What is a Labral Tear?
A labral tear is a tear of the cartilage in the shoulder that surrounds the socket and helps to make it deeper. The ligaments that hold the ball of the shoulder to the socket attach to the shoulder at the labrum. These structures are often injured together. The biceps tendon attaches to the top of the shoulder socket at the labrum. Injuries to this attachment are called SLAP lesions (Superior Labrum Anterior-Posterior).
What causes a Labral Tear?
There are many ways in which the labrum can be injured. The most common include: shoulder dislocations, falls onto the shoulder or outstretched arm, and heavy lifting.Traction injuries, in which the shoulder is pulled away from the body, frequently lead to labral tears. Athletes who compete in sports requiring use of the arm overhead are particularly at risk. Sports where labral injuries are commonly identified include: baseball, softball, tennis and volleyball. Age related labral tears are common findings in older patients.
What are the symptoms?
Patients with labral tears will have shoulder pain, and may experience a click with range of motion. There is generally a loss of strength, and for throwing athletes, a loss of velocity. Overhead movements of the shoulder are painful. Re-dislocation may also occur. Tears involving the biceps tendon, will cause pain in biceps muscle. Patients may develop pain in their rotator cuffs as a result of failure of the labrum to hold the humeral head centered in the socket.
How is a Labral Tear diagnosed?
Your surgeon will obtain a careful history of your shoulder pain, and the mechanism by which the shoulder was injured. Patients who have had shoulder dislocations have a labral tear by definition. Physical exam may suggest a labral tear, but these are generally confirmed on MRI. Your surgeon may obtain an MRI with dye placed in the shoulder to more accurately evaluate the labrum. If the dye is seen to have entered inside, or completely surround the labrum, it is torn or detached. Even with MRI, labral tears can be difficult to detect. In this instance, your surgeon may suggest a shoulder arthroscopy to evaluate the labrum.
How is it treated?
Labral tears in sedentary or older patients may be successfully treated non-operatively. Physical therapy to strengthen the rotator cuff will help maintain the humeral head in the socket and reduce pressure on the labrum. Anti-inflammatory medications or a cortisone injection may be offered.
Symptomatic labral tears in patients who have failed non-operative treatment, will require arthroscopic surgery. If the labrum is not repairable, it is trimmed away. Labral tears, which can be repaired, are reattached to the socket with small plastic devices containing suture. Young patients who have suffered shoulder dislocations should undergo operative repair, as the labrum and ligaments injured during a dislocation do not heal. This leaves the patient at risk for future dislocations and arthritis. SLAP tears are treated identically, except when they extend into the biceps tendon. If the biceps attachment is severely compromised, the biceps is released from the socket, and reattached outside the shoulder joint.