Specialized Shoulder Care in Colorado Springs

Shoulder Labral Tear with Instability

Colorado Springs Orthopaedic Group

Your shoulder is one of the body's most mobile joints, allowing you to reach, lift, rotate, and perform countless everyday movements. Because of this mobility, the shoulder can also be susceptible to injuries, overuse, arthritis, and other conditions that cause pain and limit movement.

CSOG provides comprehensive evaluation and treatment for a wide range of shoulder conditions, from sports injuries and tendon problems to arthritis, instability, and fractures. Depending on your condition, treatment may include physical therapy, activity modification, medications, injections, minimally invasive procedures, or surgery.

Our shoulder specialists take the time to understand your symptoms, activity level, and goals so you can receive treatment designed to reduce pain, improve function, and help you get back to the activities that are important to you.

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What is Shoulder Labrum?

The shoulder consists of a ball-and-socket joint formed by the upper end of the humerus (upper arm bone) and a cavity in the shoulder blade called the glenoid. The glenoid cavity is surrounded by a rim of cartilage called the labrum. The labrum adds depth to the cavity making the joint more stable and positions the ball within the socket.

What is Shoulder Instability?

Shoulder instability results when the humeral head is not held firmly within the glenoid cavity and may lead to a dislocation. Tearing, stretching or peeling of the labrum can result in shoulder instability. It can also occur with defects of the shoulder capsule and ligaments.

What are the Types of Labral Tears?

Based on location, labral tears are classified as:

SLAP tear: Detachment of the upper portion of the labrum

Bankart tear: Detachment of the lower portion of the labrum

Posterior tears: Detachment of the labrum at the back of the shoulder joint

What are the Causes of Labral Tears?

Labral tears may occur due to the following causes:

• A blow to the shoulder
• Falling on an outstretched arm
• Forceful pulling of the arm
• Excessive overhead activities

SLAP tears usually occur in athletes involved with frequent overhead activities such as baseball, tennis, and volleyball. Bankart tears commonly occur with a shoulder dislocation. Labral tears are often associated with other injuries such as rotator cuff injuries or a tear in the biceps tendon which is attached to the upper part of the labrum.

What are the Symptoms of Labral Tears?

The symptoms associated with labral tears differ from the type of tear. They generally include:

• Aching pain
• Cracking, locking, catching or popping of the shoulder joint
• A difficulty with shoulder movements
• The weakness of the arm
• Pain in the front of the shoulder with a SLAP tear
• Instability or dislocation of the joint with a Bankart tear

How are Labral Tears Diagnosed?

Your doctor will review your symptoms and perform a physical examination to assess shoulder movement, strength and your level of pain. An MRI or CT scan may be ordered to diagnose a labral tear and any other injuries. They can also help determine if the shoulder joint has been properly reduced after a dislocation. X-rays can help diagnose damage to your shoulder bones.

What are the Treatment Options for Labral Tears?

Treatment involves non-surgical or surgical procedures based on the severity of the injury and existing symptoms. If the dislocation is present, your doctor will manipulate your shoulder joint to bring the humeral head back into the socket. This is called a closed reduction.

Non-surgical methods

Non-surgical methods focus on relieving pain and strengthening the muscles. They include:

• Immobilization of your arm in a sling
• Pain medications
• Steroid injections into the joint
• Physical therapy to strengthen the rotator cuff and other shoulder muscles

Surgical methods

Surgery is recommended when pain and instability are not relieved by non-surgical methods. Your doctor may recommend arthroscopy or open surgery to treat a labral tear.

Arthroscopy: Arthroscopy involves insertion of a thin device with a camera to visualize the affected joint. Your surgeon views the labral tear or other injuries on a monitor and performs the necessary surgical procedure to fix the injury.

Open surgery: This approach is recommended if you are experiencing recurrent instability and involves a larger incision. The damaged part of the labrum is removed by your surgeon who then places an anchor in the glenoid. A suture passed through the anchor helps secure the labrum and any damaged ligaments to the glenoid thus improving the stability of the joint.

What Does Postoperative Care Involve?

Following surgery, your arm is supported with a sling for about 1 month. With physical therapy, you will soon be able to return to regular activities. Complete healing may take about 9-12 months and an additional 6 months to develop strength and endurance for sports.

How Can Labral Tears Be Prevented?

Shoulder injuries causing labral tears and instability may be prevented by:

• Strengthening your muscles with regular exercise.
• Receiving proper coaching for athletics.
• Avoiding overuse of the shoulder.
• Stopping an activity when you have pain and getting yourself evaluated if pain persists beyond a few days.