Labral tears of the shoulder

The shoulder labrum is a type of rubbery cartilage that lines the shoulder socket (called the glenoid) of the shoulder joint. The labrum helps keep your shoulder joint in place. When the labrum tears, you may feel shoulder pain or experience shoulder instability (the feeling that your shoulder is slipping out of place). Labral tears are usually caused by overuse or injury and commonly accompany other injuries to the shoulder.

Penn Medicine Orthopaedics and its specialists are experts in diagnosing and treating shoulder labral tears and other orthopaedic shoulder pain.

There are several areas around the glenoid where a shoulder labral tear can occur:

• Bankart tear: A Bankart tear or lesion occurs at the front/lower part of the glenoid.
• Posterior labrum tear: This tear occurs at the back of the shoulder joint.
• SLAP tear: A superior labrum anterior to posterior (SLAP) tear occurs at the top of the glenoid (shoulder socket) and extends from the front to the back, where the biceps tendon connects to the shoulder. This is a common injury for athletes such as baseball pitchers and tennis players who move with quick motions with the arm raised over the shoulder.

If you experience any of the following symptoms, see a Penn orthopaedic specialist to see if you’ve torn your shoulder labrum:

• Loss of range of motion
• Loss of strength
• Popping, catching, locking or grinding sensation in the shoulder joint
• Shoulder instability
• Shoulder pain

To evaluate for a possible shoulder labrum tear, a Penn orthopaedic specialist will examine your shoulder, conduct several physical tests to check your range of motion, take a full health history and discuss any past injuries you may have had.

You may require further imaging tests to ensure an accurate diagnosis, such as:

• X-ray
• MRI
• CT scan
• Musculoskeletal ultrasound

Musculoskeletal radiologists carefully review imaging to determine the severity of your labral tear and share their findings with the orthopaedic team. Together, they will create an individualized treatment plan that may include a combination of different therapies.

Treatments for shoulder labrum tears vary depending on the type of tear and its severity. Severe tears may require surgery. If the tear is mild, your doctor will likely begin your treatment using conservative methods. Noninvasive therapies for shoulder labrum tears include:

• Activity modification
• Anti-inflammatory medication
• Corticosteroid injection into the shoulder joint

Shoulder surgery for labral tears

If your shoulder labrum tear is severe and conservative therapies are not enough, your doctor may recommend surgery to repair the tear. Surgery can be performed using the following arthroscopic techniques:

Shoulder arthroscopy for labral tears

To repair your torn shoulder labrum, your surgeon will make a small incision in your shoulder. Using a tiny camera attached to a thin tube called an arthroscope, the surgeon will be able to view the damage to the glenoid. The surgeon will either cut out or trim frayed areas of the labrum or work to reattach the labrum to the rim of the joint socket.

Minimally invasive arthroscopic surgical techniques allow for quicker recovery times, less pain and improved outcomes.

Shoulder labrum tear surgery recovery

After surgery, your arm and shoulder will be in a sling for approximately four to six weeks. As soon as the swelling subsides and you begin to heal, you will begin working with a physical therapist on specific exercises to help you regain mobility.

Personalized rehabilitation programs for shoulder labral tears

Your recovery from shoulder labral tear surgery could take up to several months. Your orthopaedic team — pain management specialists, physical therapists and orthopaedic specialists — will work closely with you to create a recovery plan specific to your condition, the type of surgery you had, and your personal needs and recovery goals.

Long-term rehabilitation helps you regain maximum function in your arm and shoulder and greatly reduce or eliminate shoulder pain from a labral tear. Speak with your orthopaedic team to assess what your particular shoulder rehabilitation plan will look like.