Shoulder Labrum Tear

What You Need to Know

  • The shoulder labrum is a thick piece of tissue attached to the rim of the shoulder socket that helps go on the ball of the joint in place.
  • The labrum can tear a few different ways: 1) completely off the bone, 2) within or along the border of the labrum, or 3) where the bicep tendon attaches.
  • Diagnosing a labrum tear involves a concrete test and most probable an MRI, CT scan and/or arthroscopy of the shoulder.
  • Treatment varies depending on type, severity and location of the labrum tear.

What is the labrum?

The labrum is a type of cartilage establish in the shoulder articulation. The shoulder is a ball-and-socket joint where the arm meets the torso. The arm bone (humerus) forms a ball at the shoulder that meets the socket, which is part of the shoulder blade. These two bones are connected by ligaments — tough tissues forming tethers that agree the basic in relationship to each other.

There are two kinds of cartilage in the articulation. The showtime type is the white cartilage on the ends of the bones (articular cartilage) which allows the bones to glide and move on each other. When this type of cartilage starts to wearable out (a procedure chosen arthritis), the joint becomes painful and stiff. The labrum is a second kind of cartilage in the shoulder, which is distinctly different from the articular cartilage. This cartilage is more gristly or rigid than the cartilage on the ends of the ball and socket. Too, this cartilage is also found merely effectually the socket where it is attached.

What is the function of the labrum?

The labrum has two functions. The first is to deepen the socket and so that the ball stays in place. Pic the shoulder articulation as a embankment brawl on a dinner plate. The ball of the humerus (the "embankment brawl") is much larger than the apartment socket (the "dinner plate"). The ligaments are the tethers that go from os to os and concord them together to help keep the ball in the socket. The other fashion the ball is kept in the socket is the labrum.

The labrum is a thick tissue or type of cartilage that is attached to the rim of the socket and essentially forms a bumper that deepens the socket and helps keep the ball in place. In individuals where the labrum is too minor or is torn due to an injury, the ball may slide part of the way out of the socket (subluxation) or all the way out of the socket (dislocation). The labrum goes all the mode around the socket and in virtually areas is firmly attached to the bone of the socket. In some areas it is not firmly attached. Merely recently accept specialists determined which parts are normal and which parts reflect tearing of the labrum.

The 2nd function of the labrum is equally an attachment of other structures or tissues around the joint. For case, the ligaments that help hold the joint together attach to the labrum in sure key locations. If at that place is an injury to the shoulder that tears the ligaments, sometimes the labrum is pulled off of the rim of the os too.

This injury usually involves a subluxation or dislocation of the shoulder and is ordinarily due to trauma. The ball of the shoulder can dislocate toward the front of the shoulder (an inductive dislocation) or it can get out the back of the shoulder (called a posterior dislocation). In either case the labrum can be torn off of the os. Usually when this happens the labrum does non heal back in the right location. Whether the joint continues to be unstable depends upon many factors.

The other structure that attaches to the labrum is the tendon of the biceps muscle. The biceps muscle is the muscle on the front of the arm which gets firm with bending the elbow. While this muscle is quite large, it turns into a small tendon about the size of a pencil that attaches within the shoulder articulation. At the other end of the muscle is a large tendon that attaches beyond the elbow in the forearm. The portion that attaches in the shoulder actually goes through a modest hole in the rotator cuff tendons designed specifically for that tendon.

Once inside the articulation, the tendon is attached in role to the bone near the socket and in role to the labrum at the top of the joint. This tendon can get torn where it attaches to the bone, where it attaches to the labrum or at both locations.

Girl throwing a softball

SLAP Tear Prevention Tips for Baseball game and Softball Players

A SLAP tear tin be a serious injury no matter your age or professional level. The majority of SLAP tears don't happen in one day and commonly result from repetitive trauma within the shoulder.

Sports medicine specialist John Wilckens, M.D. explains the origin of SLAP tears and what players, parents and coaches can do to prevent this injury.

What is a labrum tear?

A labrum tear tin take several forms, and it is very piece of cake to confuse these types. Equally a result, it is important that yous discuss with your medico exactly what blazon of tear you have. The first type of tear is 1 where the labrum is torn completely off of the bone. This is usually associated with an injury to the shoulder in which the shoulder has subluxated or confused. Sometimes this type of tear occurs and the private does not realize that the shoulder has slid out of the socket.

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 trigger-happy is quite common and rarely causes symptoms. Information technology is seen frequently in the shoulder as people go older (over 40 years of historic period). Sometimes the labrum may take a large tear where a portion of the labrum gets into the articulation and causes clicking and catching as the ball moves around in the socket. This blazon of tear is very rare, and nearly labrum tears do not cause these symptoms.

A third type of labrum tear is in the area where the biceps tendon attaches to the upper end of the socket. The socket can exist divided into four regions: anterior (front), posterior (dorsum), superior (the upper cease near your head) or inferior (the lower end, which is toward the elbow).

The biceps tendon attaches at the superior end, where it blends in with the labrum. The labrum runs from there around the joint, both in an anterior and in a posterior direction. Due to injury in this expanse where the biceps tendon attaches, the labrum also tin can go injured. The injury in this area can exist mild or it tin can be astringent. Because the injury typically involves the biceps tendon and the labrum, because it is at the superior end of the socket and because it can affect the labrum attachments inductive and posterior to where the biceps attaches in this region, the acronym or abbreviation for this injury is a SLAP lesion. This stands for an injury that is superior labrum anterior and posterior.

There have been several grading systems or nomenclature systems of this injury. In a lesser injury, the labrum is only partially detached in this area. In a more than severe injury, the whole labrum is pulled off of the bone along with the biceps tendon. The nearly common classification divides SLAP lesions into four types.

How is a diagnosis of a labrum tear made?

Considering this cartilage is deep in the shoulder, information technology is very difficult to make the diagnosis of a torn labrum upon physical examination. There are several tests that the doc can perform that may indicate a torn labrum, but these tests are not always accurate. The other problem is that labrum tears take different forms as described above, and certain tests will observe 1 kind of tear only non some other. Some physicians feel very confident that they tin make the diagnosis of a labral tear upon physical examination, only this is controversial. In that location are not many scientific studies that prove that physical exam is reliable for making the diagnosis of a labral tear. As a outcome of this uncertainty, other studies tin can be done to confirm the diagnosis if it is suspected.

The best tests available to make the diagnosis of a labral tear are magnetic resonance imaging (MRI) scans or a test called a CT-arthrogram (the latter is a Cat scan preceded by an arthrogram where dye is injected into the shoulder). Both of these tests are relatively skilful at defining a labrum tear due to a subluxation or dislocation, just they are simply effectually fourscore percent to 85 percent authentic. For that reason, some physicians believe that tests are not always needed if the diagnosis of subluxation or dislocation can be fabricated by history and concrete exam. Neither of those tests is currently very skillful at making the diagnosis of a SLAP lesion. This area is very complex and information technology is difficult to reliably become good pictures of this expanse with MRI.

However, if the MRI definitely shows a tear then oft information technology will be present. The problem is that the MRI may miss smaller tears and cannot reliably brand the diagnosis in larger tears of the labrum.

The best way to brand the diagnosis of labrum tearing is with arthroscopy of the shoulder. Unfortunately this is an operative procedure and requires some form of anesthesia. Making the diagnosis likewise takes some feel on the part of the surgeon, since the anatomy of the inside of the shoulder tin be quite complex. The human relationship between labrum tears and symptoms has not been totally figured out, and then it is not clearly known which ones should exist repaired and which ones can exist left lone.

What is the treatment for labrum tears?

The treatment depends upon which kind of tear there is in the labrum. Tears that are due to instability of the shoulder, either subluxation or dislocations, crave that the labrum be reattached to the rim of the socket. This can be done with an incision on the forepart of the shoulder, or information technology can exist done with arthroscopic techniques through smaller incisions. At that place are advantages and disadvantages of each approach. At this institution nosotros favor an open up operation with an incision until arthroscopic techniques become more perfected.

If the labrum is frayed, usually no handling is necessary since information technology doesn't usually cause symptoms. Notwithstanding, if there is a large tear of the labrum, the torn part should either exist cut out and trimmed, or it should be repaired. Which treatment is used depends upon where the tear is located and how big it is. This type of tear requiring repair without instability of the shoulder is rare.

Tears of the labrum near the biceps tendon attachment (SLAP lesions) may be but trimmed or may need to exist reattached to the acme of the socket. The best style to do this is with arthroscopic surgery since this surface area is difficult to reach with an open operation through a large incision. Using the arthroscope and minor incisions for other instruments, the labrum can be reattached to the rim of the socket using either sutures or tacks.

How is the recovery from labrum surgery?

The recovery depends upon many factors, such as where the tear was located, how severe it was and how skillful the surgical repair was. It is believed that it takes at least iv to vi weeks for the labrum to reattach itself to the rim of the bone, and probably another four to six weeks to get potent. In one case the labrum has healed to the rim of the os, it should see stress very gradually so that it tin can gather strength. It is of import not to reinjure it while it is healing.

How much motion and strengthening of the arm is allowed subsequently surgery depends upon many factors, and it is up to the surgeon to allow you know your limitations and how fast to progress. Because of the variability in the injury and the type of repair washed, information technology is difficult to predict how before long someone can to return to sports and activities later the repair. The type of sport also is of import, since contact sports accept a greater gamble of injuring the labrum repair. Nevertheless, a vast majority of patients have full function of the shoulder after labrum repair, and most patients can return to their previous level of sports with no or few restrictions.