Shoulder Injury

Torn Labrum

The shoulder joint is a ball and socket joint, similar to the hip; however, the socketof the shoulder joint is extremely shallow, and thus inherently unstable. This means that the bones of the shoulder are not held in place adequately, and therefore extra support is needed to help the muscles stabilize the joint. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements. The biceps tendon attaches to the labrum.

How can a labral tear occur?

The labrum can get torn from repetitive, high force movements such as, throwing hard or a tennis serve. Having an extreme stretch of the biceps tendon with exercises like dips or full range bench press can also lead to labral damage. Falling on an out stretched arm or having a hard impact at the shoulder can also lead to a labral tear. The labrum becomes brittle with age and can become more vulnerable to fraying or tears.

What are the symptoms of a torn labrum?

Symptoms of a labral tear depend on where the tear is located, but may include:
An aching sensation in the shoulder joint, Catching of the shoulder with movement, Pain with weight bearing on the arms, Pain and/or loss of range in shoulder internal rotation and reaching across the body.

What are the common types of labral tears?

SLAP Tears
A SLAP (superior labrum anterior to posterior) tear is a type of labral tear most commonly seen in overhead throwing athletes such as baseball players and tennis players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder, and when severe can be related to complete detachment of the biceps.

Bankart Lesions
A Bankart lesion is a labral tear that occurs when a shoulder dislocates. When the shoulder comes out of joint, the labrum is torn, and makes the shoulder more susceptible to future dislocations.

Posterior Labral Tears
Posterior labral tears are less common, but sometimes seen in athletes in a condition called internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder.

How do I know if there is a labral tear?

A doctor or physical therapist can do movement tests to see if the labrum is irritable but the tests are not considered to be consistent. An MRI is often needed to confirm a labral tear. If a shoulder problem is not getting better a consultation with a physician who specializes in shoulders is advised.

What is the treatment for a torn labrum?

As with any shoulder injuries, initially, the movements which irritate the injury must be stopped and the inflammation controlled. At Premier Physical Therapy we will discuss the daily activities which may be irritating the condition. Icing is critical to control the inflammation in the early phase. Another priority in the early phase is to normalize the shoulder motion with safe stretches, including some to improve internal rotation. Then, a comprehensive shoulder-strengthening program should be undertaken, emphasizing the back part of the shoulder and the ability to keep the shoulder blade in good posture. It is important to progress at a cautious rate so as to not irritate the torn labrum. As the symptoms recede and the strength returns,the mechanics of irritable motions must be addressed. For example, technique refinement with swimming, throwing, weight training, or a work task might be done with coaching or video analysis. In severe cases of labral tears the conservative treatment won’t sufficiently resolve the problem and surgical intervention may need to be explored. Even if surgery needs to be done ultimately the conservative program will make the post operative-recovery faster. At Premier Physical Therapy we make you an active participant in your rehab and not a passive recipient of our care. We will teach you how to fix yourself with the above-mentioned approach and return to your every day activities.

by John Slattery