Causes of Labral Tears
Tears to the front (anterior) and back part (posterior) of the oval shaped ring may occur following dislocation and partial dislocation and may lead up to further instability and further damage to the labrum and shoulder joint.
Tears to the top of the ring can (SLAP lesions) occur in people who lift weights and in throwing sports when the biceps tendon pulls forcefully against the top of the labrum.
Labral tears can also be caused by a direct injury to the shoulder, such as falling with an outstretched hand. Wear and tear from overuse can also cause a labral tear.
Diagnosing Labral Tears
A doctor may suspect a labral tear after performing movement tests of the shoulder and discussing medical history. Previous shoulder injuries and the way the pain presents itself can point to this injury, as well as catching sensation as the arm is raised overhead. MRI usually with a dye (MR-arthrogram) will help to confirm the diagnosis.
An arthroscopy (keyhole surgery) may be arranged for a confirmed diagnosis. A small incision is made and a camera inserted into the joint through a very narrow tube and the images shown on a TV screen. This will show up if the labrum is torn.
Frequently Asked Questions on Shoulder Labral Tears
HOW ARE LABRAL TEARS TREATED?
Treatment depends on many factors including the location of the tear, patients age and sporting activity. The risk of further dislocations as a result of anterior labrum tear, is high in a young person but decreases as we get older. Therefore, it is fair to consider surgery in a young sporty individual.
Anterior tears in older age, may be treated first with physiotherapy before considering surgery (although MRI scan may be recommended to exclude damage to other structure including rotator cuff tendons). Non-surgical treatment may also be first stage for treating SLAP lesions (tears to the top part of the oval ring). This involves resting and anti-inflammatory medication. If further pain-control is required, then cortisone injections may be the next stage of treatment.
Physical therapies such as hot and cold treatments as well as hands-on therapies can be effective. Gentle exercises to improve the range of motion will be part of a rehabilitation treatment plan that may take between four to six weeks. This will include strengthening exercises and a gradual return to activity.
WHAT DOES SURGERY INVOLVE?
Tears to the front of labrum (anterior labrum tears) can be treated with keyhole surgery which involves repairing the oval shaped ring back to the socket.
With SLAP lesions, if the tear is small, then a labral debridement might be arranged and performed again with keyhole surgery. This involves loose parts of the labrum including frayed edges being removed. However, in larger tears, the damage can be repaired by anchoring the labrum to the bone with sutures.
This enables the labrum to repair in the correct position. In some patients, biceps tenodesis is sometimes performed as this is more successful at treating the cause of the problem, i.e., the biceps tendon pulling on the labrum. The biceps tendon is detached from the socket and is fixed further down the bone and the torn labrum is debrided.
WHAT IS THE DOWNTIME LIKE AFTER LABRAL TEAR SURGERY?
Depending on the type of surgery, there is a period of between four to eight weeks of physical therapy sessions. A full recovery may take up to four to six months.
If you have further questions about possible treatment options for labral tears, please arrange a consultation with the London Shoulder Specialists.
