The shoulder is one of the most mobile joints in the body. This mobility however does come at a cost of being less stable. For this reason, shoulder injuries are common. The shoulder is a ball (head of humerus) and socket (glenoid fossa) joint, with the ‘socket’ being surrounded by a cartilaginous ring called the labrum. This labrum serves to increase the depth and width of the ‘socket’ in an attempt to create stability around the shoulder joint. The biceps muscle also attaches to the labrum via a long tendon. As a result, tears of the labrum often also involve the biceps tendon.
There are many causes of labral tears, however most commonly they occur following a fall on to an outstretched arm or repetitive activities like throwing, such as baseball pitching., or swimming. This repeated stress on the labrum can cause it to tear and become painful. Tears can also occur due to direct hits to the shoulder, sudden pulling on the arm or a hit while reaching overhead.
Shoulder pain is the most common symptom. This pain is usually generalised around the shoulder rather than any pin-point pain. The pain is usually worsened by overhead activities or taking your hand behind your back such as reaching to your back pocket. Other symptoms may include catching, locking, popping or grinding. You may also feel some instability around the shoulder, limited movement and reduced strength. Pain is usually present with daily activities and may also be present at night.
Quite often labral tears co-exist with other pathologies around the shoulder such as rotator cuff injuries or long head of bicep tears. When this is the case, symptoms and location of pain can vary. Sometimes the shoulder also becomes unstable, leading to subluxations or dislocations.
A physiotherapist can often provide a preliminary diagnosis of a labral tear by assessing your shoulder via a variety of tests. An MRI can confirm the diagnosis, as well as any other pathology that may also be present. The severity and location of the tear can also be determined by MRI, which will help with a treatment plan. There are 3 main types of labral tears; SLAP tear, Bankart lesion, posterior labrum tear.
The size and location of the tear, as well as any co-existing pathologies, will assist in determining a treatment plan. Smaller tears that are less symptomatic can usually be treated conservatively with physiotherapy involving restoring shoulder movement, and a stabilisation and strengthening program. Larger tears may require surgical repair initially, followed by a period of rehabilitation with your physiotherapist. Your physio can also discuss activities to avoid and provide you with exercises to complete at home.
Please remember this advice is general. If you are suffering from a shoulder injury, speak to one of our physiotherapists today about your specific injury and situation.