Labral Tears – Shoulder
Dr. Samuel Koo – Seattle, WA
The labrum is a ring of specialized cartilage resting on the outer edge of the socket of the shoulder joint. The labrum serves to deepen the shoulder socket and make it more concave. It helps keep the ball inside the socket. The labral tissue is very soft and can be caught between the glenoid and the humerus. When this happens, the labrum may start to tear. If the tear gets worse, it may become a flap of tissue that can move in and out of the joint, getting caught between the head of the humerus and the glenoid.
Causes of a Shoulder Labrum Tear
The labrum can be torn anywhere along its length. It can tear for many reasons:
- It frequently tears as a result of injury or shoulder dislocation.
- Repetitive wear and tear, such as in throwing athletes.
- Degenerative disease such as arthritis.
Symptoms of a Shoulder Labrum Tear
Since many tendons and muscles are needed in the stability of the shoulder, when the labrum tears it often leads to instability or mobility issues. Shoulder instability from a damaged labrum may cause the shoulder to feel loose, as though it slips with certain movements. However, the main symptom caused by a labral tear is a sharp pop or catching sensation in the shoulder during certain shoulder movements. This may be followed by a vague aching for several hours. You may also experience sharp pain when the shoulder is in certain positions. At other times, the tear may not cause any pain.
If you experience these symptoms, Dr. Koo may perform a physical exam and look at your medical history, which can help determine if a labral tear is a possibility. However, it’s very difficult to diagnose a labral tear, even with diagnostic imaging. The only sure way to diagnose a labral tear is through arthroscopy.
Shoulder Labrum Tear Treatment
The biceps tendon passes from the arm into the shoulder joint where it attaches to the labrum. Typical treatment for labral tears involves activity modification, anti-inflammatory medications, and physical therapy. When medical treatment fails, arthroscopic repair of the labrum can be performed. Typically, a Bankart Repair is used to treat labral and SLAP tears.
Bankart Repair Treatment for Labral Tear
This procedure involves repairing the over stretched or torn labrum and capsule deep within the shoulder joint. This is done anthroscopically (minimally invasive). Labral tears are treated by reattaching and tightening the torn labrum and ligaments of the shoulder (see slideshow below). This usually done using sutures and small bone anchors. An anthroscope is inserted through a small slit in the skin on the back of the shoulder, and small tools enter through portals on the front of the shoulder. Dr. Koo can then see the procedure on a screen. This is done anthroscopically because there is a smaller wound, a faster repair and less risk than a full open procedure.