The labrum is a special ring of cartilage that lines the outside rim of the shoulder joint.
It helps to deepen the socket of the shoulder joint and acts to suck the head of the humerus (ball) into the socket.
Therefore it helps to keep the shoulder stable, as it is a joint that otherwise naturally doesn’t have much bone surrounding it to hold it all together.
People with shoulder labral tears and suboptimal muscle control of their shoulder will have less control of their ball within the socket during movement, and therefore are more likely to dislocate their shoulder.
People with previous shoulder dislocations are likely to have labral tears.
Labral tears can be either degenerative (occurring over time) or traumatic
People will usually report a general sense of instability in the shoulder. They will also report pain with particular shoulder movements, especially with overhead activities.
They may also report catching or clicking within the shoulder, although a shoulder which has catching and clicking alone does not mean that there is a labral tear. It may also be accompanied with a decreased range of motion and reduction in strength compared to the other shoulder.
How are Shoulder labral tears diagnosed?
Diagnosis can be confirmed through thorough subjective questioning and testing. The best scan to rule in or out a labral tear is an MRI, though this is not always required. Schwartzberg et al (2016) showed that in a group of 53 people, aged 40-65, that 72% had labral tears, though no pain!
This reiterates that you need to treat the person, not just the imaging results. If the shoulder has dislocated, MRI may show an injury to the front portion of the labrum called a Bankart lesion.
The diagnosis of a labral tear does not necessarily mean that it needs to be surgically repaired. The decision to get further surgical opinion will depend on several factors including the severity of the tear and symptoms, mechanism of injury and patient goals.
What are the treatment options for a Shoulder labral tear?
Physiotherapy managementfocuses on restoring optimal movement of the ball and socket of the shoulder joint. This allows the ball of the shoulder to move appropriately within the socket and reduces stress on the labrum during movement, particularly in outstretched and overhead positions where the shoulder is most stressed such as shoulder pressing at the gym, raising the arm to mark a football, hitting a tennis ball, fending-off opponents during rugby, throwing a ball and swimming.
The muscular control of the scapula (shoulder blade) and rotator cuff are the main focus during physiotherapy management, with consideration to both the cervical spine (neck) and thoracic spine (mid back) as they also contribute to the quality of shoulder movement. Hands-on treatment may also be beneficial in helping to settle the pain for some.
Taping can help guide the shoulder blade to move in a more optimal pattern if extra assistance is needed short-term.
Exercise rehabilitation usually starts below shoulder level before progressing towards outstretched and overhead positions where there is naturally more stress on the shoulder labrum.
Although a small percentage of people may require surgery, it is possible to avoid it and return to full sports and athletic activities in the majority of cases where people complete their physiotherapy management.
There are numerous ways to assist you with your recovery from a shoulder labral tear.
Relative rest / Load management for shoulder labral tears
There may be shoulder pain with certain activities in life, yet there are some things that you just need to get on with despite your shoulder labral tear.
Here’s a traffic light system to help you decide what activities are okay to do and which you’re better off avoiding:
Ice or heat
For shoulder labral tear pain, both ice and heat are possible options. Some people find one choice more effective than the other. If using ice, use a towel to protect the skin and apply for 15-20 minutes at a time while sitting comfortably. If using heat, frequent warm showers or heat packs can be used. Take care not to burn the skin when using heat packs.
Injection therapies (such as corticosteroids) for shoulder labral tear
These are recommended only in some cases. They are not a first line of treatment or at all necessary, however they can be useful to help people progress through physiotherapy management where pain prevents successful completion of the exercises.
Sports doctors and shoulder surgeons may also suggest these as an earlier strategy to help reduce shoulder labral tear pain before considering surgery as a treatment option. Injection therapies such as corticosteroids do not fix shoulder labral tears on their own and do not replace physiotherapy management, rather they can be considered an option to assist.
In the minority of cases, surgery is needed to repair the labrum to help get rid of or reduce shoulder labral tear pain. Shoulder surgeons will need to be confident that the person has undergone high quality physiotherapy management before recommending surgery.
Numerous types of procedures can be performed with different time frames of recovery, the type of procedure depends on the extent and location of the tear within the labrum. It is important to note that surgery itself will not help someone return to good shoulder movement, strength, power and athletic activities without comprehensive physiotherapy management.
Technique considerations to manage a shoulder labral tear
For athletic activities such as weight lifting, swimming, tennis and cricket, modifying technique may be necessary to help reduce stress on the labrum to help limit the chance of future re-injury.