The shoulder is made up of three bones: the shoulder blade, the collarbone, and the arm bone. The arm bone fits into the shoulder blade in a shallow socket called the glenoid. Within the glenoid, tissue called the labrum stabilizes the joint. The labrum cups the rim of the joint, allowing the ball of the arm bone to stay in the socket, and provides an attachment point for many ligaments needed for proper movement within the shoulder.
The labrum can tear as a result of a trauma, such as a fall or blow to the shoulder, or overuse or strain on the shoulder joint. The most common cause of labral tears is overhead throwing injury, such as baseball pitching or tennis serving. An improperly performed pulling or lifting movement can also lead to injury.
There are many types of labral tears, so it is important to consult with a physician in order to understand your exact condition.
A SLAP tear involves the bicep tendon. SLAP is an acronym that stands for “superior labral anterior to posterior.” It is a tear in the tissue above the middle of the socket and is seen most commonly in throwing athletes or swimmers. Many times, this type of tear is found during surgery to repair another shoulder condition, and may coexist with rotator cuff tendonitis. There are four types of SLAP tears, and a specialized physician will help identify the condition specific to your injury.
Posterior labral tears can be seen in athletes when they have a condition called internal impingement, though this type of tear is not as common as others. This occurs when the labrum is pinched with the rotator cuff in the back of the shoulder joint.
A condition called Bankart Lesion occurs when the labrum is torn completely off the bone, which is most commonly a result of a shoulder dislocation. There are also tears in which the labrum itself wears down. This is the kind of injury with very few symptoms, and commonly occurs in patients over 40.
Symptoms and Diagnosis
In order to diagnose a labral tear, a doctor such as Dr. Leah Urbanosky of Hinsdale Orthopaedics, will do a full physical examination, including tests of range of motion, stability, and pain. You will need to discuss the history of your pain with the physician in order to receive optimal care.
Some physical symptoms of a labral tear include:
There is possibility that the diagnosis may not be made, however, until arthroscopic surgery is performed, since tears in the tissue are deep within the shoulder and do not show up on an x-ray. An MRI may be used to spot the condition.
A physician such as Dr. Urbanosky may prescribe measures for temporary relief, including anti-inflammatory medication and mild rehabilitation to strengthen surrounding muscles. Restoring motion to the shoulder is the first goal.
Arthroscopic surgery is often recommended if the physician sees no improvement in pain after initial non-surgical treatment. Surgery includes a thorough look at the tear itself in order for the physician to determine the extremity of the condition. Unless it is an anterior labral tear, this surgery is performed with an arthroscope, or a small camera, that allows for a full view of the shoulder joint.
If the tear occurs only within the rim of the glenoid, then it can simply be removed since the shoulder would be considered stable. If the tear involves the bicep tendon or extends further than just the rim, the surgeon may need to use tacks, wires or sutures to fully reattach the tendon.
Recovery from surgery involves rehabilitation in order to strengthen the muscles around the joint. Avoiding strenuous activity during rehabilitation period is essential to allow the tissue to reattach to the rim properly. A sling is necessary to allow the shoulder to heal. Full recovery usually takes from three to four months. Most patients are able to return to activity with little to no restriction.
If you think that you may be experiencing a labral tear, contact Dr. Leah Urbanosky for a consultation: (815) 462-3474.
Labral Tears (including SLAP tear)
Total Shoulder Replacement
Total Shoulder Replacement Animations
Advantage TSR (shown top)
Global TRS (shown bottom)