According to the American Academy of Orthopaedic Surgeons, in 2006 approximately 7.5 million people went to the doctor’s office for a shoulder problem. Most problems in the shoulder involve the ligaments and tendons, rather than the bones. These issues usually develop slowly over time with wear and tear. But trauma can also injure the shoulder – such as a fall. Injuries to the labrum in the shoulder are common. Understanding the different kinds of labrum injuries and recommended treatment can help guide you on a path to getting better.
What is the labrum in the shoulder?
The labrum of the shoulder (or glenohumeral labrum) is a soft tissue structure that provides stability to the shoulder joint. Imagine the ball and socket of your shoulder like a golf ball sitting on its tee. Inherently, this setup up is unstable and the ball can easily fall off the tee. Now imagine placing a rubber washer on the tee. Then sit the ball back in place. The rubber washer provides a stable support system for the ball and prevents it from easily falling off the tee. The labrum of the shoulder functions in much the same way, proving stability for the shoulder while allowing it to rotate, slide and glide just enough to function properly.
The labrum of the shoulder can be damaged by being overstretched or pulled, by a fall on an outstretched hand, collision or by wear and tear over time.
Common symptoms of a labrum injury
Common symptoms of a shoulder labral injury include pain (especially with overhead activity, reaching or throwing), pain when trying to sleep, a catching feeling when moving the shoulder through its range of motion, instability (feeling like the shoulder is sliding out of socket) and weakness during daily tasks or recreational activity.
What does SLAP tear, bankhart tear and posterior labral tear mean?
There are different types of lesions or tears that can occur in the shoulder labrum. The smallest is referred to as fraying. Fraying of the labrum is generally a degenerative type of lesion. When viewed directly under arthroscopy, the edges of this normally smooth washer/like structure appear ragged and wavy or fibrillated, sometimes the tissue descends into the ball and socket joint.
If the labrum has more damage than just fraying, then your physical therapist or physician may classify the tear depending on its position. A SLAP tear (superior labrum anterior to posterior) is a tear that is in the region from 10 to 2 o’clock. A bankart tear is in the front of the shoulder, generally somewhere between 2 and 6 o’clock. A tear in the back side of the shoulder is referred to as a posterior labral tear. It’s not uncommon to have tears of the labrum in more than one of these regions and sometimes in all of them.
Fraying and tearing of the labrum can be painful and limit the function of your shoulder. If the tear is large enough, the shoulder may become unstable and being to sublux (partially dislocate) or fully dislocated with certain movements.
How do I know if I have a labral tear in my shoulder?
By visiting a physical therapist or physician who has training in orthopedic and sports-related injuries you can receive an evaluation that can help determine the nature of your shoulder injury. During the evaluation, the physical therapist will ask you about how the injury occurred and what type of symptoms you’re having. The answers to these questions are clues for the clinician that direct the physical exam portion of your evaluation. During the physical exam, a number of assessments are performed. Range of motion (ROM) is measured and compared to the uninvolved side. Limitations in ROM can help predict the area of the injury. Strength is also assessed for weakness and painful movements. The physical therapist will also palpate the region to rule in or out specific structures that might be involved. Finally, a series of special orthopedic tests are performed that stress various structures of the shoulder. The results of each of these tests help draw conclusions as to the nature of the injury. In addition, your physician may order more advanced imaging like an MRI (magnetic resonance imaging) to aid in the diagnosis.
Physical Therapy following a labral tear in the shoulder without surgery
Physical therapy can be very helpful following a labral tear in the shoulder. Smaller tears with no instability usually have good success with just physical therapy. Larger tears and/or instability usually require surgery followed by physical therapy.
If you are a good candidate for PT only, the treatment will initially focus on decreasing pain and improving any ROM deficits that might exist. If there are certain directions that create instability in the shoulder then your physical therapist will advise you on what activities and movements to avoid during the initial phases of your recovery.
Then, you will progress to basic strengthening exercises that target the muscles around the shoulder blade and rotator cuff. The rotator cuff is a group of four small muscles that circle the ball and socket joint of the shoulder. These muscles are commonly weak and need specific exercises to target their recovery.
Once you’ve established good basic strength of the scapulothoracic and rotator cuff muscles you will begin to integrate movements and exercises of a more functional nature – like pulling, pushing, lifting and throwing type movements.
By the time you are finished with your therapy, you should be able to return to your prior level of function and resume your normal activities.
What happens if I need surgery on my labrum?
If your orthopedic surgeon determines that your labral tear is large enough that it requires surgical repair, or if you are experiencing repeated episodes of instability or dislocation, then it is likely that you will need surgery.
What is physical therapy like after labral surgery on the shoulder?
Physical therapy will begin in the days or weeks following your surgery based on surgeon preference and the extent of the repair. Expect to be in a sling for anywhere from 2-6 weeks. The initial stage of therapy focuses on protecting the repair, controlling pain and preserving range of motion within post-surgical guidelines. Your physical therapist can help you with all of these items and will often also assign you a home exercise program to complete on the days that you do not have therapy.
Once you have passed the initial protective phase of therapy then your recovery will progress much like the non-surgical progression above. Your physical therapist will work with you to regain full range of motion and basic strength. Then you will progress to more functional exercises, like pulling, pushing, lifting and throwing. If you are an athlete or participate in sports, you will receive guidance for a gradual return to play protocol that will re-introduce sport-like activities until you can eventually return to practice or play.
Final clearance will usually be based on a number of factors like range of motion, manual muscle testing, functional testing, and potentially isokinetic dynamometry testing if this is available at your clinic. Achieving normal and symmetrical results with these assessments helps your therapist with decisions to all you to return to prior activities, practice, and competition.
If you have any questions about this type of injury, or would like to schedule a visit with a physical therapist at one of our clinics, please contact us.
Remember the information in this blog is intended for educational use and does not substitute for medical care. Any suspected injury should be evaluated by a qualified medical professional.