March 21, 2017
Shoulder labral tears are a common acute injury. Learn more about how tears occur and some of the best options to fix them.
What is the Labrum?
Let’s start simple: The shoulder joint is comprised of 3 major bones: wing bone (scapula), collarbone (clavicle) and upper arm bone (Humerus). The Labrum surrounds the shoulder socket (Glenoid). The Glenoid Labrum is a bumper of cartilage that surrounds the shoulder joint and is pear-shaped. The purpose of the Labrum is to help stabilize the shoulder joint and keep the Humerus in the socket.
How do tears occur?
Labral tears can occur from an acute injury (sudden onset) or chronic injury (occurs over time). Acute injuries commonly occur from a fall on the shoulder when the arm is outstretched, lifting something heavy, or taking a blow to the shoulder. Chronic injuries often develop in a throwing athlete or a person that does repetitive overhead motion for their job. Oftentimes when a person dislocates (pops out of joint) their shoulder, a Labral tear results from the injury.
What are the types of tears?
There are several different types of Labral tears that can occur. These include SLAP tears, anterior tears, posterior tears and Bankart tears. SLAP tear stands for “Superior Labrum Anterior Posterior” which means that the tear is in the upper part of the labrum and extends to the back and the front of the Labrum. An anterior tear means that the front part of the Labrum is torn and a posterior tear means that the back portion of the Labrum is torn. Bankart tears usually result when a person dislocates their shoulder.
What are the symptoms?
Most common symptoms of a labral tear include a pain/ache that’s deep inside the shoulder joint, loss of velocity when throwing, and instability of the shoulder (feeling that the shoulder is going to ‘pop out’). Other symptoms include a popping or clicking sensation inside the shoulder, pain with overhead activity, pain in the front or back of the shoulder depending on where the potential tear is, and trouble sleeping at night.
How is a tear diagnosed?
The best way to diagnose a labral tear is seeking an evaluation from an Orthopedic Physician. The Orthopedic Physician will perform a clinical exam to evaluate for a tear. In order to do an evaluation, the Physician will perform several common orthopedic special tests that indicate a labral tear could be present. These common tests include Obrien’s test, Jerk test and Mayo test. Obrien’s test is performed in order to rule out a tear in the front part of the shoulder. Jerk test is performed to evaluate for instability in the back portion of the Labrum. The Mayo test is performed in order to evaluate for a Labral tear in the front of the shoulder as well.
If the physician suspects a labral tear, further imaging is needed to confirm the diagnosis. Further imaging in the form of an MR arthrogram is typically ordered. The MR arthrogram is a little different than a typical MRI because dye is injected into the affected joint. This dye adds to the imaging test because the fluid from the dye can sneak under the tear and make it easier to detect on the images. This is the best way to interpret a labral tear short of having surgery.
How is a labral tear treated?
Labral tears can be treated conservatively or surgically. Conservative treatment includes anti-inflammatory medication, physical therapy, steroid injections and rest. If conservative treatment doesn’t reduce the patient’s pain, surgical intervention may be necessary.
Surgical intervention means that an arthroscopic surgery will be performed to repair the labral tear. Anchors are used so that sutures can be passed through them in order to tie the torn Labrum back into the socket. The amount of sutures used depends on the size of the tear. If the tear is in the Bicep region, a procedure called an Open Subpectoral Bicep Tenodesis can be performed. This involves moving the Bicep Tendon to underneath a chest muscle so that the Bicep Tendon is no longer pulling on the front part of the Labrum.
Recovery from surgery:
Recovery from Labrum Repair surgery can take up to 6 months depending on the extent of the repair. Initially after surgery, the patient will be in a sling for 6 weeks. After that, the patient will have a lifting restriction of 5 pounds for the next 6 weeks and then a 10 pound lifting restriction for the 3 months following. At 6 months from surgery, the patient will most likely be cleared for all activity with the understanding that it may take up to a full year from surgery for the patient to feel fully recovered. Physical therapy is also required in order to regain the range of motion and strength that’s required for a full recovery.
When should you consider surgery?
A Labral Tear can only be “fixed” by having it arthroscopically repaired. The Labrum can also be a pain generator, therefore if Physical Therapy and Steroid injections can reduce the amount of pain, surgery may not be needed. If the pain is affecting activities of daily living and/or the shoulder joint is unstable, repairing the tear may be the best option. Talking with an Orthopedic Surgeon like Dr. Robert Rolf is the best way to determine the most beneficial treatment method.