Shoulder Labral Tear
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What is a Shoulder Labral Tear
The shoulder is one of the most mobile joints within the human body. The shoulder is primarily a ball and socket joint consisting of the humeral head (ball) and the glenoid cavity (socket). This configuration allows for significant mobility necessary for day-to-day reaching tasks and more complex sporting activities. The glenoid labrum is a fibro-cartilage disc attached around the borders of the glenoid cavity (socket). A fall or repetitive movements such as throwing in sports can result in a shoulder labral tear.
The glenoid labrum plays a vital role in stabilising the shoulder joint by deepening the socket and increasing the area of congruency between the humeral head and the glenoid cavity. The labrum also has an essential proprioceptive function, allowing us to balance correctly during weight-bearing tasks on our hands. Moreover, it helps distribute the load evenly throughout the shoulder joint. Lastly, the glenoid labrum is closely connected with the long head of the biceps muscle, which also acts as a dynamic stabiliser of the shoulder by compressing the humeral head into the socket.
Shoulder Labral Tear Causes
Due to its essential role in shoulder stability, the glenoid labrum is quite vulnerable to injury. Exceedingly large or repetitive forces directed to the long head of the biceps can, over time, detach the upper portion of the glenoid labrum from the socket.
This is common in baseball pitchers or cricket bowlers, where a high degree of stress is transferred to the labrum via the long head of the biceps during the “cocking” and the “follow through” phases. However, albeit most commonly seen in overhead athletes such as swimmers and overhead labourers can equally be affected for similar reasons.
Most commonly, the mechanism of injury for a labral injury involves carrying a heavy object or carrying and catching a heavy falling object. Nonetheless, you may have suffered a traumatic labral injury also if:
- You have fallen on an outstretched arm (common in skiing)
- You sustained a direct blow to the shoulder (fall from a bicycle or contact sports)
- For example, you sustained a sudden pull because your dog suddenly pulled the leash, or the bus abruptly stopped while you were holding the handle above you.
Shoulder Labral Tear Symptoms
Regardless of the mechanism of injury, whether traumatic or overuse, the main symptoms of a labral tear are:
- Pain, located in the posterior-superior part of the shoulder
- Aggravating factors may include overhead activities and movements behind the back
- Popping, catching or grinding during shoulder movement
There may or may not be signs of instability (i.e. feeling apprehensive that the shoulder could “pop out” from the socket), depending on whether the labral tear is unstable. Furthermore, numbness and a “dead arm” feeling may indicate a labral injury in overhead athletes.
Treatment for a Shoulder Labral tear – Is surgery required?
The large majority of labral tears are treated conservatively nowadays. Only major labral injuries, such as following shoulder dislocation, with a significant acquired instability or an associated rotator cuff tear, may benefit from early operative treatment. Nevertheless, the decision should also be based on the level of sports and activity to be practised.
As a general rule of thumb, conservative management involves gradual rotator cuff and scapular muscle strengthening, along with a progressive increase in range of motion. Proprioception is an integral part of the treatment, given the critical role of the labrum in providing proprioceptive feedback during movement. Activities loading the biceps tendon should be delayed to later rehabilitation stages to avoid traction of the injured superior portion of the labrum.
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We are specialists in treating shoulder conditions such as Biceps Tendonitis and have experts in shoulder conditions in our clinic in Fulham, South West London.
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