Shoulder labrum tears and instability
Treatment ranges from rest and medication to surgery.
April 28, 2020
The shoulder is a joint where the arm bone meets the shoulder blade and collarbone. It has a shallow socket where the head of the upper arm bone sits. The labrum is a ring of rubbery tissue attached to the rim of the socket.
The labrum helps keeps the arm bone in place. Also, other ligaments that help keep the shoulder together are attached to the labrum. If the labrum is ever torn or injured, the damage can cause pain, instability and shoulder dislocation.
Common types of tears
A shoulder labrum tear can take several forms, including the two described here:
- A traumatic shoulder dislocation often tears the labrum off bone. If the tear doesn’t heal on its own, it can lead to recurring shoulder instability. In younger, more active patients, the chances of an untreated shoulder dislocation happening again are as high as 90%.
- A SLAP tear happens where the labrum and long biceps tendon meet. This area can tear from trauma or overuse. This is especially true for athletes who do a lot of overhead movements, such as baseball pitchers and volleyball players.
Pain deep within the shoulder is a common sign of a SLAP tear. The pain can also radiate down toward the biceps, or toward the back as the tear extends in that direction.
A physical exam of the shoulder can reveal pain, loss of motion and concern about possible dislocation. Doctors often use imaging studies, including a complete X-ray series, to rule out breaks of the socket and head of the upper arm.
Magnetic resonance imaging (MRI) is also important, especially if surgery is needed. It can provide detailed images of the labrum, bone surfaces and the rotator cuff. A dye may be injected into the joint before the MRI to highlight details.
Treatment usually starts with simplest approach. Rest and medications like Advil® and Aleve® are used to take care of immediate pain. Physical therapy can improve any movement problems. It can also help with long-term pain relief and return to activities.
If these treatments don’t work, or if the chances of ongoing instability are high (for example, in younger, more active patients), surgery may be needed. If so, minimally invasive techniques, in which the doctor operates through a small incision, will be used.
This approach allows the surgeon to repair multiple types of labrum tears without fully opening up the joint. It also means less pain and faster recovery. During the procedure, the labrum will be reattached to the bone, helping heal and restore its important function.
Recovery time depends on a number of factors, including where the tear was located and how severe it was. But, in general:
- Many people can do basic daily activities (light office work and using a keyboard) within days.
- General movement is typically restored in four to six weeks.
- Basic strength and endurance are often restored in two to three months.
- Highly competitive athletes may need up to 12 months of physical therapy to reach peak performance.
- Overhead athletes, such as baseball pitchers, will need the most time.
If you have questions about shoulder injuries, including labrum tears, Dr. Jim Hsu at The Polyclinic orthopedic department provides expert diagnosis and care. The number is 1-206-860-5578.
By Jim C. Hsu, MD
The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs.