Shoulder Labral Injuries

LABRAL INJURIES

 The shoulder is a ball (humeral head) and socket (glenoid) joint.  The socket is extremely shallow, and thus inherently unstable.  The shoulder joint is compared to a golf ball on a tee – the ball (humeral head) is not held in place by the tee (socket).  Thus extra support is needed to stabilize the ball.

To compensate for the shallow socket, the glenoid (socket) has a circumferential cuff of cartilage – the labrum – which deepens the socket and forms a cup for the humeral head (ball) to move within and makes the shoulder joint much more stable.  This allows for a very wide range of movements and makes the shoulder the most mobile joint in the body – allowing the shoulder to perform in a variety of overhead sports like tennis, volleyball, baseball/softball, and/or freestyle/butterfly swimming.

The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. The labrum also becomes more brittle with age; it can fray and tear as part of the aging process. When the glenoid labrum becomes injured or torn, it is described as a labral tear. These tears may be classified by the position of the tear in relation to the glenoid (socket) – superior, anterior-inferior, or posterior.

Symptoms of a labral tear depend on where the tear is located, but may include: 

• An aching vague pain in the front or top of the shoulder.
• Clicking or catching sensation in the shoulder during certain movements.
  • Ex: catching/clicking during the “cocked” position of throwing.
• Pain with specific overhead activities.

In addition, some types of labral tears, specifically a Bankart lesion (anterior-inferior labral tear), can increase the potential for shoulder dislocations.

X-rays can rule out chips, cracks or other problems with bones but they can not identify soft tissue injuries like labral tears. MRI arthrograms are very effective in identifying labral tears. The “gold” standard for identifying a labral tear is through arthroscopic surgery of the shoulder.

The most common patterns of labral tears are:

SLAP Tears (Superior Labral Tears from a Anterior to Posterior Direction)

• Seen in overhead throwing athletes such as baseball players, tennis players, golfers, and/or weightlifters.
• The torn labrum is at the top of the shoulder socket where the biceps tendon attaches to the shoulder.

Bankart Tears

• Seen when the shoulder dislocates out the front (anteriorly).
• The torn labrum is in the front, lower (anterior, inferior) part of the shoulder socket.

 

Posterior Tears

• Less common.
• Sometimes seen in athletes in a condition called internal impingement – the rotator cuff and labrum are pinched together in the back of the shoulder.

 

The treatment of a torn labrum depends on the type of tear that has occurred. Most labral tears do not require surgery; treatment will begin with a conservative approach. Physical therapy is prescribed to stretch and strengthen the surrounding muscles.  In addition, ice, pain medications or anti-inflammatory medications may be used to help decrease pain and improve function of the shoulder. 

If the conservative approach to managing a labral tear is not effective, surgery may be required. An orthopaedic surgeon may be able to repair or remove the torn part of the labrum through arthroscopic surgery or through an open shoulder procedure. If the labral tear is also associated with an unstable glenohumeral joint, the surgeon may also be able to surgically stabilize the glenohumeral joint.