- Shoulder Labrum Tear
Shoulder Labrum Tear
Shoulder Labrum Tear
A shoulder labrum tear is an injury to the labrum, which is the soft, fibrous tissue rim that surrounds the shoulder socket to help keep the ball of the upper arm in place. The labrum helps guide movement of the shoulder joint and provides stability. When the shoulder labrum becomes torn, it can cause pain or a sensation of popping or clicking.
What is the labrum of the shoulder?
The shoulder has 3 bones, including the shoulder blade, collarbone, and the upper arm bone. The part of the shoulder blade that comprises the shoulder socket is referred to as the glenoid. The glenoid is a flat and shallow structure. The labrum of the shoulder is made up of soft tissues that make the shoulder socket appear more cup-like. The shoulder labrum helps to mold the surface of the glenoid to properly fit the top of the humerus bone. The rotator cuff, a structure in the shoulder made of the fused tendons from 4 shoulder muscles, helps to secure the humerus to the shoulder blade.
As the labral tissues are soft and delicate, they may become ensnared between the humerus and the part of the shoulder blade known as the glenoid. This may cause the labral tissues to become damaged and eventually tear. If a shoulder labrum tear progresses, it may result in a tissue flap that moves to and from the joint, which can also get trapped between the glenoid and humerus. This flap of tissue can cause painful shoulder symptoms such as discomfort and a popping sensation. The shoulder often becomes more unstable after a shoulder labrum tear.
What causes shoulder labrum tears?
One of the most common causes of shoulder labrum tears is a direct injury or impact to the shoulder. Patients may suffer from a glenoid labrum tear if they fall and land on an outstretched hand. Repeated arm movements that use the labrum may also cause degeneration of the labral tissues, which can lead to the development of a glenoid labrum tear. Patients with a torn shoulder labrum are more prone to developing shoulder instability. Shoulder instability causes excess mobility and movement of the internal structures of the shoulder, often leading to further shoulder damage. In severe cases of shoulder instability, shoulder dislocation may occur, which can damage the shoulder labrum further.
The tendon of the bicep connects to the front section of the shoulder labrum. In sports that frequently use the bicep muscle, injury to the shoulder labrum may occur when the muscle quickly pulls on the section of the labrum it is attached to. Softball and baseball pitchers are often prone to shoulder labrum tears, as the position requires them to use quick bursts of energy to move the bicep muscle. Weightlifters also may suffer from an injury to the shoulder labrum, as well as golfers.
What are the symptoms of a shoulder labrum tear?
The most common symptoms of a shoulder labrum tear is a popping sound or sensation in the shoulder during use. This sensation may be followed by a dull ache for several hours. It is possible that a shoulder labrum tear may not cause pain. Most patients experience mild-to-moderate aching or pain following an injury to the shoulder labrum. If you are experiencing shoulder instability, you may feel like your shoulder is looser than normal and slips forward more during activity.
How can Dr. Rozbruch diagnose a glenoid labrum tear?
Dr. Rozbruch must understand your prior medical health before being able to properly diagnose you with a glenoid labrum tear. If you have had certain medical conditions or have experienced shoulder injuries before, our orthopedic specialist may be able to more accurately diagnose a shoulder labral tear sooner. Physical examinations are often useful tools that can provide detailed information on your symptoms and what is causing your shoulder pain. Dr. Rozbruch may gently move your arm to see what movements cause pain, which can indicate an injury to the shoulder labrum. Actions that may cause pain in patients with a torn shoulder labrum include raising the arm above the head, raising the arms forward to shoulder level, or pressure being applied to the shoulder.
Dr. Rozbruch may order a shoulder MRI scan to diagnose a torn shoulder labrum. While shoulder MRIs are powerful tools, a shoulder labrum tear may be difficult to diagnose on this kind of medical imaging test. A CAT scan with contrast dye may help to detect the presence of a shoulder labrum injury. While soft tissues cannot be seen from a CT scan, the contrast dye can easily be viewed from a shoulder CAT scan. The dye used during a CT scan can highlight the shoulder labrum’s outline. In cases of a torn shoulder labrum, the dye will penetrate the labral tissues and blur the outline. In some cases of inconclusive test results, an arthroscopic shoulder labrum tear exam may be required. This arthroscopic exam uses a small camera on the end of a tube that can be inserted into the body through an incision in the shoulder. The images gained from the arthroscope will be displayed on a screen and can help Dr. Rozbruch see and diagnose a shoulder labrum tear.
What nonsurgical glenoid labrum tear treatments are available?
A nonsurgical shoulder labrum tear treatment can help reduce the inflammation and pain associated with the injured labral tissue. At first, Dr. Rozbruch may suggest a period of rest and anti-inflammatories to help alleviate any swelling around the labrum. If these treatments do not help manage painful symptoms, Cortisone injections for shoulder pain may be recommended to ease pain and discomfort. A strong anti-inflammatory medication or Cortisone injections can provide temporary relief to shoulder labrum tear symptoms.
A period of physical therapy may also help reduce pain and inflammation levels in patients with a torn shoulder labrum. Ice and heat treatments may be used during physical therapy to reduce inflammation and alleviate discomfort in the shoulder. As physical therapy progresses, strength exercises will be implemented to help increase stability and control of the muscles, tendons, and mechanisms in the shoulder. Your physical therapist can help you relearn how to properly move your shoulder to avoid injury or pain. Physical therapy for a torn shoulder labrum may last 4-6 weeks.
What shoulder labral tear surgeries are available?
If your symptoms are not properly managed by a nonsurgical treatment, shoulder labrum tear surgery may be required to correct the injury. There are 3 main forms of shoulder labrum surgery that can help alleviate symptoms. Some of the most common surgeries include arthroscopic labrum surgery, shoulder labral repair surgery, and open shoulder labrum surgery.
Arthroscopic Labrum Surgery
Arthroscopic labrum surgery is used to treat the symptoms from a shoulder labrum tear. In cases of a small shoulder labrum tear, removal of the damaged edges of the labrum and any loose parts within the shoulder can adequately treat a torn labrum. Arthroscopic labrum surgery is also known as labral debridement surgery.
Shoulder Labral Repair Surgery
In a more severe case of a torn shoulder labrum, the labrum itself may need to be fully repaired rather than having the ends removed. Staples may be applied to the torn labrum to help promote healing. These staples are designed to secure the labral tissues to the glenoid. Shoulder labral repair surgery is often performed through an arthroscope for a less invasive surgery.
Open Shoulder Labrum Surgery
Some patients may require open shoulder labrum surgery, which is performed through a large incision without the use of an arthroscope. While a larger incision makes for a more invasive shoulder labrum surgery, many patients experience a dramatic improvement of their symptoms and regain proper functionality of their arm. Patients undergoing open shoulder labrum surgery may require additional time to fully heal after surgery.
What should I expect after a shoulder labral tear treatment or surgery?
Physical therapy is suggested even after undergoing a nonsurgical treatment for a torn shoulder labrum. Physical therapy for a labrum tear is designed to help increase the strength and control of the shoulder muscles and tendons. By strengthening the rotator cuff, physical therapy can help the shoulder to become more stable. After your physical therapy sessions end, your physical therapist will create an at-home exercise plan that you can continue to help promote a healthy shoulder.
If you have undergone shoulder labrum tear surgery, recovery time may be longer. Physical therapy can help to protect the labrum during this time of healing. The initial exercises and physical therapy sessions will be designed to reduce pain and inflammation. In cases of arthroscopic shoulder surgery, physical therapy may progress more quickly, as patients generally heal at a faster rate due to the less invasive surgery. Immediately following shoulder labral tear surgery, your physical therapist will start by introducing passive exercises. Passive exercises are where your physical therapist or a machine will move your arm and shoulder gently so that the joint is exercised while the muscles stay relaxed.
Strength training and active exercises are introduced approximately 6 weeks following the day of your glenoid labrum tear surgery. These exercises are designed to help you move your arm and shoulder independently and rebuild strength. 2-3 months after your shoulder surgery, your strength exercises will slowly become more complicated and difficult. This helps to rebuild strong, healthy muscles of the arm and shoulder. Strength exercises also can help treat shoulder instability. As your physical therapy sessions end, your physical therapist will provide you with a list of at-home exercises that you can continue to reduce any future shoulder pain or discomfort.
How can I learn more about a shoulder labrum tear?
To learn more about a shoulder labrum tear, please request an appointment online or call Dr. Rozbruch’s orthopedic office in NYC at 212-744-9857. Prior to an office visit, please fill out Dr. Rozbruch’s patient forms to expedite your first visit.