The shoulder joint is one of the loosest, most unstable joints in the body, which makes it prone to injury. Labral tears in the shoulder can occur due to this instability and in conjunction with other injuries, such as shoulder dislocation, rotator cuff injuries, and torn biceps tendons.
What is the shoulder labrum?
The labrum is a pear-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder, supporting the joint as well as the muscles and rotator cuff tendons. The labrum acts as a stabilizer and protector of the shoulder joint, deepening the socket so that the ball stays in place. The labrum also attaches other structures and tissues around the joint.
What is a shoulder labral tear?
A shoulder labral tear occurs when the labrum is torn in any area of the shoulder joint. The type of tear is categorized by its location.
Types of shoulder labral tears
There are three main types of labral tears in the shoulder:
- SLAP tear: A Superior Labrum from Anterior to Posterior (SLAP) tear occurs in the front of the upper arm where the biceps tendon connects to the shoulder. SLAP tears are more common among athletes involved in overhead sports, including tennis and volleyball players and baseball pitchers.
- Bankart tear: Bankart tears occur during shoulder dislocation, typically in younger patients. When the shoulder comes out of the joint, the labrum is torn. This creates instability that makes it easier to dislocate the shoulder again.
- Posterior labral tear: Posterior labral tears occur when the labrum and the rotator cuff are pinched together in the back of the shoulder. Posterior labral tears are rare, only occurring in 5-10% of all shoulder injuries.
What causes a shoulder labral tear?
“Labral tears can occur from trauma or they can occur from degeneration,” according to Dr. Vladimir Alexander, Founding Partner of Alexander Orthopaedics. “Traumatic labral tears, meaning a labral tear in an otherwise normal shoulder, can happen from a shoulder dislocation or shoulder subluxation, which is a partial dislocation.”
Traumatic labral tears can be caused by the following:
- A direct hit to the shoulder
- A violent blow while reaching overhead
- A fall on an outstretched arm
- A hard pull on the arm
“Degenerative labral tears occur in an arthritic shoulder,” states Dr. Alexander. “The cartilage is breaking down and the labrum breaks down as well. In those cases, we treat the shoulder arthritis.”
What does a shoulder labral tear feel like?
While the tear can feel different depending on the type of injury, the general symptoms of a shoulder labral tear include:
- Pain in the shoulder joint
- Grinding, locking, or catching sensation in the shoulder joint
- An unstable feeling during shoulder movement
- Reduced range of motion and shoulder strength
In addition, if you have a Bankart tear, it can feel like your shoulder will slip out of its joint.
How is a shoulder labral tear diagnosed?
First, your doctor will perform a physical exam to determine if a labral tear is present. There are several tests that they can perform to evaluate whether or not you have a labral tear, but it can be difficult to tell given that the cartilage is deep in the shoulder. They will look at your range of motion, pain, and stability.
Then, because physical examination cannot always confirm the diagnosis, your physician will order an MRI scan or a CT-arthrogram to affirm that a tear is present along with any other injuries. According to Johns Hopkins Medicine, MRI scans and CT-arthrograms are good at defining a labrum tear due to partial or complete shoulder dislocation, but they are only about 80 to 85% accurate. In addition, these tests are not very helpful in diagnosing SLAP tears.
The best way of diagnosing a torn shoulder labrum is through an arthroscopic examination, which provides a more detailed view of the labrum and any injuries to it.
What is the treatment for a shoulder labral tear?
Treatment for your torn shoulder labrum depends on the type, location, and severity of the tear. Surgery is typically recommended only if other methods of treatment are unsuccessful.
Along with rest, anti-inflammatory medications like ibuprofen and aspirin can help relieve pain and may be recommended if the tear isn’t too severe.
Cortisone injections can help reduce inflammation and pain in the affected shoulder.
Physical therapy can help strengthen the muscles of the shoulder and restore range of motion. An experienced, certified physical therapist can show you exercises and stretches you can do at home, as well as identify what activities and positions to avoid.
Shoulder labral tears that are caused by either a complete or partial shoulder dislocation are treated with arthroscopic surgery, especially in younger patients. In a shoulder arthroscopy, the orthopedic surgeon makes small incisions to repair the shoulder tissue.
How long is labral tear shoulder surgery recovery?
After surgery for a torn shoulder labrum, it can take several weeks to recover. Your doctor will most likely recommend that you wear a sling for 4 weeks after the procedure. After you are done wearing the sling, you may take 4 to 6 months to fully heal.
Receiving effective treatment for your shoulder labrum tear is essential for the long-term stability, strength, and range of motion in your shoulder. Our team of expert orthopedic surgeons and physical therapists will work with you to determine the best way to proceed with your shoulder surgery and treatment.