Advances in medical technology are enabling us to identify and treat injuries that went unnoticed 20 years ago. The labrum tear is one such injury that was rarely diagnosed and treated prior to arthroscopic surgery. Now, with high-strength MRI scans and current arthroscopic surgery techniques, we are able to successfully diagnose and treat labrum tears in the shoulder.
Anatomy
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.
How a Labrum Tear Occurs
Injuries to the tissue rim surrounding the shoulder socket can occur from acute trauma or repetitive shoulder motion. Examples of traumatic injury include:
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* Falling on an outstretched arm
* Direct blow to the shoulder
* Sudden pull, such as when trying to lift a heavy object
* Violent overhead reach, such as when trying to stop a fall or slide
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).
Signs and symptoms
It is difficult to diagnose a tear in the shoulder socket rim because the symptoms are very similar to other shoulder injuries. Symptoms include
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* Pain, usually with overhead activities
* Catching, locking, popping or grinding
* Occasional night pain or pain with daily activities
* A sense of instability in the shoulder
* Decreased range of motion
* Loss of strength
We will always take a history of your injury. You may be able to remember a specific incident or you may note that the pain gradually increased. We will do several physical tests to check range of motion, stability and pain. In addition, we may request X-rays to see if there are any other reasons for your problems.
Because the rim of the shoulder socket is soft tissue, X-rays will not show damage to it. We will usually order a magnetic resonance image (MRI). For labrum tears we will often ask the radiologist to inject "contrast material" into the shoulder joint just prior to the MRI, which increases the accuracy of the MRI for detecting labrum tears. Ultimately, however, the diagnosis will be made with arthroscopic surgery.
Treatment
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.
During the surgery, I will examine the rim and the biceps tendon. If the injury is confined to the rim itself, without involving the tendon, the shoulder is still stable. I 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. I will need to repair and reattach the tendon using absorbable tacks, or sutures.
Tears below the middle of the socket are also associated with shoulder instability. We will reattach the ligament and tighten the shoulder socket by folding over and "pleating" the tissues.
Rehabilitation
After surgery, you will need to keep your shoulder in a brace for two to three weeks. We will also prescribe gentle, passive, pain-free range-of-motion exercises. When the brace is removed, you will need to do motion and flexibility exercises and gradually start to strengthen your biceps, under the direction of a physical therapist. 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.
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