Shoulder Instability (Labrum Tears)
What is the labrum?
The labrum is a thick piece of cartilage that lines the rim of the shoulder socket to deepen the socket for shoulder stability. The labrum also functions as an attachment for shoulder ligaments and the bicep tendons.
However, the labrum has no blood supply so it may be difficult for a large tear to heal on its own. A small tear may heal with conservative measures if the patient is able to function and avoid putting stress on the injury.
What are the different of types labrum tears?
The labrum can tear off the bone, along the edges or where the biceps tendon attaches.
- A tear along the front bottom (anteroinferior) aspect of the shoulder socket (glenoid) is called a Bankart lesion. These tears result from trauma, cause instability and predispose to subsequent shoulder instability. Bankart lesions are especially common in young, active individuals who participate in contact sports.
- A tear at the top of the shoulder socket is called a SLAP (superior labrum anterior posterior) tear. This injury may be caused by repetitive trauma from overhead motions that fray the labrum. This injury pattern is common in tennis, baseball pitchers, swimmers, golfers and weightlifters.
- A tear on the back of the shoulder is called a posterior labral tear, or a reverse Bankart lesion.
- A combination of these tears can involve 270 to 360 degrees of the shoulder socket.
What causes a labral tear?
Labral tears can result from a traumatic event like a fall or a direct blow, repetitive stress and normal wear and tear. A SLAP tear may also occur in conjunction with injuries to the long head biceps tendon. A shoulder subluxation or dislocation and tear the labrum off the bone. Long-term instability caused by lax ligaments or impingement can also cause labral tears.
What are the symptoms of a labral tear?
Symptoms are related to the type of tear.
- A sharp popping, catching or grinding sensation in the shoulder with certain movements, mostly overhead
- A deep ache, or no pain at all
- Loss of strength
- Decreased range of motion
- Shoulder instability – subjective, objective or both
How is it diagnosed?
Dr. Godin will take a complete medical history, ask about previous shoulder injuries and evaluate your complaints and symptoms. He will conduct a physical exam, including range of motion, strength, stability and pain testing.
X-rays will be taken to rule out other injuries and to assess for bone loss. Advanced imaging including a MRI and a CT scan allow for further evaluation of the bone and soft tissues.
What are the treatment options?
Treatment depends on the type, severity and location of the tear, as well as the patient’s age, activities, activity level and instability events/symptoms.
Most labral tears due to repetitive stress are initially treated with conservative measures except when the tear is accompanied by another injury or damage to the shoulder tendons, muscles and ligaments. When there is combined damage, surgery will likely be necessary.
Conservative measures include taking a break from the repetitive activities that caused the problem, anti-inflammatory medication to decrease pain and swelling, and physical therapy to strengthen shoulder muscles and improve range of motion. When your symptoms fail to resolve with nonsurgical treatment, minimally invasive surgery may be recommended.
Arthroscopy is minimally invasive surgery to view, diagnose and treat problems inside the shoulder joint. Shoulder arthroscopy can be performed in an outpatient setting under regional anesthesia.
After surgery you will need to wear a sling to immobilize and protect the shoulder for a few weeks. Pain and swelling will be managed with ice and electrical stimulation. Physical therapy will help you regain motion, flexibility, strength. Complete healing and full recovery can take about 6 months. The good news is that a majority of patients will regain full use of the shoulder after surgery.
In some cases where arthroscopic surgery has failed, or in the setting of bone loss on the shoulder socket (glenoid) and/or humeral head, open surgery may be recommended. Open surgery options include open Bankart repair, Latarjet procedure (moving a piece of bone (coracoid) from one part of the shoulder to fill in a bone defect on the socket), or allograft reconstructions. Open shoulder surgery can also be performed in an outpatient setting under regional anesthesia.
Dr. Jonathan Godin has successfully treated a large selection of shoulder conditions in professional athletes and everyone else! His expertise is in complex shoulder repairs. Dr. Godin offers compassionate personalized care and treatment options geared to your needs and goals.