Labral tears of the Shoulder
What is the shoulder labrum?
The shoulder or glenoid is a rim of thick cartilage tissue around the edge of the shoulder socket (the shoulder is a ball and socket joint). The labrum helps to make the shoulder socket deeper and in this way helps to make the shoulder more stable. The labrum is the site of attachment to one of the tendons of the bicep muscle (it attaches to the top part of the labrum) as well as the shoulder joint ligaments and the shoulder joint capsule.
How is the labrum injured?
The most common injury to the labrum is the SLAP lesion. SLAP stands for Superior Labrum Anterior to Posterior and refers to injuries involving the biceps tendon and the labrum. Other labral injuries are referred to as non-SLAP lesions.
SLAP lesions occur when excessive force is placed through the biceps tendon/labrum combination and can occur in a single incident or as the result of repetitive loads. Activities that can result in a tear include catching a heavy load, holding a load overhead, falling onto an outstretched arm. Overhead sports such as baseball and tennis can cause injury via repetition.
Non-SLAP lesions can occur in association with shoulder dislocation and subluxation (partial dislocation) as well as from the end result or repetitive loads.
The pain casued b such injuries is not well defined, but commonly activities like lifting, overhead activities and twisting motions are painful. There may also be a clicking and popping catching and grinding with movement. Labral tears are best diagnosed with a combination of clinical tests and MRI scan.
Treatment for a Labral Tear
They are usually treated with arthroscopic surgery to the shoulder to either cut away the torn and irritated tissue or to re-attach the labrum to the socket of the shoulder.
Following surgery it is important to restore the strength and proprioception (or balance) to the shoulder joint. This will usually involve a graduated exercise programme to allow enough time for post surgical healing and progressing through more and more challenging exercises until pre-injury levels of performance are achieved.
Returning to Sport
As labral tears are often associated with repetitive actions in sport, it is important that sporting technique is carefully assessed before return to sport.
Returning to your sport or activity is determined by how long it takes for your shoulder to recover, not by how may days or weeks it has been since your injury occurred.
You may safely return to your sport/activity when:
Your injured shoulder has full range of motion without pain.
Your injured shoulder has regained normal strength compared to the non injured shoulder.
Your surgeon has cleared you to return to sport.
Following surgery physiotherapy treatment involves a gradual strengthening and balance of the shoulder using stretching and strengthening exercises and massage.
You will do strengthening exercises to improve the strength and control of the rotator cuff and shoulder blade muscles. Your therapist will help you retrain these muscles to keep the bal of the humerus in the glenoid. This will improve the stability of your shoulder and help it move smoothly during all your activities.
It is important to remember that everyone recovers from injuries at a different rate and the majority of patients are able to get back to their activities with full use of their arm.