Labral Tears and Instability of the Shoulder
What is the Labrum?
The labrum is a type of cartilage found in the shoulder joint. The shoulder is a ball and socket joint where the arm meets the body The arm bone (humerus) forms a ball at the shoulder which meets the socket which is part of the shoulder blade. These two bones are connected by ligaments which hold the bones in relationship to each other.
There are two kinds of cartilage in the joint. The first type is the white cartilage on the ends of the bones (called articular cartilage) which allows the bones to glide and move on each other. When this type of cartilage starts to wear out (a process called arthritis), the joint becomes painful and stiff. The labrum is a second kind of cartilage is more fibrous or rigid than the cartilage on the ends of the ball and socket. This cartilage is found only around the socket where it is attached.
What is the function of the Labrum?
The labrum has two functions: 1) to deepen the socket so that the ball stays in place and 2) to attach other structures or tissues around the joint.
What is a Labrum Tear?
The first type of tear is one where the labrum is torn completely off of the bone and is usually associated with an injury to the shoulder where the shoulder has dislocated.
The second type of labrum tear is tearing within the substance of the labrum itself. The edge of the labrum over time may get frayed so that the edge is not smooth. This type of tearing is quite common especially with people that are older and rarely causes symptoms.
A third type of labrum tear is in the area where the biceps tendon attaches to the upper end of the socket. This injury typically involves the biceps tendon and the labrum and is commonly referred to as a SLAP (Superior Labrum Anterior to Posterior) tear. Typical symptoms of a SLAP tear include a catching sensation and pain in shoulder movements. Patients usually complain of pain deep within the shoulder or in the back shoulder joints.
How do you Treat a Labral Tear?
The conservative treatments for labral tears include: physical therapy to strengthen the shoulder muscles to help improve stability, avoiding overhead or other aggravating activities, and anti-inflammatory medications (NSAIDS). If conservative treatments fail to resolve the pain and improve the function of the shoulder, or subluxation/dislocation recurs, surgical intervention may be recommended. A shoulder labral repair can usually be performed arthroscopically through a series of small incisions, but occasionally a surgeon will need to make a larger incision to repair the labrum if the repair cannot be completed successfully through an arthroscope.