Shoulder Labral Tear

An unstable shoulder joint can be the cause or the result of a labral tear. “Labral” refers to the glenoid labrum—a ring of cartilage that surrounds the base of the shoulder joint. Injuries to the labrum are common, can cause a great deal of pain, and may make it hard to move your arm. A labral tear can occur from a fall or from repetitive activities or sports that require you to use your arms raised above your head. Some labral tears can be managed with physical therapy; in severe cases, surgery may be required to repair the torn labrum.

What is a Shoulder Labral Tear?

The glenoid labrum provides extra support for the shoulder joint, helping to keep it in place. A labral tear occurs when part of this ring is disrupted, frayed, or torn. Tears may lead to shoulder pain, an unstable shoulder joint, and, in severe cases, dislocation of the shoulder. Likewise, a shoulder dislocation can result in labral tears.

When you think of the shoulder joint, picture a golf ball (the head of the upper-arm bone, or humerus) resting on a golf tee (the glenoid fossa, a shallow cavity or socket located on the shoulder blade, or scapula). The labrum provides a rim for the socket (golf tee) so that the humerus (golf ball) does not easily fall off. If the labrum is torn, it is harder for the humerus to stay in the socket. The end result is that the shoulder joint becomes unstable and prone to injury.

Because the biceps tendon attaches to the shoulder blade through the labrum, labral tears can occur when you put extra strain on the biceps muscle, such as when you throw a ball. Tears also can result from pinching or compressing the shoulder joint when the arm is raised overhead. There are 2 types of tears:

  • Traumatic labral tears usually happen because of a single incident, such as a shoulder dislocation or an injury from heavy lifting. People who use their arms raised over their heads—such as weight lifters, gymnasts, and construction workers—are more likely to have traumatic labral tears. Activities the force is at a distance from the shoulder, such as striking a hammer or swinging a racquet, also can create shoulder joint problems.
  • Nontraumatic labral tears most often occur because of muscle weakness or shoulder joint instability. When the muscles that stabilize the shoulder joint are weak, more stress is put on the labrum, leading to a tear. People with nontraumatic tears tend to have more “looseness” or greater mobility throughout all their joints, which might be a factor in the development of a tear.

How Does a Shoulder Labral Tear Feel?

With a shoulder labral tear, you might have:

  • Pain over the top of your shoulder
  • “Popping,” “clunking,” or “catching” with shoulder movement,  because the torn labrum has “loose ends” that are flipped or rolled within the shoulder joint during arm movement and that may even become trapped between the upper arm and shoulder blade
  • Shoulder weakness, often on one side
  • A feeling that your shoulder joint will pop out

How Is a Shoulder Labral Tear Diagnosed?

Not all shoulder labral tears cause symptoms. In fact, when tears are small, many people are able to function without pain. In some instances, the labrum might even heal on its own, if care is taken not to stress the injured tissues. Due to the lack of blood supply available at the labrum, complete healing may be difficult. The shoulder with a labral tear may pop or click without being painful; however, if a tear progresses, it is likely to lead to pain and weakness.

If your physical therapist suspects that you may have a labral tear, the therapist will review your health history and perform an examination that is designed to test the condition of the glenoid labrum (the ring of cartilage at the base of the shoulder). The tests will place your shoulder in positions that may recreate some of your symptoms, such as “popping,” “clicking,” or mild pain. Using this examination, your physical therapist will determine whether your shoulder joint is unstable. Magnetic resonance imaging (MRI) also may be used. Labral tears may be difficult to diagnose with certainty without arthroscopic surgery, where a tube-like instrument called an arthroscope is inserted into the joint through a small incision to view or repair an injury.

How Can a Physical Therapist Help treat a Shoulder Labral Tear?

When shoulder labral tears cause minor symptoms but don’t cause shoulder instability, they usually are treated with physical therapy. Your physical therapist will:

  • Educate you about positions or activities to avoid
  • Tailor a treatment plan for your recovery
  • Design specific shoulder strengthening exercises, such as external rotation and internal rotation exercises, to help support the joint and decrease strain on the glenoid labrum
  • Design stretching exercises, such as the cross-body stretch or the doorway stretch, to help improve the function of the muscles surrounding the shoulder
  • Perform a special technique called manual therapy to decrease pain and improve movement

In more severe cases, when conservative treatments are unable to completely relieve the symptoms of a labral tear, surgery may be required to re-attach the torn labrum. Following surgery, your physical therapist will show you how to slowly and safely return to your daily activities.

A surgically repaired labrum takes 9 to 12 months to completely heal. Immediately following the repair, you should avoid putting excessive stress or strain on the repaired labrum and should increase stress to your shoulder slowly over time. Your physical therapist is trained to gradually introduce activity in a safe manner to allow you to return to your usual activities without re-injuring the repaired tissues.

Can a Shoulder Labral Tear be Prevented?

Forceful activities with the arms raised overhead may increase the likelihood of developing a labral tear. To avoid putting excessive stress on the labrum, you need to develop strength in the muscles that surround the shoulder and scapula. Your therapist will:

  • Design exercises to help you strengthen your shoulder
  • Show you how to avoid potentially harmful positions
  • Determine when it is appropriate for you to return to your normal activities
  • Train you to properly control your shoulder movement and modify your activities to reduce your risk of sustaining a labral injury

References:

http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=99c2e561-5a77-450c-867a-2e2edaaa9b7c#.VYGNlflViko