Labral Tear (Glenoid Labrum of the Shoulder)
What is a Labral Tear?
A labral tear is a cause of shoulder pain. The glenoid labrum provides extra support for the shoulder joint, helping to keep it in place. The labrum is a cartilage ring that surrounds the shoulder socket. The biceps tendon, which comes from the muscle on your arm, goes through the shoulder joint and attaches to the top of the labrum.
A labral tear occurs when part of this ring is disrupted, frayed, or torn. Tears may lead to shoulder pain, an unstable shoulder joint, and, in severe cases, dislocation of the shoulder.
What Causes a Labral Tear?
Many times, a labral tear occurs from repetitive trauma in overhead throwers, such as baseball or volleyball. It can also occur from a traction injury to the arm, such as lifting a heavy object off the ground, or getting your arm jerked.
These tears may be classified by the position of the tear in relation to the glenoid, which is often called the “shoulder socket”.
- Bankhart Tear: A Bankhart tear is a tear in the labrum located in the front, lower (anterior, inferior) part of the shoulder socket. This type of tear occurs most commonly during a shoulder dislocation. A Bankhart tear makes the shoulder more prone to recurrent dislocations.
- SLAP Tear: A SLAP tear is a tear in the labrum that covers the top part of the shoulder socket from front to back (Superior Labral tear from Anterior to Posterior). A SLAP tear occurs at the point where the long head of biceps tendon attaches. This type of tear occurs most commonly during falls on an outstretched arm.
How Does it Feel?
With a labral tear, a patient may have:
- Pain over the top of your shoulder
- “Popping,” “clunking,” or “catching” with shoulder movement, because the torn labrum has “loose ends” that are flipped or rolled within the shoulder joint during arm movement and that may even become trapped between the upper arm and shoulder blade
- Shoulder weakness, often on one side
- A feeling that your shoulder joint will pop out
How Is It Diagnosed?
Many patients with a labral tear have pain in the front of the shoulder or deep inside the joint. There also may be a feeling of catching or grinding in the joint. A physical examination in the office may confirm the presence of a labral tear. A set of x-rays is usually ordered to make sure there are no fractures in the shoulder. An MRI is helpful to confirm the tear of the labrum or biceps tendon, and evaluate other areas of the shoulder like the rotator cuff.
What are the treatment options for Labral tears?
The treatment primarily depends on a patient’s activity level and symptoms. Most times, treatment will begin with a conservative approach. A program of stretching and strengthening exercises, icing, pain medications or anti-inflammatory medications may be used to help decrease pain and improve function of the shoulder. Doctors and physical therapists can help outline an individualized treatment program. Labral tears untreated do not heal because of the lack of blood supply in the area.
If the conservative approach to managing a labral tear is not effective, surgery may be required. An orthopedic surgeon may be able to repair or remove the torn part of the labrum through arthroscopic surgery or through an open shoulder procedure.