Shoulder Labrum Tears, shoulder joint pain, or physical therapy, please submit an online appointment request or contact our office at 817-529-1900