As one of the most-used and loosest joints in the human body, the shoulder is particularly prone to injury. The labrum is a primary component of the shoulder’s connective tissue, and can be torn not only the joint’s due to the joint’s constant use and inherent instability, but also in conjunction with other injuries, from rotator cuff tears to shoulder dislocations.
While some shoulder labral tears can be treated nonsurgically, it’s extremely important that all joint injuries be evaluated promptly by a qualified physician such as those at Alexander Orthopaedic Associates in order to determine the best course of treatment, as well as to prevent further complications down the road.
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 causes a shoulder tear in the labrum?
According to Dr. Vladimir Alexander, M.D., founding partner of Alexander Orthopaedic Associates , “Labral tears can occur from trauma, or they can occur from degeneration.
“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.” Some causes of traumatic labral tear include:
- Using an outstretched arm to try and stop a fall
- Lifting with or pulling on the arm in a sudden or jerky motion
- A direct hit to the shoulder, often as in a motor vehicle accident
- A blow while reaching overhead
Non-traumatic labral tears, on the other hand, occur most often as a component of degenerative arthritis in the shoulder.
Types of shoulder labral tears
While there are several types of shoulder tear to the labrum, the vast majority fall into three main categories.
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 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.
Labral shoulder tear symptoms
While there are a few different types of labral tears that can occur in the shoulder — often occurring as the result of sports-related activity — according to SPORTS-Health.com, most present one or more of five symptoms that are fairly unique to this type of injury:
- Pain inside the shoulder joint. Sufferers often describe this type of pain as more of a deep ache than an acute pain of the nerves. If the injury is a SLAP-type tear involving the biceps tendon, pain may also occur at the front of the shoulder.
- Popping, catching or grinding. This could be compared to the feeling one has of needing to “pop one’s neck,” when there’s a sensation of rough friction with movement of the shoulder.
- Weakness or instability.
- Pain with overhead motion or general reduced range of motion.
- Reduced athletic ability regarding shoulder performance.
If you experience one or more of these symptoms, it’s important to schedule an examination with an experienced specialist like the physicians at Alexander Orthopaedic Associates as soon as possible for an accurate diagnosis and proper course of treatment.
Shoulder labral tear diagnosis and treatment
If you suspect you have a torn labrum, appropriate diagnosis and treatment are crucial to promote optimal recovery and prevent future complications, particularly if you’re an athlete or enjoy a thoroughly independent, active lifestyle.
Labral tear diagnosis
There are multiple ways for your doctor to test for a labral tear in the shoulder. First, they will perform a physical exam to determine if a labral tear is present, 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 likely order an MRI scan or a CT-arthrogram to affirm that a tear is present along with any other injuries. While these are powerful and detailed diagnostic tools, they can’t always “see” deep enough into the shoulder’s mass with 100% accuracy, particularly with regard to diagnosing SLAP-type labral shoulder tears — in some cases, you doctor may also recommend arthroscopic examination, which is a very minor type of exploratory surgery.
Labral tear treatment
As previously mentioned, not every shoulder labral tear requires surgical intervention. Frayed or partially torn labral injuries in particular can often be remedied without surgery. But every potential labral tear needs to be evaluated by a professional, and a clear and appropriate course of treatment needs to be prescribed.
Can a shoulder labral tear heal without surgery? It certainly can, depending on its type and severity. Generally speaking, a nonsurgical course of treatment for a shoulder labral tear will include some or all of the following:
- Anti-inflammatory medication
- Cortisone injection(s)
- Physical therapy/shoulder labral tear exercises
If a patient is compliant with a prescribed nonsurgical course of treatment and still doesn’t recover, however, surgery may be recommended as a further course of action.
Some shoulder labral tears must be treated with arthroscopic surgery, particularly those in younger patients, and injuries that carry risk of further dislocations or other complications later in life. In arthroscopic surgery, an orthopedic surgeon makes tiny incisions and uses very small tubes called endoscopes to repair the damaged tissue of the labrum.
Recovery from shoulder labral tear surgery
It can take several weeks to fully recover from arthroscopic surgery to repair a labral tear, and it’s vitally important that the patient give the joint time to heal in order to regain and retain full use of the shoulder.
If you’re wondering what to expect after labral tear surgery, your doctor will likely recommend that you wear a sling for four weeks after the procedure. Once your arm comes out of the sling, it’s important to follow any instructions given by your physician regarding use or physical therapy, as it can take from four to six months for the joint to fully heal.
Contact Alexander Orthopaedics Today
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.