Shoulder Labrum Tear
What Is A Shoulder Labrum Tear?
The shoulder joint is an extremely moveable joint and is therefore susceptible to injury, including labral tears. The bones that make up the shoulder joint include the clavicle, scapula, and humerus. The shoulder joint is a ball and socket type of joint in which the humeral head sits in a shallow socket (glenoid fossa). The humeral head is usually much bigger than the shallow glenoid fossa; therefore, additional support is needed. A soft tissue, known as the labrum, provides extra support for the joint and acts as an attachment site for various ligaments.
Labral tears can occur either superior or inferior to the midline of the shallow glenoid socket. A SLAP lesion (involving the superior labrum, in an anterior to posterior direction) involves a labral tear occurring superior to the midline of socket. This type of tear can also affect the biceps tendon. Conversely, a Bankart lesion involves a labral tear inferior to the midline of the socket. This type of lesion also affects the glenohumeral ligament. Another type of labral tear, which is rare, is a posterior labral tear. Posterior labral tears develop over time and are often accompanied by partial rotator cuff tears.
Symptoms of labral tears are similar to those of other shoulder joint injuries, including:
• Pain with overhead activity
• Grinding, popping, locking, or catching of the shoulder
• Aching type pain
• Occasional nighttime pain
• Decreased shoulder movement
• Decreased strength in the affected arm
• A feeling of apprehension that the shoulder may dislocate
To diagnose a tear of the labrum, a history, physical examination, and imaging studies will be performed. Questions related to the history of the injury will be asked and a physical examination including inspection, palpation, range of motion testing, muscle testing, reflex and sensation testing, as well as orthopedic testing to determine the source of pain will be performed. X-rays will likely be taken to rule out other pathologies; however, they are not useful in detecting soft tissue injuries. If a tear of the labrum is suspected, magnetic resonance imaging (MRI) or computed tomography (CT) may be performed. However, a diagnosis of a labral tear can be confirmed through shoulder arthroscopy.
Causes of Shoulder Labrum Tear
Shoulder labrum tears can occur from repetitive shoulder movements or from trauma. Traumas such as falling on an outstretched arm, a direct hit to the shoulder, a sudden pull on the shoulder, or an aggressive overhead reach can all lead to labral tears. Athletes who participate in throwing or weightlifting sports are at risk of glenoid labral tears due to repetitive shoulder movements.
Treatments for Shoulder Labrum Tear
Initially, most labral tears will be treated with conservative care with the primary goals being to control pain and inflammation. Rest is usually advised along with anti-inflammatory medications. A cortisone injection into the shoulder joint may be warranted for patients who do not report pain relief from rest and over-the-counter pain medications. Once the pain and inflammation are under control, physical therapy should be initiated. Hands on manual therapy as well as stretching and strengthening exercises to improve shoulder range of motion and strength will be included in a typical rehabilitation program.
If symptoms persist, surgery may be warranted. Various surgical techniques are available, depending on the type of injury. Shoulder arthroscopy is minimally invasive and involves inserting a small camera into the shoulder joint through a small incision. This camera allows for visualization inside the affected shoulder joint. An additional incision is made if repair is needed. Specialized, small surgical tools are then inserted into the second incision to repair the torn labrum and reattach any torn tendons.
Biceps tenodesis is often performed on older adults, whereas a SLAP repair is typically performed on younger patients. Biceps tenodesis is usually performed to treat biceps tendonitis for patients who have significant biceps tendon symptoms as well as evidence of biceps tendon inflammation visualized on shoulder arthroscopy. Patients experiencing biceps tendon problems may have developed a SLAP tear or may have irritation and inflammation of the biceps tendon itself. During a biceps tenodesis procedure, the surgeon cuts the attachment of the biceps tendon from the labrum and reattaches it to a new position on the humerus. By doing this, the pressure is removed from the labrum.
A SLAP repair is an arthroscopic shoulder surgery that uses sutures to reattach the torn labrum back to the bone of the shoulder socket. During a SLAP repair, other injuries in the joint may be found and repaired including rotator cuff tears, bursa inflammation, and cartilage damage. A SLAP repair restores normal functioning of the shoulder as the labrum is reattached to its normal position.
A Bankart procedure is another type of arthroscopic shoulder surgery used to repair a Bankart lesion and involves reattaching and tightening of the torn labrum and ligaments of the shoulder.
After surgical intervention, it is advised that the shoulder remain immobilized for two to six weeks. After this time, physical therapy consisting of stretching and strengthening exercises should be initiated. Allowing adequate time, usually approximately three to four months, for complete healing is necessary to avoid further injury.
There are various types of labral tears including SLAP lesions, Bankart lesions, and posterior labral tears. Symptoms of labral tears can vary among patients but include aching pain (especially with overhead activity), catching, popping or locking of the shoulder, decreased shoulder range of motion and strength, and a feeling of instability of the shoulder. Treatment of a labral tear often begins with conservative treatment consisting of rest, pain relievers, and anti-inflammatory medications followed by physical therapy. Various arthroscopic surgeries exist for patients who do not respond to conservative treatment methods. Patients are encouraged to speak to their physicians about their symptoms and expectations to determine what treatment option is best for their labral tear.
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