Shoulder Joint Tear / Labrum Tear
Shoulder joint tear, also know as a Glenoid labrum tear refers to an injury
to the tissue rim surrounding the shoulder socket. The shoulder joint
involves three bones: the shoulder blade (scapula), the collarbone (clavicle)
and the upper arm bone (humerus). The head of the upper arm bone (humeral
head) rests in a shallow socket in the shoulder blade called the glenoid.
Because the head of the upper arm bone is usually much larger than the
socket, a soft fibrous tissue rim called the labrum surrounds the socket
to help stabilize the joint. The rim deepens the socket by up to 50 percent
so that the head of the upper arm bone fits better. In addition, it serves
as an attachment site for several ligaments. Tears can be located either
above (superior) or below (inferior) the middle of the glenoid socket.
A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is
a tear of the rim above the middle of the socket that may also involve
the biceps tendon. A tear of the rim below the middle of the glenoid socket
that also involves the inferior glenohumeral ligament is called a Bankart
lesion. Tears of the glenoid rim often occur with other shoulder injuries,
such as a dislocated shoulder (full or partial dislocation).
The labrum is a rim of cartilage that surrounds the Glenoid or shoulder
socket. A Bankart Lesion typically occurs when an individual sustains a
dislocated shoulder, either partial or full disclocation. As the shoulder pops out of joint,
it often tears the labrum, especially in younger patients.
Causes of a Shoulder Joint Tear
Injuries to the tissue rim surrounding the shoulder socket can occur from
acute trauma or repetitive shoulder motion. Falling on an outstretched
arm, a direct blow to the shoulder, and a sudden pull such as when trying
to lift a heavy object can all result in a shoulder joint tear. Throwing
athletes or weightlifters can experience tears due to repetitive shoulder motion.
Shoulder Joint Tear Symptoms
It is difficult to diagnose a tear in the shoulder socket rim because the
symptoms are very similar to those of other shoulder injuries. Symptoms
may include pain, usually with overhead activities; decreased range of
motion and a loss in strength; locking, popping or grinding; and a sense
of instability in the shoulder.
Shoulder Joint Tear Treatment Options
Until the final diagnosis is made, your physician may prescribe anti-inflammatory
medication and rest to relieve symptoms. Rehabilitation exercises to strengthen
the rotator cuff muscles may also be recommended. If these conservative
measures are insufficient, your physician may recommend arthroscopic surgery.
Surgical Options for a Shoulder Joint Tear
During the surgery, your physician will examine the rim and biceps tendon.
If the injury is confined to the rim itself without involving the tendon,
the shoulder is still stable. The surgeon will remove the torn flap and
correct any other associated problems. If the tear extends into the biceps
tendon or if the tendon is detached, the result is an unstable joint.
The surgeon will need to repair and reattach the tendon using absorbable
tacks, wires or sutures. Tears below the middle of the socket are also
associated with shoulder instability. The surgeon will reattach the ligament
and tighten the shoulder socket by folding over and “pleating”
After surgery, you will need to keep your shoulder in a sling for three
to four weeks. Your physician will also prescribe gentle, passive, pain-free
range-of-motion exercises. When the sling is removed, you will need to
do motion and flexibility exercises and gradually start to strengthen
your biceps. Athletes can usually begin doing sports-specific exercises
after six weeks, although it will be three to four months before the shoulder
is fully healed.