Labral Tear of the Shoulder
What is a labral tear of the shoulder?
A shoulder labral tear is an injury to the cartilage in the shoulder joint. The labrum is a ring of firm tissue that surrounds and cushions the shoulder. It contributes to shoulder stability and serves as the attachment site for the capsular ligaments. When torn, can lead to partial or complete shoulder dislocation (instability). The labrum is susceptible to injury with trauma to the shoulder joint. It also becomes more brittle with age, and can fray and tear as part of the aging process.
How does a labral tear occur?
There are several different types of labral tears:
- SLAP (superior labrum anterior and posterior) tears are injuries to the uppermost part of the labrum, where the biceps tendon attaches to the shoulder. SLAP injuries are common in overhead throwing athletes, such as baseball and tennis players. Other common causes include falling on an outstretched arm, falling on a shoulder, or lifting heavy objects repeatedly or too suddenly.
- Bankart tears are injuries to the lower part of the labrum and occur when the shoulder dislocates. The labrum is torn as the shoulder pops out of the joint. Bankhart tears are especially common in young athletes.
- Posterior labral tears are less common and occur when the rotator cuff and labrum are pinched together in the back of the shoulder, a condition called internal impingement.
What are the symptoms of a labral tear?
Symptoms of a torn labrum depend on where the tear is located. You may feel an aching sensation in your shoulder joint, shoulder weakness or instability, a catching or popping sensation in the shoulder with movement, or pain with specific activities such as moving your arm over your head or throwing a ball. Sometimes, the tear may not cause any pain at all.
(Left) An MRI image of a healthy shoulder.
(Right) This MRI image shows a tear in the labrum.
How is a labral tear diagnosed?
Because labrum cartilage is deep in the shoulder, it is difficult to make the diagnosis of a torn labrum with a physical examination alone. Doctors use MRI and an arthrogram (images of the shoulder joint after injection of a contrast dye) to confirm the diagnosis and determine the type of labrum tear involved.
What is the treatment?
Treatment of a torn labrum depends on the type and severity of the injury. Most labral tears do not require surgery. Your doctor may prescribe non-operative treatment such as rest, anti-inflammatory medication and exercises to strengthen the rotator cuff muscles. If these conservative measures are insufficient, arthroscopic surgery may be necessary.
Arthroscopic repair of labral injuries allows surgeons a full view of the shoulder so they can reattach the torn tissue without having to cut through nerves or muscles. Patients experience less pain and blood loss, fewer complications and a faster recovery. The result is a more balanced, stable repair that helps restore full function.
(Left) An arthroscopic view of a healthy labrum. (Center) In this image, the surgeon uses a small instrument to evaluate a large SLAP tear. (Right) The labrum has been reattached with sutures.
Recovery requires keeping the shoulder in sling for four to six weeks, followed by several months of rehabilitation to restore range of motion, flexibility and strength. Athletes can usually begin doing sport-specific exercises 12 weeks after surgery, although it will be several more months before the shoulder is fully healed. Athletes typically can return to collision sports and unrestricted throwing 6 months or more post-surgery.