The labrum is a fibrocartilaginous rim of soft tissue that is part of the shoulder and hip joint. For this post the focus will be on the glenoid labrum of the shoulder. The shoulder joint is a ball and socket joint with the shallow socket being known as the glenoid cavity. The labrum deepens the socket with its base fixing to the circumference of the cavity and the other edge being free. By deepening the cavity, it provides more static stability to the joint and is a primary stabilizer while the surrounding musculature acts as secondary stabilizers. Tears can occur anywhere along the labrum attachment to the glenoid cavity and can be caused by overuse from repetitive motion or trauma to the shoulder joint.
Once torn the shoulder itself becomes more unstable leading to increased risk of subluxation and dislocation. Multiple types of labrum tears include Bankart lesions/tears, SLAP (superior labrum anterior to posterior) lesions/tears, and posterior shoulder instability. Bankart lesions occur in the front lower portion of the glenoid cavity and are most common in young individuals who dislocate their shoulder. SLAP tears occur front to back through the middle of the glenoid cavity seen mostly in athletes that make quick snapping movements over the top of the shoulder with tennis, baseball, or softball. Posterior shoulder instability is the least common labrum tear and occurs in the back of the glenoid cavity.
A magnetic resonance imaging (MRI) can confirm if a tear is present; however, physical therapists also use a physical examination assessing the patient’s range of motion, pain level, and stability of the shoulder with various special tests to determine if a lesion is present. There are several treatment options for a torn labrum including surgical and nonsurgical methods. Most doctors tend to recommend surgery only if all other nonsurgical methods are not working and/or if the shoulder is not healing correctly. Nonsurgical treatments can include: physical therapy, cortisone injections, resetting the shoulder if dislocated, rest, and over the counter pain relievers/anti-inflammatories. If surgical intervention is necessary, the surgeon typically performs arthroscopic surgery using scope holes being less invasive than open surgery which requires a larger incision. After surgery physical therapy is also recommended in order to regain range of motion and strength.
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Madison Feeney, PT, DPT