What is the shoulder labrum?
The labrum is a circular rim of cartilage in the shoulder that serves two important functions. The first function is to deepen the socket so the shoulder remains in place while in motion, and the second function is an attachment site for the biceps tendon and the glenohumeral ligaments. The labrum plays a significant role in contributing to shoulder stability, and when torn, can lead to shoulder instability and dislocations.
What is a labral tear?
Shoulder labral tears are quite common and can occur from acute traumatic injuries, such as a fall or shoulder dislocation, or from repetitive shoulder motions like those used in sports activities or work. Labral tears are hard to prevent, especially in athletes, because the force of the overhead motion contributes to the injury. When labral tears occur, the shoulder can lose functional stability and lead to pain or disability.
What are the most common types of labral tears?
The shallow, socket-like opening of the shoulder where the labrum is located is called the glenoid. Shoulder labrum tears can happen anywhere around the glenoid socket. There are two types of labral tears that occur most commonly:
- SLAP tear – The upper, or superior, part of your labrum attaches to your biceps tendon. SLAP stands for “Superior Labrum, Anterior to Posterior.” This means the labrum is torn at the top of the glenoid in both the front (anterior) and back (posterior) of where it attaches to the biceps tendon. SLAP tears commonly develop due to overuse or repetitive arm motions, and are especially common in the overhead athlete.
- Bankart tear – A tear that happens in the lower rim of the glenoid labrum. This tends to happen when the shoulder dislocates anteriorly, meaning the head of the humerus is forced forward and pops out of the glenoid socket. As it is forced forwards, it can damage the labrum, causing it to tear. Bankart tears are more common in younger people with shoulder instability and dislocations.
What are the symptoms of a labral tear?
Labral tears are usually accompanied by aching pain and difficulty performing normal shoulder movements. Once the labrum is torn, it’s much easier for the humerus to slip out of its socket.
The most common symptoms of a labral tear include:
- Deep shoulder pain
- Shoulder instability / recurrent dislocations
- Shoulder weakness
- Sensation of popping, clicking, or catching
- Decreased range of motion
- Loss of strength
- Pain at night or while doing daily activities
How is a labral tear diagnosed?
In order to diagnose the type of labral tear, Dr. Potts will perform a thorough history and physical examination. It is important to determine if there is significant instability in the setting of a labral tear. Dr. Potts may order x-rays and a specific kind of MRI known as an MRI arthrogram (where contrast dye is injected into the shoulder) in order to evaluate and diagnose a labral tear.
What is the treatment of a shoulder labral tear?
Treatment of labral tears depends on the severity of the injury, type of labral tear, shoulder instability, age, and activity level. In general, non-operative treatment is usually most appropriate for older patients or those who are less active, while younger patients or athletes who regularly participate in higher impact sports may require surgical intervention.
- Non-Surgical – In cases of a mild labral injury, Dr. Potts usually prescribes a conservative treatment plan including rest, activity modification, anti-inflammatory medications and a physical therapy program designed to restore shoulder function and strength.
- Surgical – Shoulder surgery may be necessary if conservative measures fail or if the labral tear is severe or causing significant shoulder instability. Potts uses minimally invasive shoulder arthroscopy to treat labral injuries in the shoulder, which typically includes a labral repair. Your individual surgery will depend on your specific injury.