man with shoulder pain
June 12, 2019 | by Jim C. Hsu MD

The shoulder is a joint with a very shallow socket, which allows a wide of range of motion. It also means the surrounding soft tissue structures are important in maintaining joint stability. One of the soft tissue structures, the labrum, is a cartilage rim that runs along the edge of shoulder socket, or glenoid. The labrum plays an important role in shoulder function: ligaments that stabilize the upper arm or humeral head (ball) against the glenoid (socket) are attached to the labrum, and the long upper biceps tendon starts off at the labrum at the top of the socket. When the labrum is torn, the damage and the loss of attachment to bone can lead to pain, partial instability, and dislocation.

Common Shoulder Labrum Tear Types

A traumatic shoulder dislocation often tears the labrum off bone. If the tear fails to heal on its own, it can lead to recurrent shoulder instability. In younger, more active patients, recurrence of untreated shoulder dislocation can reach as high as 90%.

Another common labrum tear, the SLAP (superior labrum, anterior to posterior) tear, occurs at the junction with the long biceps tendon. This area is under multiple stress factors, and can tear from trauma or overuse, especially in overhead-sport athletes such as baseball pitchers, basketball and volleyball players. Pain deep within the shoulder is a common symptomatic feature. The pain can also radiate down toward the biceps, or toward the back as the tear extends in that direction.

Diagnosing Shoulder Labrum Tears

The physical exam of a labrum tear can reveal pain, loss of motion, and concern about possible impending dislocation. We often use imaging studies including a complete x-ray series to rule out glenoid and humeral head fractures. Magnetic resonance imaging (MRI) is also important here, especially if surgery is needed, since it allows us to clearly assess the soft tissue structures including the labrum, cartilage on joint surfaces, and the rotator cuff. The MRI is typically done with an injection of contrast directly into the joint (arthrogram).

Treating Shoulder Labrum Tears

Treatment of labrum tears typically begins with a conservative approach. Rest, anti-inflammatory medications can often address the immediate pain. Physical therapy can improve biomechanical deficiencies and to lead to long-term pain relief and return to sports and activities.

If conservative treatment fails, or if the likelihood of recurrent instability is high—in younger, more active patients for example—surgery may be required. Minimally invasive surgical techniques, through small incisions and with a fiber-optic camera, allow the surgeon to repair multiple types of labrum tear without fully opening up the joint, with less pain and quicker recovery. The procedure reattaches the torn labrum back to the bone, to help with healing and restoring its important function.

Rehabilitation is Key

If conservative treatment fails, or if the likelihood of recurrent instability is high—in younger, more active patients for example—surgery may be required. Minimally invasive surgical techniques, through small incisions and with a fiber-optic camera, allow the surgeon to repair multiple types of labrum tear without fully opening up the joint, with less pain and quicker recovery. The procedure reattaches the torn labrum back to the bone, to help with healing and restoring its important function.

Following shoulder labrum surgery, return to basic daily activities (keyboarding, light office work) can occur within days; general movement is typically restored within four to six weeks; and basic strength and endurance can often be restored in two to three months. For highly competitive athletes, it may take six to 12 months of thorough rehabilitation to reach peak performance, with overhead athletes such as baseball pitchers needing the most time.

Contact Us for Care

If you have questions about shoulder injuries including labrum tears, please call Jim C. Hsu MD at The Polyclinic Orthopedic Department at 206-860-5578 for expert diagnosis and comprehensive treatment.

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Written By: Jim C. Hsu MD