Shoulder Labral Tear with Instability

What is Shoulder Labrum?

The shoulder consists of a ball-and-socket joint formed by the upper end of the humerus (upper arm bone) and a cavity in the shoulder blade called the glenoid.  The glenoid cavity is surrounded by a rim of cartilage called the labrum. The labrum adds depth to the cavity making the joint more stable and positions the ball within the socket.

What is Shoulder Instability?

Shoulder instability results when the humeral head is not held firmly within the glenoid cavity and may lead to a dislocation. Tearing, stretching or peeling of the labrum can result in shoulder instability. It can also occur with defects of the shoulder capsule and ligaments.

Types of Labral Tears

Based on location, labral tears are classified as:

SLAP tear: Detachment of the upper portion of the labrum

Bankart tear: Detachment of the lower portion of the labrum

Posterior tears: Detachment of the labrum at the back of the shoulder joint

Causes of Labral Tears

Labral tears may occur due to the following causes:

• A blow to the shoulder
• Falling on an outstretched arm
• Forceful pulling of the arm
• Excessive overhead activities

SLAP tears usually occur in athletes involved with frequent overhead activities such as baseball, tennis, and volleyball. Bankart tears commonly occur with a shoulder dislocation. Labral tears are often associated with other injuries such as rotator cuff injuries or a tear in the biceps tendon which is attached to the upper part of the labrum.

Symptoms of Labral Tears

The symptoms associated with labral tears differ from the type of tear. They generally include:

• Aching pain
• Cracking, locking, catching or popping of the shoulder joint
• A difficulty with shoulder movements
• The weakness of the arm
• Pain in the front of the shoulder with a SLAP tear
• Instability or dislocation of the joint with a Bankart tear

Diagnosis of Labral Tears

Your doctor will review your symptoms and perform a physical examination to assess shoulder movement, strength and your level of pain. An MRI or CT scan may be ordered to diagnose a labral tear and any other injuries. They can also help determine if the shoulder joint has been properly reduced after a dislocation. X-rays can help diagnose damage to your shoulder bones.

Treatment of Labral Tears

Treatment involves non-surgical or surgical procedures based on the severity of the injury and existing symptoms. If the dislocation is present, your doctor will manipulate your shoulder joint to bring the humeral head back into the socket. This is called a closed reduction.

Non-surgical methods

Non-surgical methods focus on relieving pain and strengthening the muscles. They include:

• Immobilisation of your arm in a sling
• Pain medications
• Steroid injections into the joint
• Physiotherapy to strengthen the rotator cuff and other shoulder muscles

Surgical methods

Surgery is recommended when pain and instability are not relieved by non-surgical methods. Your doctor may recommend arthroscopy or open surgery to treat a labral tear.

Arthroscopy: Arthroscopy involves insertion of a thin device with a camera to visualise the affected joint. Your surgeon views the labral tear or other injuries on a monitor and performs the necessary surgical procedure to fix the injury.

Open surgery: This approach is recommended if you are experiencing recurrent instability and involves a larger incision. The damaged part of the labrum is removed by your surgeon who then places an anchor in the glenoid. A suture passed through the anchor helps secure the labrum and any damaged ligaments to the glenoid thus improving the stability of the joint.

Recovery after Surgery

Following surgery, your arm is supported with a sling for about 1 month. With physiotherapy, you will soon be able to return to regular activities. Complete healing may take about 9-12 months and an additional 6 months to develop strength and endurance for sports.

Preventive Measures

Shoulder injuries causing labral tears and instability may be prevented by:

• Strengthening your muscles with regular exercise.
• Receiving proper coaching for athletics.
• Avoiding overuse of the shoulder.
• Stopping an activity when you have pain and getting yourself evaluated if pain persists beyond a few days.