Shoulder Labrum Tear

What You Need to Know

  • The shoulder labrum is a thick piece of tissue attached to the rim of the shoulder socket that helps keep the ball of the articulation in place.
  • The labrum tin can tear a few different ways: 1) completely off the bone, ii) within or forth the border of the labrum, or 3) where the bicep tendon attaches.
  • Diagnosing a labrum tear involves a physical examination and most likely an MRI, CT browse and/or arthroscopy of the shoulder.
  • Handling varies depending on blazon, severity and location of the labrum tear.

What is the labrum?

The labrum is a blazon of cartilage found in the shoulder joint. The shoulder is a ball-and-socket joint where the arm meets the body. The arm os (humerus) forms a ball at the shoulder that meets the socket, which is part of the shoulder blade. These 2 bones are connected past ligaments — tough tissues forming tethers that hold the bones in relationship to each other.

There are ii kinds of cartilage in the articulation. The first type is the white cartilage on the ends of the bones (articular cartilage) which allows the bones to glide and motion on each other. When this blazon of cartilage starts to wear out (a process chosen arthritis), the joint becomes painful and stiff. The labrum is a 2d kind of cartilage in the shoulder, which is distinctly different from the articular cartilage. This cartilage is more fibrous or rigid than the cartilage on the ends of the ball and socket. Also, this cartilage is likewise found only around the socket where information technology is attached.

What is the function of the labrum?

The labrum has ii functions. The first is to deepen the socket so that the ball stays in place. Picture the shoulder joint every bit a beach ball on a dinner plate. The ball of the humerus (the "beach brawl") is much larger than the flat socket (the "dinner plate"). The ligaments are the tethers that become from os to bone and concord them together to assistance go along the ball in the socket. The other way the ball is kept in the socket is the labrum.

The labrum is a thick tissue or blazon of cartilage that is attached to the rim of the socket and essentially forms a bumper that deepens the socket and helps keep the ball in place. In individuals where the labrum is besides small or is torn due to an injury, the ball may slide part of the way out of the socket (subluxation) or all the way out of the socket (dislocation). The labrum goes all the mode around the socket and in most areas is firmly attached to the bone of the socket. In some areas it is not firmly fastened. Only recently have specialists determined which parts are normal and which parts reflect tearing of the labrum.

The 2d function of the labrum is every bit an attachment of other structures or tissues effectually the articulation. For example, the ligaments that help hold the joint together attach to the labrum in sure key locations. If in that location is an injury to the shoulder that tears the ligaments, sometimes the labrum is pulled off of the rim of the bone as well.

This injury usually involves a subluxation or dislocation of the shoulder and is usually due to trauma. The ball of the shoulder can dislocate toward the front of the shoulder (an anterior dislocation) or information technology can go out the back of the shoulder (chosen a posterior dislocation). In either instance the labrum can exist torn off of the bone. Unremarkably when this happens the labrum does non heal dorsum in the right location. Whether the articulation continues to be unstable depends upon many factors.

The other structure that attaches to the labrum is the tendon of the biceps muscle. The biceps musculus is the muscle on the front end of the arm which gets firm with bending the elbow. While this muscle is quite large, information technology turns into a small tendon about the size of a pencil that attaches inside the shoulder joint. At the other terminate of the musculus is a large tendon that attaches beyond the elbow in the forearm. The portion that attaches in the shoulder actually goes through a small-scale hole in the rotator cuff tendons designed specifically for that tendon.

Once inside the articulation, the tendon is attached in function to the os near the socket and in office to the labrum at the top of the joint. This tendon can get torn where information technology attaches to the bone, where it attaches to the labrum or at both locations.

Girl throwing a softball

SLAP Tear Prevention Tips for Baseball and Softball Players

A SLAP tear can exist a serious injury no thing your age or professional level. The majority of SLAP tears don't happen in one day and usually result from repetitive trauma within the shoulder.

Sports medicine specialist John Wilckens, Thou.D. explains the origin of SLAP tears and what players, parents and coaches can do to forestall this injury.

What is a labrum tear?

A labrum tear can accept several forms, and it is very easy to confuse these types. As a result, information technology is of import that you discuss with your medico exactly what blazon of tear y'all have. The first blazon of tear is one where the labrum is torn completely off of the os. This is commonly associated with an injury to the shoulder in which the shoulder has subluxated or dislocated. Sometimes this type of tear occurs and the individual does not realize that the shoulder has slid out of the socket.

The 2d type of labrum tear is violent within the substance of the labrum itself. The edge of the labrum over time may get frayed so that the border is not smooth. This type of tearing is quite mutual and rarely causes symptoms. Information technology is seen oft in the shoulder every bit people get older (over 40 years of age). Sometimes the labrum may have a big tear where a portion of the labrum gets into the joint and causes clicking and catching as the ball moves around in the socket. This blazon of tear is very rare, and well-nigh labrum tears do not cause these symptoms.

A third type of labrum tear is in the area where the biceps tendon attaches to the upper end of the socket. The socket can be divided into four regions: anterior (front), posterior (back), superior (the upper stop near your head) or inferior (the lower end, which is toward the elbow).

The biceps tendon attaches at the superior end, where it blends in with the labrum. The labrum runs from there around the joint, both in an inductive and in a posterior direction. Due to injury in this area where the biceps tendon attaches, the labrum too can become injured. The injury in this area can be mild or it tin be astringent. Because the injury typically involves the biceps tendon and the labrum, considering information technology is at the superior end of the socket and considering it can affect the labrum attachments inductive and posterior to where the biceps attaches in this region, the acronym or abbreviation for this injury is a SLAP lesion. This stands for an injury that is superior labrum anterior and posterior.

There have been several grading systems or nomenclature systems of this injury. In a lesser injury, the labrum is just partially detached in this surface area. In a more severe injury, the whole labrum is pulled off of the bone along with the biceps tendon. The most common classification divides SLAP lesions into iv types.

How is a diagnosis of a labrum tear made?

Considering this cartilage is deep in the shoulder, information technology is very difficult to brand the diagnosis of a torn labrum upon physical examination. There are several tests that the doctor can perform that may indicate a torn labrum, simply these tests are not always accurate. The other trouble is that labrum tears take different forms every bit described above, and sure tests will detect i kind of tear but not another. Some physicians feel very confident that they can make the diagnosis of a labral tear upon physical examination, but this is controversial. In that location are not many scientific studies that show that physical examination is reliable for making the diagnosis of a labral tear. As a effect of this uncertainty, other studies tin can be done to confirm the diagnosis if it is suspected.

The best tests available to make the diagnosis of a labral tear are magnetic resonance imaging (MRI) scans or a test called a CT-arthrogram (the latter is a CAT browse preceded by an arthrogram where dye is injected into the shoulder). Both of these tests are relatively good at defining a labrum tear due to a subluxation or dislocation, only they are only around 80 percent to 85 percent accurate. For that reason, some physicians believe that tests are not always needed if the diagnosis of subluxation or dislocation can exist made by history and physical test. Neither of those tests is currently very skillful at making the diagnosis of a SLAP lesion. This surface area is very complex and it is hard to reliably get good pictures of this area with MRI.

Still, if the MRI definitely shows a tear and then oftentimes information technology will be nowadays. The trouble is that the MRI may miss smaller tears and cannot reliably brand the diagnosis in larger tears of the labrum.

The best manner to make the diagnosis of labrum violent is with arthroscopy of the shoulder. Unfortunately this is an operative procedure and requires some class of anesthesia. Making the diagnosis also takes some experience on the part of the surgeon, since the beefcake of the within of the shoulder tin exist quite complex. The relationship betwixt labrum tears and symptoms has not been totally figured out, so information technology is not clearly known which ones should exist repaired and which ones can be left alone.

What is the treatment for labrum tears?

The treatment depends upon which kind of tear in that location is in the labrum. Tears that are due to instability of the shoulder, either subluxation or dislocations, require that the labrum exist reattached to the rim of the socket. This tin be done with an incision on the forepart of the shoulder, or it can be done with arthroscopic techniques through smaller incisions. There are advantages and disadvantages of each approach. At this institution we favor an open operation with an incision until arthroscopic techniques become more perfected.

If the labrum is frayed, usually no handling is necessary since it doesn't usually cause symptoms. However, if there is a big tear of the labrum, the torn part should either exist cut out and trimmed, or it should be repaired. Which treatment is used depends upon where the tear is located and how large it is. This type of tear requiring repair without instability of the shoulder is rare.

Tears of the labrum near the biceps tendon attachment (SLAP lesions) may be just trimmed or may need to be reattached to the top of the socket. The all-time way to do this is with arthroscopic surgery since this area is hard to attain with an open operation through a large incision. Using the arthroscope and modest incisions for other instruments, the labrum can exist reattached to the rim of the socket using either sutures or tacks.

How is the recovery from labrum surgery?

The recovery depends upon many factors, such every bit where the tear was located, how severe it was and how good the surgical repair was. It is believed that it takes at least iv to half-dozen weeks for the labrum to reattach itself to the rim of the bone, and probably some other 4 to 6 weeks to get strong. In one case the labrum has healed to the rim of the os, it should come across stress very gradually and then that it can assemble force. It is important not to reinjure it while it is healing.

How much motion and strengthening of the arm is allowed after surgery depends upon many factors, and it is up to the surgeon to let y'all know your limitations and how fast to progress. Because of the variability in the injury and the type of repair washed, it is difficult to predict how soon someone tin can to return to sports and activities afterward the repair. The type of sport also is important, since contact sports have a greater take chances of injuring the labrum repair. However, a vast majority of patients have full function of the shoulder after labrum repair, and most patients can return to their previous level of sports with no or few restrictions.