Shoulder Pain: Labrum Tears

By: Joshua M. Neubauer, MD

Labrum tears are painful and can be caused by a number of situations. The most common cause is an acute traumatic injury or strain caused by repetitive overhead activity, including sports like volleyball, tennis, or baseball. Falling on an outstretched arm or forcefully pulling the arm away from the body such as lifting a heavy object or catching oneself while falling can also injure the labrum.

Anatomy of a Shoulder

The shoulder is essentially a ball and socket joint. The official term for the socket is the glenoid, which is an extension of the scapula or shoulder blade. The upper part of the humerus—the bone that goes from the shoulder to the elbow—is where you’ll find the ball portion of the joint. Structures including the labrum help keep the ball in the socket while also allowing for the wide range of motion of the shoulder. If the socket was completely bone, we would have much less shoulder range of motion. The labrum is a tough tissue that is attached to the shoulder socket. Its job is to keep the ball joint in place.

A shoulder injury can cause the labrum to pull away from the bone resulting in pain with activity or the feeling that the shoulder may come out of place. In more extreme cases, the shoulder can fully dislocate, which means the rounded ball portion of the humerus no longer sits in the socket of the glenoid.

Symptoms of a Labrum Tear

If you have a labrum tear you may experience pain, catching, popping, or a clunk feeling with shoulder range of motion. It is also common to feel discomfort at night, pain when reaching and loss of range of motion or strength.

A feeling of instability or pain that continues after a period of rest should prompt a visit to an orthopedic physician. Your doctor will review a history of your symptoms, discuss specific injuries or painful activities you have experienced, and conduct an exam including tests to evaluate the range of motion, stability, and strength.

Diagnosing a Labrum Tear

In addition to a physical exam, you can expect your doctor to take X-rays of your shoulder. And, although the soft tissue of the labrum will not show up on the X-ray, the image will show other problems that might be causing your symptoms. If the labrum is suspected as the culprit, more advanced imaging like a CT scan or MRI may be ordered. In some cases, contrast fluid, which is a dye, may be injected into the shoulder prior to the test. This fluid then fills in the areas of tearing, making it easier to see apparent damage on the MRI images.

Treatment Options

In the event you have a labrum injury, treatment options vary from conservative treatment including anti-inflammatory medications and physical therapy to surgical repair. Surgery is usually done via arthroscopy, with a few small incisions made at different points around the shoulder.

In surgery, we bring the torn labrum back to where it belongs and reattach it to the bone, recreating the stable shoulder joint. Successful surgery also involves a period of rest in a sling to allow the reattached labrum the time needed to fully heal in place. The rest period typically lasts for several weeks. Physical therapy helps the patient regain range of motion and strength and usually begins one to two weeks after surgery. Depending on your level of activity, you should expect three months of healing time before you can return to full activity at six months. The expectation and goal, however, is your return to all activities including sports.

If you’re suffering from shoulder pain, please contact me or your MOSH specialist right away.