The shoulder joint is one of the most complex joints in the body, being made up of four bones and a network of soft tissue structures (ligaments, tendons, and muscles). They all work together to produce the shoulders wide range of motion.
Shoulder labrum is a piece of cartilage that lines and reinforces the shoulder ball and socket joint, and acts as an attachment site for the ligaments. It also supports the rotator cuff tendons, muscles, and is one of the main contributors to shoulder stability.
What is a Labrum Tear
A torn labrum occurs when the cartilage inside of the ball and socket joint tears, often as a result of physical activity or aging over time.
Types of Labrum Tear
Shoulder Labrum tears can happen anywhere around the glenoid socket, which is the shallow, socket-like opening where the labrum is located.
The three main types of a torn labrum shoulder are:
- SLAP tear or lesion: A tear that occurs above the middle of the glenoid is known as a SLAP tear or SLAP lesion. The term SLAP stands for “superior labrum, anterior to posterior,” which means front to back. This type of shoulder tear is most common in sports that use a lot of overhead arm motions, for example tennis players or baseball players. Damage to the biceps tendon often occurs along with this injury.
- Bankart tear or lesion: Is when there is a tear in the lower half of the glenoid socket. Bankart tears are more common in younger people with dislocated shoulders.
- Posterior labrum tear: An injury to the back of the shoulder joint. This injury is rare, making up only 5 to 10 percent of all shoulder injuries.
Common Causes of a Torn Labrum
Labral tear shoulder injuries can be caused by both traumatic injury or through wear and tear of repetitive upper arm motions.
These injuries are most commonly caused by:
- Falling on an outstretched arm
- A sudden tug on the arm such as when lifting a heavy object
- Repetitive throwing motions
- A violent blow when reaching overhead
Those with more mileage on their body, such as an athlete, are more at risk to a labral tear injury as the same motions are continually used throughout their career. The risk is further increased with age as the strength of joints begin to deteriorate.
Torn Labrum Shoulder Symptoms
A labral tear is usually painful and may feel like your shoulder joint is:
Other symptoms include a decreased range of motion, loss of strength and a sense of instability in the shoulder. The tendency for shoulder dislocations also increases.
If there’s no signs of instability, the pain is often:
- Felt deep inside
- Located at the back on top of the shoulder or in the front on top of the shoulder
- Not duplicated when the shoulder is pressed on
As a SLAP tear can sometimes involve damage to the biceps tendon, pain can often be felt in this area, for example when using a screwdriver, the pain may be felt as the bicep is the primary muscle for this motion.
A patient with a torn labrum from internal shoulder impingement (a pinching of the soft tissues) will often associate their pain with throwing actions. The pain is usually the worst when the arm changes direction suddenly.
If you have a Bankart tear, your shoulder may feel as if it will slip out of its joint.
All types of labral tears are usually coupled up with other shoulder injuries, such as rotator cuff injuries, shoulder dislocations, and torn bicep tendons. Your doctor will diagnose what type of injury you have.
How a Labrum Tear is Diagnosed
Your doctor will first take a look at your history of injuries in order to learn how the tear occurred – So be sure to tell them about any events that may have caused the pain.
Your shoulder doctor will then test the range of motion, stability and pain level in your shoulder/arm. Any stiffness found when testing your shoulders range of motion will often indicates labral damage.
An instability exam will be performed followed by an O’Brien test which focuses on the bicep to reveal pain and can help diagnose a tear in the labrum.
Labrum tissue is too soft to show up in X-rays, but an X-ray is often used by your doctor to see if there are any other injuries causing your pain. A CT Scan or MRI scan may be ordered for your doctor to see any damage to your labrum.
For greater accuracy, your doctor may perform an arthroscopic examination by inserting a tiny camera (called an arthroscope) through a small cut. This will give your doctor a more detailed view of your torn labrum shoulder.
Labrum tears that are less severe are often treated with rest, over-the-counter medications, and physical therapy.
A Bankart tear can be popped back into place by your doctor and then followed up by physical therapy.
Labral tear shoulder injuries can often be fixed at home, with rest being the most important. This is because the area has a rich blood supply that helps with the healing process. Anti-inflammatories, such ibuprofen (Advil, Motrin IB) or aspirin (Bufferin, Bayer Genuine Aspirin) may help relieve the pain. A cortisone injection can also be given for pain relief.
Physical therapy may be recommended by your doctor to strengthen the muscles of your shoulder, especially the rotator cuff. Massages or manual therapy could also be given during visits.
Your physical therapist will show you what activities and positions to avoid, in addition to exercises and stretches you can do at home.
Depending on the severity of the injury, a physical therapy program can last from six weeks to two months.
Labrum Tear Shoulder Surgery
Injuries that have shown no sign of healing on their own will require labrum tear surgery.
Labrum surgery involves the surgeon removing any damaged cartilage from the labrum that’s preventing proper motion of the joint.
For the first four weeks after surgery, you will be told to wear a sling to immobilize the shoulder. You will then be advised to join a physical therapy program to increase range of motion and gradually strengthen the joint.
Labrum surgery can take 9 to 12 months to completely heal, but it will be possible to quickly return to many activities.