What is a Shoulder Labral Tear?
The shoulder is a unique joint that has a nearly 360-degree range of motion. This is accomplished by having a round “ball” of bone connected to a small flat “socket” of bone. This flat socket has a thin rim of cartilage creating a “lip” around the edge helping keep the ball from sliding off the edge of the socket. This rim of cartilage is called the “labrum”. Ligaments surround and connect the ball to the socket. These ligaments attach directly to the ball but attach to the labrum as opposed to the bone at the socket. The labrum attachment to the bone is the “weak link” of this setup.
How Do I Tear My Labrum?
In general, if the shoulder joint gets stretched beyond its capacity something needs to give. This usually results in the labrum ripping off the socket.
This can happen with a violent single event when the shoulder “dislocates” (comes completely out of the socket or “dislocation”) or “subluxates” (comes partially out of the socket or “subluxation”).
The labrum can also tear if repeatedly stressed such as throwing a ball, playing tennis or hanging drywall.
What Are the Symptoms of a Labral Tear?
The symptoms are extremely variable. They can range from recurrent dislocations to a simple feeling of weakness or soreness after minor shoulder activity. With a subluxation you may momentarily feel a “dead arm”.
How Do You Make the Diagnosis of a Labral Tear?
A detailed history and thorough physical examination by an experienced sports medicine trained physician is very important but accuracy is increased with imaging studies.
Do I Need an X-Ray or an MRI?
X-rays are standard, but MRI is even more valuable in making the diagnosis when combined with an appropriate physical exam. MRI’s however have a very high false-negative and an even higher false-positive rate (up to 70%) so are not 100% accurate.
Are there Different Types of Labral Tears? What’s the Difference Between a Shoulder Dislocation, Subluxation, and Separation?
Labral tears can be in the front, back, bottom, or around the socket entirely. A SLAP tear is a unique tear at the top of the socket where the biceps tendon attaches to the labrum. A dislocation is when the main ball and socket joint (glenohumeral joint) goes completely out of the socket. A subluxation is when the ball slides slightly out of the socket but then goes back into place on its own. A separation involves the acromioclavicular joint (AC joint) which is the connection between the collar bone (clavicle) and the bone on top of your shoulder (acromion). This usually results in a bump on top of your shoulder.
If I Have a Labral Tear Do I Need Surgery?
No. The shoulder’s primary constraints are your muscles so frequently strengthening exercises will be adequate. There are some sports and activities that will cause continual symptoms in which case surgery may be necessary.
If I Choose Surgery, What Does That Mean?
The goal of surgery is to reattach the labrum and ligaments back to the socket. This is performed as an outpatient. In the majority of instances this is performed with an arthroscope although there are times when making an incision and performing “open” surgery offers a better outcome.
If I Choose Surgery, How Long is the Recovery?
Depending on the extent of the labral tear and your desired activity you are in a sling for 2-6 weeks before starting physical therapy. Most people have resumed activities of daily living by 2-3 months, most sports by 3-4 months, collision sports (football, rugby, skiing) 4-6 months, throwing sports 9-12 months.
To set up an appointment for further evaluation, please call (208) 336-8250.