Labral Tears

Labral tears are injuries to the labrum surrounding the shoulder socket that can occur from acute trauma or repetitive shoulder motion. Examples of acute trauma include falling on an outstretched arm; a direct blow to the shoulder; a sudden violent pull, as when trying to lift a heavy object; or a sudden overhead reach.

Tears can be located either above (superior) or below (inferior) the middle of the glenoid socket. A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the labrum above the middle of the socket that may also involve the biceps tendon. A tear of the labrum below the middle of the glenoid socket involving the inferior glenohumeral ligament is called a Bankart lesion. Tears of the labrum often occur with other shoulder injuries, such as a dislocated shoulder (full or partial dislocation).

The symptoms of a tear in the shoulder socket rim, which are similar to those of other shoulder injuries, include pain, usually with overhead activities; catching, locking, popping, or grinding; occasional night pain, or pain with daily activities; a sense of instability in the shoulder; decreased range of motion; or loss of strength.

Treatment

Anti-inflammatory medication and rest to relieve symptoms may be prescribed initially. Rehabilitation exercises to strengthen the rotator cuff muscles also may be recommended. If these conservative measures are insufficient, arthroscopic surgery may be prescribed.

During arthroscopic surgery, the doctor will examine the rim and the biceps tendon. If the injury is confined to the rim itself, without involving the tendon, the shoulder is still stable. The surgeon will remove the torn flap and correct any other associated problems. If the tear extends into the biceps tendon, or if the tendon is detached, the shoulder is unstable. The surgeon will need to repair and reattach the tendon using absorbable tacks, wires, or sutures.

Tears below the middle of the socket also are associated with shoulder instability. The surgeon will reattach the ligament and tighten the shoulder socket by folding over and "pleating" the tissues.

Rehabilitation

After surgery, a sling is used for three to four weeks. Your physician also will prescribe gentle, passive, and pain-free range-of-motion exercises. When the sling is removed, motion and flexibility exercises can be started. Athletes usually can begin doing sport-specific exercises six weeks after surgery, although it will be three to four months before the shoulder is fully healed.

To prevent shoulder injury, use the correct technique at all times, along with a stretching and strengthening program.