What the Hell is a Shoulder Labral Tear?

Understanding Shoulder Labral Tear

Shoulder glenoid labrum injuries are common in sports where repetitive overhead movements and physical contact are present. The shoulder has more range of motion than any joint in the human body.  It’s constructed of a very shallow ball socket joint, which makes it vulnerable to injury.

The three bones that make up the shoulder joint are the clavicle, humerus, and scapula. The proximal head of the humerus (upper arm bone) is held in place by a combination of connective tissues, joint capsule and ligaments.  This fibrous tissue of the labrum ‘cups’ the head of the humerus and holds it within the glenoid cavity. The labrum of the shoulder is important in ensuring stability within a mobile joint.  During injury to the shoulder joint or with repeated strain, tear of the glenoid labrum may occur.

Prior to the development of arthroscopic surgery, treatment for labrum tears within the sports medicine community was quite limited.  Before the ability to easily see the inner workings of a joint, identifying the cause of shoulder pain was much more difficult.

Shoulder labral tears are also attributed to the contraction of the biceps muscle against the labrum. Throwing a baseball, for example, is a common cause of this type of tear. SLAP stands for ‘superior labral from anterior to posterior’ and is the acronym used to describe a superior labrum tear common in pitchers. A tear of the anterior labrum is referred to as a Bankhart tear and is often associated with shoulder subluxations and dislocations. Posterior labrum tears are less common and involve pinching of the rotator cuff and labrum.

Signs and Symptoms of Shoulder Glenoid Labrum Injury

  • A ‘catching’ feeling with overhead movement.
  • Pain on the anterior or posterior side of the shoulder.
  • A sense of hesitancy and insecurity with shoulder during exercise that requires shoulder strength and range of motion.
  • Deep aching and/or grinding within the shoulder joint.
  • Unexplained weakness of the shoulder and surrounding muscles.
  • Decreased shoulder range of motion.
  • Symptoms of a labral tear within the shoulder joint is not always immediately linked to the precise injury during physical examination. A correct diagnosis of this injury may require an MRI-arthrogram to properly determine the presence and the location of a labral tear.

    Professional Treatment of Torn Labrum

  • Discontinue overhead shoulder activities.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Utilize massage of the chest muscles, upper traps and posterior shoulder rotator cuff muscles to help reduce pain and increase pain-free range of motion.
  • Working with a physical therapist to properly strengthen the rotator cuff and surrounding musculature along with improving the pain-free biomechanics of the shoulder girdle during activities of daily living (ADL). 
  • Arthroscopic surgery may be required but only after an aggressive non-invasive rehab plan has been given sufficient time in an effort to reduce symptoms.
  • Asking the Right Questions Like a Pro

    Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports: 

    1. Do I need an MRI or MRI-arthrogram to confirm the diagnosis of a torn shoulder labrum?
    2. What are the key physical therapy activities that I need to focus on to speed up my recovery?
    3. What do you consider to be the likelihood of me needing surgery on my shoulder?
    4. How long should I allow for this injury to properly heal before returning to my sport?  Can you write me a general progression to follow as I plan to return to athletics?
    5. What else can I do on my own to avoid a re-injury?

    Elite Sports Medicine Tips from Mike Ryan

    • ICE Early & Often – Icing immediately after a workout or rehab is the simplest way to control swelling and reduce pain.
    • Pay Attention – Do not disregard recurring shoulder pain. Inability to recognize a shoulder labrum tear early on can increase your risk of requiring surgery later.
    • Listen Up – If you experience shoulder pain following any activity, listen to your shoulder to help determine the specific movement or activity that aggravated the injury.
    • Stretch – Stretching/warming up the shoulder joint and it’s associated muscles, tendons, ligaments and fascia prior to any physical activity will help keep you in the game.
    • It’s a Marathon – Shoulder labral tears don’t heal so they just don’t go away.  Take your rehabilitation program seriously to help keep you in the game and hopefully avoid surgery and downtime.