Labral Tear

Written by Giovanni Bruno

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What is a Labral Tear ?

Your shoulder is a socket-shaped joint and the labrum a cartilaginous structure that forms a ring around the socket which is called the glenoid fossa. The labrum of the shoulder has 2 important functions, one is to deepen the socket of the shoulder and the second is to create a suction effect. The combination of these 2 functions provide more stability and mobility to your shoulder. A labral tear occurs as a result of overuse or direct trauma to the shoulder joint. Leading to instability within the shoulder.

What are the signs and symptoms of Labral Tear ?

The most common symptoms of a labral tear include:

  • Shoulder pain
  • Grinding or clicking sensation in the shoulder
  • A sensation of blockage in the shoulder which prevents from full range of motion being achieved.

Typically the pain is present during shoulder motion, you may also feel a lack of strength in your shoulder; depending on the type of lesion you may feel pain during certain specific movements such as the abduction, external or internal rotation.

There are different types of labral lesions which are caused by different injury mechanisms causing tears in various sites around the labrum. These include the Bankart lesion, Slap lesion and Kim lesion.

  • Bankart Lesion. The Bankart lesion occurs typically after repeated shoulder subluxations or after traumatic shoulder dislocation. In this case it is the lower portion of the labrum that is injured. It is more common in younger people. The name of the lesion derived from a British orthopaedic consultant that firstly described this lesion at the beginning of the last century. There is also a specific type of Bankart lesion called “ Bony Bankart lesion”. This lesion happens when the socket part of the shoulder, the glenoid is fractured (specifically the lower part), it is always associated with a labrum tear.
  • SLAP lesion. The SLAP lesion occurs when the superior area of the labrum is injured. The term SLAP refers to the nature of the injury and stands for Superior Labrum Anterior and Posterior. A slap lesion may involve the biceps tendon as well, this is because the head of the biceps tendon inserts into the top part of the labrum. This can lead to pain in the arm and lack of strength doing arm flexion.
  • Kim lesion: The Kim Lesion is a superficial tear between the posterior labrum and the glenoid articular cartilage. Failure to identify and treat this lesion may lead to permanent posterior instability. The lesion is named after orthopedic surgeon Seung-Ho Kim who first described this type of lesion in 2004. This type of injury is typically related to overhead activities such as playing basketball or volleyball.

What are the common causes of a Labral Tear?

There are several factors that may cause a labral tear, and some of them are linked to the mechanism of injury and therefore the specific type of lesion. All the lesions may also be associated with rotator cuff or biceps injuries.

The Bankart lesion is related to sport injuries, typically linked to collisions (football, rugby, hockey) falls (gymnastics, skiing), and overhead movements ( baseball volleyball). It can occur also as a result of a shoulder dislocation.

SLAP lesion is related to repetitive movements and sport injuries. The most affected athletes are the ones that are performing excessive overhead movements such as tennis and baseball players. Falls onto an outstretched arm or a force pulling of the arm are one of the common causes of SLAP lesion.

Kim lesion as stated above is related to traumas in doing certain types of sports such as basketball or volleyball. It is less common than Bankart and SLAP lesions, and is typically caused by repetitive posterior force on the glenohumeral joint. The inferior labral attachment is the most affected area by posterior forces. If these forces are small, only the inner portion of the labrum is affected. Larger forces can affect the cartilage of the chondrolabral junction as well.

How is a Labral Tear diagnosed ?

The diagnosis of a labral tear is not simple as the symptoms of a Labral tear are similar to many other shoulder injuries.

During your consultation your healthcare practitioner will ask about your daily and sport activities to evaluate any possible cause of labral tear. Following the consultation a thorough physical examination and orthopedic testing will be carried out. Your healthcare practitioner will assess your shoulder evaluating the stability, strength and the range of motion. Your neck may also be assessed to exclude any other cause that may cause your pain such as a pinched nerve.

The physical examination unfortunately discerning between a type of tear to one another is quite challenging for a therapist, for this reason after the physical examination your healthcare practitioner may suggest you to have a further imaging examination.

MRI is used to detect the extent and exact site of the labral tear. The imaging technique also shows the effect the tear has had on the surrounding soft tissues including tendons and muscles. For smaller tears arthroscopy may be used as this provides very clear and detailed imaging.

Lastly you may be referred for an X-ray. This is used to rule out any possible fracture in your shoulder that may occur associated with a labral tear.

What are the treatment options for a Labral Tear?

The treatment options for labral tear are always chosen according to the severity of the injury; with a complete labral tear typically the only solution remains the surgery while with a partial rupture a conservative approach can be effective.

The conservative treatment approach is based on over the counter medications which will help you to reduce your shoulder inflammation or your GP can prescribe you cortisone injection. Cortisone is a really strong pain reliever and anti inflammatory medication, it cannot be used for a long time, but it is effective in reducing pain symptoms for a while.

Together with medication your GP may suggest physical therapy such as Physiotherapy to help strengthen and stretch your muscles. After a labral tear the stability of the shoulder joint is usually compromised and an increase in your muscle strength is vital to avoid any relapses of the pain or increases in injury severity.

Alongside physical therapy, manual therapy may also be suggested. Osteopathy focuses on the mechanical and postural disturbances that may affect your shoulders resulting in a more global treatment not aimed just to your shoulder, but to your entire body. Techniques will also be used to help reduce the tension developed in the muscle and will aim to improve the range of motion in your shoulder joint.

A correction on your daily habits, avoiding awkward positions or movements for your shoulder will be crucial for your rehabilitation, your healthcare practitioner may recommend you to avoid all the movements which trigger the inflammation inside your shoulder.

Lastly, if conservatitve treatment does not work the next option could be the surgery.
Surgery for labral tears is based on arthroscopy techniques, the surgeon will cut the part of the labrum that is still attached to your shoulder that prevents proper motion. The cut inside your shoulder is really small, the recovery may take anywhere from 6 months up to 9 months, in some cases, especially in athletes, coming back to the same performance prior the injury may take up to 1 year. Surgery is usually suggested to young athletes that require full range of motion, with elderly patients using physical therapy may be more suitable.

Can a Labral Tear be prevented?

Not all causes of labral tears can be prevented. In athletes the best thing that can be done to try and prevent labral tears is increasing muscle and shoulder strength. In this instance a plan tailored for each athlete is strongly recommended that is aimed at increasing the power of the rotator cuff and biceps muscles and at increasing the mobility and stability of the shoulder joint.

In non athletes the recommendation is to avoid any repetitive overhead movements or for elderly patients avoid any behaviours or habits that may lead to a fall which may cause a shoulder dislocation or fracture and then consequently a labral tear.

How long does a Labral Tear last ?

As it was mentioned previously the recovery process after a surgical procedure can last 4-6 months up to 1 year. The healing time is strictly related to the severity of the damage, surgery outcomes and to the post surgery rehabilitation which is really fundamental for a good recovery.

With a partial tear that does not require any surgical treatment it can take you 4 to 6 weeks to heal and another 4 to 6 weeks to develop strength in your shoulder. However, you should always be aware that your injured shoulder will be more sensitive to repetitive motions and it is important to build up strength and stability in the shoulder to prevent any further injury.

What are the best exercises for a Labral Tear* ?

Wall shoulder stretching. Place yourself in a standing position in front of a wall. Lean forward with your hands above your head and place your arms and hands against the wall. Gently bend your body forward, crawl your hands upwards climbing the wall, you will feel a stretch at the top of your shoulder. Hold the stretch for 10-15 seconds and perform the exercise between 2- 5 times .

Side Lateral Raises. Place yourself in a standing position with your arms to the side of your body. This exercise can be performed with or without weights (no more than 2 kg). Raise your arm laterally up to your shoulder height, do not go above shoulder height and keep a slight bend in your elbows. Perform 2- 4 sets of 7-12 repetitions. Hold each repetition for 3 seconds and then release.

External Rotation 90 Degrees. Tie a resistance band at shoulder level to a handle or to a leg chair (must be a firm surface). Place yourself in a standing position in front of where the band is tied up. Pull the resistance band up over your shoulder, lift your elbow to 90 degrees, and rotate your arm outwards. Perform 2 – 4 sets of 7- 12 repetitions. Hold each repetition for 3 seconds and then release.

Prone Row to External Rotation. Lie face down on a bed or on a surface where you can hang your arm down loosely. This exercise can be performed with or without weights (no more than 2 kg). Bring your arm up to your side and hold for 3 seconds. Raise your arm toward the ceiling as far as comfortable for you and hold for another 3 seconds, then release to the ground. Perform 2 – 4 sets of 7 to 12 repetitions.

Towel Press. Lie on your back on a bed or a couch, hold a towel with your hands touching and with the palms facing your feet, your elbows must be at 90 degrees and attached to your sides. Push your hands up to the ceiling as if you‘re doing a chest press exercise. You should push your hand till your elbows are almost fully straight. Then release and come back at the starting position. Perform 2-4 sets of 7 to 12 repetitions.

*It is recommended to get the go-ahead from your GP or physical therapist before carrying out any of these exercises.

References

Shah, K., Tsai, J. A., & Sussmann, A. R. (2020). Kim lesion of the shoulder in a young adult: Case report. Radiology case reports, 15(12), 2500–2502.

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