Overview of Shoulder Labral Tear
The shoulder is made up of three bones: the shoulder blade (scapula), the humerus (upper arm bone), and the clavicle (collarbone). A part of the scapula, called the glenoid, makes up the shoulder socket. The glenoid is very shallow and flat. The labrum is a rim of soft tissue that makes the glenoid socket deeper so that it molds to fit the head of the humerus.
The labral tissue can be caught between the glenoid and the humerus. When this happens, the labrum may start to tear or get damaged. If the tear gets worse, it may become a flap of tissue that can get caught between the head of the humerus and the glenoid and cause pain. The labrum combined with the ligaments, tendon, and capsule all contribute to the stability of the shoulder. When people develop a labral tear the shoulder often becomes much less stable.
Causes and Symptoms of Labral Tear in the Shoulder
Labral tears can often be caused by a direct injury to the shoulder, such as falling on an outstretched hand. The labrum sometimes becomes torn from wear and tear activities, called overuse injuries. An injured labrum can lead to extra motion in the shoulder called shoulder instability. The extra motion of the humeral head within the socket can cause additional damage to the labrum. An extremely unstable shoulder may dislocate fully or try to slide partially out of the joint. This type of abnormal motion can often result in a labral tear.
The biceps tendon attaches to the top of the labrum and the glenoid. Some activities can produce injuries to the area where the biceps and the labrum come in contact creating a SLAP tear. This is a more common injury in athletes or laborers who do strenuous rotatory overhead activity like pitchers or volleyball players. Overhead weight lifters and golfers who hit the ground with a club can also sustain this injury.
Labral tears can cause several symptoms. One symptom caused by a labral tear is a sharp pop or catching sensation in the shoulder during certain shoulder movements. This may be followed by a vague aching for several hours. At other times, the tear may not cause any pain. Shoulder instability from a damaged labrum may cause the shoulder to feel loose, as though it slips with certain movements.
Treatment of Labral Tear of the Shoulder
Controlling your pain and inflammation while restoring stability to the shoulder is the goal of treatment. Initial treatment for pain control is usually rest and anti-inflammatory medications. Depending on the presentation an injection can often help relieve pain and decrease inflammation.
A physical or occupational therapist often helps improve your rehabilitation program. Therapy treatments can help ease pain and inflammation by using various treatments. Various types of exercises are used to improve the range of motion in your shoulder and the nearby joints and muscles. Strengthening exercises to improve the strength and control of the rotator cuff and shoulder blade muscles. Therapy will help you retrain these muscles to help keep the ball of the humerus in the glenoid. This will improve the stability of your shoulder and help it move smoothly during all your activities.
Depending on the severity of the injury you may need therapy treatments for four to six weeks. Most patients are able to get back to their activities with full use of their arm within this amount of time.
Surgical Treatment of Labral Tear of the Shoulder
Surgical intervention is sometimes needed to treat labral injuries. When surgery is indicated, many labral injuries are treated in a minimally invasive approach with arthroscopic surgery. Occasionally, a formal open surgical approach is needed depending on the nature of the injury and the condition. Arthroscopic surgery allows excellent visualization of the joint and many of the surrounding structures and allows the surgeon to address any problems that may co-exist with labral tears like rotator cuff tears, biceps lesions, or impingement.
Recovery after Surgery for Labral Tear of the Shoulder
Rehabilitation after surgery is more complex. You will probably need to wear a sling to support and protect the shoulder for several weeks after surgery. A physical or occupational therapist will probably direct your recovery program. Depending on the surgical procedure, you will probably need to attend therapy sessions for several months, and you should expect full recovery to take up to four to six months if you are expecting to participate in athletics.
Getting the shoulder moving as soon as possible is important. However, this must be balanced with the need to protect the healing tissues. The first few therapy treatments will focus on controlling the pain and swelling from surgery. After surgery to repair the labrum, therapists usually begin with passive exercises. In passive exercises, the shoulder joint is moved, but your muscles stay relaxed. Your therapist gently moves your joint and gradually stretches your arm. You may also be taught how to do passive exercises at home.
Active range-of-motion exercises help you regain shoulder movement using your own muscle power they will be implemented as directed by your physician. Exercises will focus on improving strength and control of the rotator cuff muscles. They help tighten the ball of the humerus in the glenoid socket and can improve the stability of the shoulder. A stronger and more stable shoulder helps keep the ball of the humerus centered in the socket during all your activities.
Some of the exercises you will do are designed get your shoulder working in ways that are similar to your work tasks and sport activities. Your therapist will help you find ways to do your tasks that don’t put too much stress on your shoulder. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.
Final thoughts on Surgery for Labral Tear of the Shoulder
Labral tear surgery of the shoulder is not to be undertaken lightly; however, if performed for the right reasons it can result in significant pain relief and an increased quality of life. If you have any further questions please don’t hesitate to schedule an appointment with Dr. Mazoch.