The shoulder socket, made of the scapula (the shoulder blade) and the humerus (the upper arm bone), is very shallow and flat. The labrum is a disk of cartilage that lines the socket to deepen the socket so that the humerus stays in place. The labrum also guides joint movement and restricts excessive motions to preserve the joint.
What causes a labral tear?
These tears are commonly the result of a traumatic event like a fall, or overuse (wear and tear). A labral tear can result from sporting activities that involve repetitive use, like throwing and overhead motions that cause wear and tear on the labrum as occurs in volleyball, tennis and swimming. Weight lifters and golfers are also at risk of a repetitive use injury that causes a labral tear.
Labral tears are a common injury in collegiate athletes and can influence a player’s ability to compete professionally. They are also common injuries in professional pitchers, linebackers, linemen, and quarterbacks.
Sometimes a labral tear can develop after a tear of the rotator cuff. Another cause involves shoulder instability. Long-term instability caused by lax ligaments or impingement can also cause labral tears, and lead to a dislocated shoulder; and a labrum tear can result from a shoulder dislocation or partial dislocation called a subluxation, also due to trauma.
What are the different types of labral tears?
A Bankart tear is a tear in labrum at the front of the shoulder. Bankart tears result from trauma, cause instability and dispose the patient to future shoulder dislocations. Bankart tears are common in people under age 30 who suffer a shoulder dislocation.
- A SLAP tear is a tear in the labrum at the top of the shoulder. It is caused by overuse, and also affect the biceps tendon.
- A Reverse Bankart tear is a tear in the labrum on the back of the shoulder.
- A combination of tears is called a 270-degree tear.
Labral tears are often accompanied by injury or damage to the tendons, muscles and ligaments in the shoulder.
What are the symptoms of a labral tear?
- Popping, clicking or grinding sensations
- A deep ache and pain
- Pain with overhead motion
- Decreased range of motion
- Loss of strength
- Shoulder instability causing a feeling that the shoulder is loose and can slip out of place (dislocate)
How is a labral tear diagnosed?
Dr. Cooper will ask for a history of your injury and conduct a physical exam to check range of motion, stability and pain. X-rays will be ordered to rule out other injuries. Dr. Cooper will order an MRI to confirm the tear. The final diagnosis will be made with arthroscopic surgery.
Nonsurgical Treatment Option
Nonsurgical conservative treatment is the preferred first line treatment. It includes activity modification, anti-inflammatory medication to decrease pain and swelling, steroid injections for pain, and physical therapy to strengthen shoulder muscles and improve range of motion.
The decision to treat labral tears with surgery and the type of surgery depend on the location and type of tear as well as the patient’s and surgeon’s preference, and sport specific demands. Arthroscopy is minimally invasive surgery to view, diagnose and treat injuries inside the shoulder joint. An arthroscope is a small instrument that permits the doctor to see inside the joint and view any injuries. Tears can be surgically repaired with the arthroscope.
Using an arthroscope Dr. Cooper will examine the all the shoulder structures including the labrum, the tendons, muscles and ligaments. The stability of the shoulder joint will be evaluated. If there is instability in addition to a labral tear, the surgeon must stabilize the joint as well as repairing the tear.
If the shoulder is stable and the only problem is a labral tear, the surgeon can repair or remove the damaged tissue. Torn tendons or ligaments will be repaired at the same time.
Occasionally labral tears are also associated with bone loss of the glenoid surface. The glenoid surface is the boney socket of the shoulder and is necessary for shoulder stability. If the boney socket has lost bone due to chronic injury, the shoulder will not be stable with labral repair alone. Glenoid bone loss is measured based on CT or MRI of the shoulder. When this occurs glenoid reconstruction is required.
Latarjet surgery is the most common option for this when the bone loss is anterior. This surgery involves moving a bony part of your scapula called the coracoid to the front of the glenoid where the bone loss has occurred and putting two screws in to hold it in place. The labrum is then repaired over the top of this new bone to provide a restored boney surface as well as a restored labrum.
Another option is reconstructing the glenoid with allograft bone. If a latarjet has been done prior and failed, or in other revision settings, Dr. Cooper may advise using a distal tibial allograft to reconstruct the bone of the shoulder socket. This has the benefit of also reconstructing a cartilage surface for the bone to move on.
Although the majority of time bone loss on the glenoid is anterior, posterior bone loss also occurs. Small amounts of bone loss can be treated arthroscopically, but large amounts of bone loss may require an open approach to the posterior shoulder with boney reconstruction similar to the distal tibial allograft reconstruction described above for the front of the glenoid.
Recovery depends on the extent of surgical repair. After surgery a sling will be necessary for up to 6 weeks to immobilize the joint. Range of motion exercises will be prescribed. As the patient improves, exercises to regain motion, flexibility, strength will be added. Complete healing and full recovery can take about 6 months. A majority of patients will regain full use of the shoulder after surgery and can return to play without restrictions.
Dr. Joe Cooper is a fellowship trained shoulder surgeon and an expert in the diagnosis and treatment of shoulder injuries.