Maybe you’ve been playing baseball for a while, and throwing has created pain in your shoulder. Or you fell hard on your outstretched arm, and now your shoulder feels like it might pop out. No matter the cause, the diagnosis is the same: you could have a labrum tear. But what kind of shoulder labral tear do you have?
The shoulder is a fascinating joint prone to different impairments and damage. Midwest Orthopedic Specialty Hospital’s Orthopedic experts will diagnose, treat, and answer your questions regarding shoulder injuries, including labrum shoulder tears.
To understand your injury, it helps to know a bit about the anatomy of your amazing shoulder. The shoulder consists of three bones: the top of the arm bone (humerus), the clavicle (collar bone), and the top of the scapula (shoulder blade). In addition, tendons, ligaments, and cartilage keep the bones together and help attach the shoulder and arm muscles like the bicep. When working together, all these components allow your shoulder to have the largest range of motion of any other joint.
The shoulder is a ball and socket joint, like the hip, but shallower. The top of the humerus is the “ball,” and the corner of the scapula is the “socket,” also known as the glenoid. To help keep the ball in the socket and to allow for such a wide array of movement, a strong fibrous tissue called the labrum covers the inside of the socket and socket rim. The main job of the labrum is to keep the ball joint in place and to allow for smooth movement.
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.
What is a Shoulder Labral Tear?
Labrum tears are painful rips in the labrum tissue. Three types of events can cause these tears:
- Acute (sudden) trauma to the shoulder: like a motor vehicle accident, falling on an outstretched arm, or a hard pull of the arm (such as lifting or catching a heavy object) that would stretch or pull the arm bone out of the shoulder socket and cause a dislocation.
- Chronic injury: overuse and repetitive movements, especially in work or sports with overhead throwing or weight lifting, can create tears and fraying that may have healed improperly.
- Age: for people over 40, the labrum can fray and incur minor damage from normal use without a history of chronic injury. For younger people, labral shoulder tears happen more frequently with shoulder dislocations.
The most common cause of shoulder labrum tears is chronic injury or strain caused by repetitive overhead motions, especially from sports like volleyball, tennis, or baseball.
There are two common types of shoulder labral tears: the SLAP tear and the Bankart tear.
What is a Shoulder SLAP Tear?
A SLAP (superior labrum anterior and posterior) tear means your labrum has torn from the top of the shoulder labrum along the back and front where the bicep tendon connects to the shoulder. When this happens, your upper arm bone loses its cushion, and your bicep tendon can become disconnected. 4% to 8% of all shoulder injuries involve SLAP tears, making these the most common shoulder labral tears.
SLAP Tear Symptoms
Like a rotator cuff injury, SLAP tears may feel like a constant deep ache in your shoulder or sudden sharp pain. Other symptoms include:
- A catching, popping, locking, or grinding in your shoulder area.
- A “clunking” feeling with shoulder movements.
- Discomfort at night.
- Shoulder pain when holding your arm in certain positions, like above your head.
- Shoulder pain when lifting objects.
- A feeling like your shoulder may jump out of the socket.
- Decreased range of motion or strength.
- Pitchers may notice a decrease in pitch speed and experience a “dead arm” feeling.
Diagnosing a SLAP Tear
A feeling of instability or pain should prompt a visit to an orthopedic specialist like those at MOSH. Your appointment will likely include:
A Medical History: Your doctor will want to know when your pain or discomfort began, the symptoms you are experiencing, any specific injuries that may have caused the shoulder labral tear, and any movements that increase the pain.
A Physical Exam: To properly diagnose your injury, your physician will perform a physical exam. First, they will examine your shoulder and injury areas. Next, they will check your range of motion, strength, and flexibility by placing your arm in different positions. The “Clunk” and “O’Brien” tests are manual assessments often used to diagnose shoulder labral tears.
Imaging: In addition to a physical exam, you can expect your doctor to take X-rays of your shoulder. 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, like fractures or arthritis.
If the labrum is suspected as the culprit, your physician will order more advanced imaging like a CT scan or MRI to view the soft tissue of the shoulder. In some cases, contrast fluid (a dye) may be injected into the shoulder before the test. This fluid then fills in the areas of tearing, making it easier to see apparent damage on the MRI or MRI arthrogram.
SLAP Tear Treatment Options
If you have a labrum injury, treatment options vary from conservative treatment, including anti-inflammatory medications and cortisone shots, to surgical repair and debridement.
Treatment for a SLAP tear will depend on which of the four general types of SLAP tears you have sustained.
- Type 1: The labrum shows evidence of tearing and fraying but still allows for normal shoulder movement. This type is common for patients in their forties and older.
- Type 2: The labrum and the tendon attaching the bicep to the shoulder are fully disconnected from the socket. Type 2 is the most common type of SLAP tear and is subdivided more by the specific tear location.
- Type 3: Material from a torn labrum is caught in the shoulder joint and is usually the reason for the shoulder making clunking, popping, or locking sounds. Type 3 tears are sometimes called “bucket handle tears.”
- Type 4: This tear includes a shoulder labrum rip extending into the bicep tendon.
Most SLAP tears are initially treated with non-surgical interventions like shoulder immobility with a sling, rest, and physical therapy. A MOSH physical therapist will help you regain the use of your shoulder and strengthen your muscles to better support your shoulder joint. Expect to work with your physical therapist for three to six months.
SLAP Tear Surgery
Surgery is recommended if the shoulder continues to be difficult to use or if there is no reduction in the pain from a labral tear. Surgery also depends on the type of SLAP tear, the patient’s age, weight, current physical health, other injuries, and prior activity level.
Shoulder joint surgery is usually done via arthroscopy, with a few small incisions at different points around the shoulder. Orthopedic surgeons can remove damaged bone and tissue (debridement), bring the torn labrum back to where it belongs, and reattach it to the bone, recreating the stable shoulder joint.
Successful surgery also involves rest in a sling to allow the reattached labrum to fully heal. 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 activity level, you should expect three months of healing before returning to full activity at six months. The expectation and goal is your return to all activities, including sports.
A Bankart tear (or a Bankart Lesion) is a rip in the lower part of the labrum at the bottom of the shoulder socket where the glenoid and the humerus bone are connected (inferior glenohumeral ligament). Most patients under 30 years old will have a Bankart tear when their shoulder is dislocated.
Bankart Tear Symptoms
Bankart tears have many of the same symptoms as a SLAP tear, such as pain or a restriction in shoulder movement, but may also include:
- A sensation of shoulder instability.
- A feeling like your shoulder is “catching” in the joint.
- A distrust of shoulder strength or mobility.
- A feeling that your shoulder would dislocate if you put your hand behind your head.
- Discomfort or a deep ache that may get worse at night.
- A shoulder dislocation.
Diagnosing a Bankart Labrum Tear
Like a SLAP tear, your MOSH orthopedic specialist will get your medical history and perform a physical exam to check for dislocation, pain, and visible signs of injury. The doctor will have you hold your arm in different positions to assess pain, strength, and your shoulder’s range of motion.
Imaging will include an X-Ray to look for possible other causes of your symptoms, like rotator cuff tears or shoulder impingement, and to check for two possible bone lesions (damage to the bone) that often occur with a Bankart tear in the shoulder labrum. A Hills Sach lesion is a divot in the humerus bone caused by a shoulder dislocation. A Bony Bankart lesion is a fracture to the socket bone’s (glenoid) rim and a lower labral tear.
Bankart tears assessed using an MRI often require contrast dye to better visualize the labrum and other soft tissue damage.
Bankart Tear Treatment Options
Bankart tears are treated first by fixing the shoulder dislocation, then rest and non-steroid anti-inflammatories (NSAIDs) are recommended. However, Bankart tears don’t often heal correctly without surgery, which makes recurrent shoulder dislocations likely.
Arthroscopic shoulder surgery to properly repair the labrum is recommended for people experiencing a lot of pain, shoulder instability, or if they are experiencing frequent shoulder dislocations. Physicians may also suggest surgery for active athletes, like those who play hockey, baseball, basketball, football, or tennis, and patients under 40. Bankart labrum tear surgery has a 90% success rate in preventing further dislocations.
Whether from an accident or overuse, a shoulder labral tear needs to be addressed by an orthopedic doctor. While SLAP and Bankart tears aren’t completely preventable, they can be treated so you can return to the activities you love. If you’re suffering from shoulder pain, please contact a MOSH specialist immediately. Visit our Performance Center for walk-in appointments, or call us at 414-817-5800.
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