Labral Tear - Torn Shoulder Labrum

What Is A Torn Shoulder Labrum?

labral tear
Labral injuries are common in athletes. Ryan McVay / Getty Images

The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. This means that the bones of the shoulder are not held in place adequately, and therefore, extra support is needed.

The Labrum

To compensate for the shallow shoulder socket, the joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within.

The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements (in fact, the range of movements your shoulder can make far exceeds any other joint in the body).

The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. When a patient sustains a shoulder injury, it is possible that the patient has a labral tear. The labrum also becomes more brittle with age, and can fray and tear as part of the aging process.

Several different mechanisms have been described as causes for superior labral tears in the shoulder. Sometimes the cause of the problem is a sudden injury such as a forceful compression or sudden traction on the arm. Conversely, some labral injuries are the result of repetitive injury to the shoulder such as is the case with overhead throwing activities.

Many studies have been performed and have identified some specific positions of the shoulder joint where the labrum is particularly at risk for injury. Depending on the activity and the position of the arm can help your doctor determine the most likely type and location of labral injury.

Symptoms of a Torn Labrum

Symptoms of a labral tear depend on where the tear is located, but may include:

  • An aching sensation in the shoulder joint
  • Catching of the shoulder with movement
  • Pain with specific activities

In addition, some types of labral tears, specifically a Bankart lesion, can increase the potential for shoulder dislocations.

Diagnosis of a labral tear can be made by taking a careful history of the injury and pain that is causing problems. On examination, specific tests can be performed to detect the different types of labral tears. Each different type of tear has specific tests that are used to assess for that specific condition.

In addition to a physical examination, tests are often performed to help make the diagnosis. A regular x-ray typically does not show abnormalities as a result of a torn labrum. An MRI is usually the best test to detect labral damage. It is important if there is a specific concern for a labral injury that the MRI is performed with injecting gadolinium enhancement (dye) into the shoulder joint. This injection helps dramatically improve the accuracy of an MRI in detecting labral tears of the shoulder.

Types of Labral Tears

The most common patterns of labral tears are:

  • SLAP Tears
    A SLAP tear is a type of labral tear most commonly seen in overhead throwing athletes such as baseball players and tennis players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder.

Treatment of a Torn Labrum

Treating a torn labrum depends on the type of tear that has occurred. Most labral tears do not require surgery; however, in patients who have persistent symptoms despite more conservative treatments, surgery may be necessary.

Typically, the first steps are simple steps to focus on allowing the body to heal the injury and for inflammation to subside. Working with a physical therapist can help to improve shoulder mechanics to take stress off the damaged labrum in the shoulder. In cases where the shoulder is unstable or if simpler treatment steps fail to alleviate the symptoms of pain, more invasive treatments can be considered. For more information about treating a labral tear, read about the specific type of tear listed above.

A Word From Verywell

Labral tears are a common finding in the shoulder. Not every labral tear requires a surgical treatment, but these injuries can be a source of pain and difficulty with certain activities. While most labral tears can improve with nonsurgical treatments, labral tears that lead to instability of the shoulder may require more invasive treatments.

Sources:

Keener JD, Brophy RH. "Superior labral tears of the shoulder: pathogenesis, evaluation, and treatment" J Am Acad Orthop Surg. 2009 Oct;17(10):627-37.

Streubel PN, Krych AJ, Simone JP, Dahm DL, Sperling JW, Steinmann SP, O'Driscoll SW, Sanchez-Sotelo J. "Anterior glenohumeral instability: a pathology-based surgical treatment strategy" J Am Acad Orthop Surg. 2014 May;22(5):283-94.

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