Understanding shoulder labral tears

Shoulder injuries are common, especially among athletes and active individuals.

One such injury that often requires attention from physiotherapists is a shoulder labral tear.

In this blog, we’ll explore the different types of labral tears, who is commonly affected, how it is diagnosed, and the available treatment options.

What is a shoulder labral tear?

A shoulder labral tear refers to damage to the labrum, a ring of cartilage that surrounds the shoulder socket (glenoid).

The labrum helps stabilise the shoulder joint, and when it is torn, it can lead to pain, instability, and decreased range of motion.

There are several types of labral tears, each with its own name and characteristics:

• Superior labrum anterior and posterior (SLAP) tear: This type of tear occurs at the top of the labrum, where the biceps tendon attaches. It is common in overhead athletes like baseball players and swimmers.
• Bankart tear: This tear happens in the lower part of the labrum and is often associated with shoulder dislocations. It is frequently seen in contact sports athletes.
• Posterior labral tear: Less common than SLAP and Bankart tears, this type occurs at the back of the shoulder and can result from repetitive stress or trauma.

Who is commonly affected?

Shoulder labral tears can affect a wide range of individuals, but certain groups are more susceptible:

• Athletes: Those involved in sports that require repetitive overhead motions, such as baseball, swimming, and tennis, are at higher risk.
• Contact sports participants: Athletes in sports like rugby, football, and wrestling are prone to labral tears due to the physical nature of these activities.
• Older adults: As we age, the labrum can become more brittle and susceptible to tears, even with minor injuries.

Instability related to labral tears

One of the significant issues associated with shoulder labral tears is instability.

The labrum plays a crucial role in maintaining the stability of the shoulder joint.

When it is torn, the shoulder can become unstable, leading to a feeling of the joint ‘slipping’ or ‘popping out’.

This instability can be particularly problematic for athletes and active individuals, as it can affect their performance and increase the risk of further injury.

How is a shoulder labral tear diagnosed?

Diagnosing a shoulder labral tear involves a combination of clinical evaluation and imaging studies:

• Clinical evaluation: Our physiotherapists will take a detailed history of your symptoms and perform a physical examination. They may use specific tests, such as the O’Brien’s test or the crank test, to assess for labral pathology.
• Imaging studies: If a labral tear is suspected, imaging studies like MRI (Magnetic Resonance Imaging) or MR arthrography (MRI with contrast dye) are often used to confirm the diagnosis. These imaging techniques provide detailed views of the soft tissues in the shoulder.

Treatment options

Treatment for shoulder labral tears can vary depending on the severity of the tear and the patient’s activity level.

Here are some common approaches:

• Conservative management: Many labral tears can be managed with non-surgical treatments. This includes physiotherapy to strengthen the shoulder muscles, improve range of motion, and reduce pain. Your physiotherapist will design a personalised rehabilitation program to address your specific needs.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation associated with labral tears.
• Surgery: In cases where conservative treatments are not effective, or if the tear is severe, surgical intervention may be necessary. Arthroscopic surgery is commonly performed to repair or remove the damaged portion of the labrum.

Early recovery from initial injury

If you experience a shoulder dislocation, it’s important to take immediate steps to manage the injury and reduce pain until you can have the injury assessed.

Here are some steps to follow:

• Do not relocate the shoulder yourself: If your shoulder remains dislocated, have somebody drive you to the emergency room, or call an ambulance. If the shoulder does relocate itself, but numbness or pain radiates down the arm, also go to the emergency room as soon as possible. If the shoulder does relocate itself without any complications, book in your physiotherapist at your earliest convenience for assessment.

In the meantime:

• Immobilise the shoulder: Use a sling or any available support to immobilise the shoulder and prevent further movement. This helps reduce pain and prevents additional damage.
• Apply ice: Apply ice packs to the injured shoulder for 15-20 minutes every 2-3 hours. This helps reduce swelling and numbs the area to alleviate pain.
• Avoid using the arm: Refrain from using the injured arm for any activities. Rest is crucial to prevent further injury.
• Pain relief: Over-the-counter pain medications, such as paracetamol or ibuprofen, can help manage pain and reduce inflammation.

Surgical management and recovery

Arthroscopic surgery for shoulder labral tears is a minimally invasive procedure where small incisions are made, and a camera (arthroscope) is used to guide the surgical instruments.

The surgeon can then repair or remove the damaged labrum.

Recovery from surgery involves several stages.

Post-surgery, you will be in a sling for a few weeks to allow for healing.

Early physiotherapy will focus on range of motion exercises, whilst strength will be added once sufficient healing time has passed.

Return to driving, work, and sports can take weeks to months, depending on the physical demand of your job or sport.

Contact sports typically require up to 6-9 months recovery before returning to play.

Conclusion

Shoulder labral tears can be a significant source of pain and dysfunction, but with the right diagnosis and treatment, most individuals can return to their normal activities.

If you suspect you have a shoulder labral tear, seeking early intervention from one of our experienced physiotherapists at Lifecare Frankston can make a big difference in your recovery.

At our clinic, we specialise in providing comprehensive care for shoulder injuries, including labral tears.

Our team of experienced physiotherapists is here to help you get back to doing what you love.

Lachlan McAlary is a physiotherapist at Lifecare Frankston, with lived experience of shoulder labral tear injuries. He has successfully rehabbed his own shoulder and continues to participate in football and cricket locally. He has a passion for helping fellow labral tear sufferers’ rehab and return to the sports they love.