Shoulder Labral Tears
Hi Everyone, for today’s blog, we are going to take a look at glenohumeral joint labral tears.
The Glenohumeral joint, more commonly known as the shoulder joint, is one of the most mobile joints in the body, making it susceptible to injury. Please check out our previous blogs on shoulder conditions such as acromioclavicular joint dysfunction, shoulder dislocation, Rotator Cuff tears and sub-acromial Impingement, for a more detailed look at the shoulder and its anatomy.
For the purpose of todays topic, let’s take a closer look at the shoulder labrum.
The glenohumeral joint is comprised of the glenoid fossa and the head of the humerus, creating a ball and socket joint.
However, the glenoid fossa is very shallow to allow for the high degree of movement achieved at the shoulder. Without the surrounding attachments of the ligaments, tendons and muscles the head of the humerus, which is significantly larger than the glenoid fossa, would simply fall off.
That is where the labrum plays its part. The labrum is the cup- shaped rim of cartilage that lines and reinforces the joint. It deepens the fossa, increasing the surface area of the joint and creates a suction seal onto the head of the humerus.
The labrum is then the attachment site for the ligaments and contributes its part in shoulder stability.
When we have an injury to the labrum this suction effect is disrupted, and the shoulder becomes inherently unstable. This instability can create pain in the shoulder, predispose the joint to subluxation and dislocation and cause pinching of the surrounding soft tissue resulting in other shoulder pathology as outline in the conditions above.
Injuries to the labrum can occur in several ways:
1. Overuse: Using the shoulder to make the same movement over and over can tear the labrum. You might repeat an overhead motion at work or during physical activity. Think of a weightlifter who jerks a barbell overhead repetitively, a volley ball player who constantly has high-energy overhead motion or a baseball pitcher who repeatedly takes the shoulder through its entire range of motion at a high velocity.
2. FOOSH Injury: FOOSH (fall onto outstretched hand) injuries that cause impact on an extended arm can cause a labrum SLAP tear. You can also tear your labrum in a motor vehicle accident, by dislocating your shoulder, or while doing something that forcefully distracts (pulls) on your arm.
3. Wear and tear: The shoulder is a highly mobile joint and day in and day out, your labrum does a lot of work to stabilise the shoulder. As we age past 40, the labrum becomes more fragile and predisposes it to injury.
The two most common types of labral injuries are a SLAP (Superior (Top) Labrum from Anterior (front) to Posterior (back)) tears and Bankart tears (Tear through the anterior (front) inferior (bottom) portion of the labrum).
There are 4 different Types of SLAP Tears
Type I SLAP is the fraying of the superior labrum with a firm attachment of the labrum to the glenoid. These lesions are typically degenerative in nature. At this time, it is currently believed that the majority of the active population may have a Type I SLAP lesion.
Type II SLAP lesions are characterized by a detachment of the superior labrum and the origin of the tendon of the long head of the biceps from the glenoid resulting in instability of the biceps-labral anchor. These is the most common type of SLAP tear.
Type III SLAP lesions are characterized by a bucket-handle tear of the labrum with an intact biceps insertion. The labrum tears and flips into the joint similar to a meniscus. The important point here is that the biceps anchor is attached, unlike a Type II. ⠀
Type IV SLAP lesions have a bucket-handle tear of the labrum that extends into the biceps tendon. In this lesion, instability of the biceps-labrum anchor is also present, similar to that seen in the type II SLAP lesion. This is basically a combination of a Type II and III lesion.
Bankart tears, on the other hand, typically occur with shoulder dislocation in younger patients.
In this injury the head of the humerus either shifts toward the front of the body, leading to “anterior instability,” or the back of the body, called “posterior instability.”
Symptoms of a labral tear can include the following:
· A catching, locking, or grinding feeling in the shoulder.
· An unstable feeling in the shoulder (more seen with Bankart’s lesion)
· Loss of strength
· Low range of motion
· Pain in overhead motion
· Pain is felt at the top/front of shoulder (more indicative of a SLAP lesion)
· Recurrent subluxation or dislocation of the shoulder.
Treatment for labral tears involves a correct diagnosis from either a physio or chiropractor. This is achieved by taking an accurate history of the injury, followed by performing a series of specific orthopaedic tests. Depending on the outcome of the tests and the history, there may be the additional need for imaging such as an MRI or contrast CT to either rule in or out the diagnosis.
Depending on the grade and type of tear as well as future use for the shoulder, surgery is generally the last option for treatment. Treatment will consist of soft tissue release to tight muscles that are inhibiting the activation of the rotator cuffs of the shoulder that are essential for shoulder stabilization. Once the muscles have been given the opportunity to activate correctly, strengthening exercises are prescribed with a gradual increase in difficulty.
It is quite hard to predict a labral tear, however there a few things you can do to help minimise the risk of it occurring.
1. Because labral tears are more common in individuals with poor shoulder stability due to poor posture, a strengthening program designed to target both the muscles that keep the upper back in a more neutral position, and increase the strength through the rotator cuff can be beneficial. Exercises such as resisted rowing and external rotation are good examples of these. You should perform 3 sets of 10 on a daily basis to get the best results.
2. Just as much as the muscles need to be strengthened, they also need a good amount of flexibility to help with repetitive overuse, common shoulder stretches that can help are outlined below. You should hold each stretch for 15 seconds and repeat x 2 on each arm.
3. If you are active in the gym, or work in a job where you are constantly loading overhead, make sure you are always lifting with the correct technique and good form.
So that’s a brief overview of how glenohumeral labrum tears can occur and how to avoid it. If you have questions or comments, feel free to e-mail us at firstname.lastname@example.org and we will happily answer them for you.
If you are suffering with shoulder pain and want relief today, call us on (08) 9486 8653 and we will arrange an appointment for you.