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What are Shoulder Labral Tears?

The labrum is similar to the meniscus in the knee. It is a ring of cartilage that attaches to the socket portion of the ball and socket of the shoulder known as the glenoid. The labrum enlarges the size of the cup and is where the stabilizing ligaments of the shoulder attach as well as the biceps tendon. The anterior labrum is often injured during shoulder dislocations. The superior portion of the shoulder labrum tears acutely when an athlete falls on an outstretched arm or over a period of time with repetitive use, such as throwing a baseball. These tears are commonly known as Superior Labrum Anterior to Posterior (SLAP) tears. Labral tears to the anterioinferior labrum occur most commonly from recurrent anterior shoulder dislocations. These tears are commonly referred to as Bankart Tears. In both instances, physical exam and detailed history are key. X-rays can be normal which leads further imaging via MRI arthrogram (injected dye into the shoulder joint) to further diagnose the injury.

Causes

  • Rapid overhead flexion of the shoulder (falling on outstretched hand)
  • Repetitive activity such as throwing a baseball or spiking a volleyball, or swimming
  • Shoulder dislocations or chronic subluxations

Signs & Symptoms

Acute

  • Sharp pain with overhead activity
  • Aching pain after injury

Chronic

  • Recurrent popping
  • Aching pain in front of shoulder along the biceps tendon (SLAP Tears)

Treatment

Initial treatment of shoulder labral tears is directed towards the reduction in pain and inflammation. This can be assisted with physical therapy to maintain or achieve normal motion while directing the greatest effort towards strengthening the muscles around the shoulder blade. If this is successful in reducing pain and restoring normal function, then a gradual return to sport is warranted. If there is no improvement, or worsening of symptoms with rest and physical therapy, then surgical intervention of the shoulder may be necessary. The surgery would be to repair the torn portion of the shoulder labrum and to tighten the shoulder ligaments as necessary. If unresolved or untreated, shoulder labral tears can lead to recurrent shoulder pain with activity and reduced tolerance of exercise due to pain.

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