14-Mar-07 10:00 AM CST

Shoulder Labral Tears

SHOULDER LABRAL TEARS
   The shoulder joint is composed of a ball (humeral head) and a socket (glenoid). The glenoid has a greater radius of curvature than the humeral head, making the shoulder inherently unstable.
   A rim of fibrous tissue (labrum) surrounds the socket and acts as a bumper to help keep the shoulder joint stable. The labrum also serves as the attachment of the biceps tendon as well as several stabilizing ligaments of the shoulder. Injuries to the shoulder such as dislocations and falling on the outstretched arm can cause the labrum to tear off of the bone.

What are the symptoms?
Tears in the front of the socket are called Bankart tears and lead to recurrent instability of the shoulder. This leads to shoulder weakness and a feeling that the joint is slipping out of place.
    Tears at the top of the labrum near the biceps tendon attachment are called SLAP tears, which stands for Superior Labrum Anterior to Posterior. SLAP tears can cause pain with lifting and overhead reaching, as well as popping, catching, or clicking.
   X-rays can show bony injuries that may contribute to the shoulder pain and instability, although the labrum cannot be seen on xray. On physical exam, special tests are performed to determine the cause of the shoulder symptoms.MRI is used to visualize the soft tissues of the shoulder including the labrum and the rotator cuff.

How are they Treated?
   In some cases, physical therapy and anti-inflammatory medications may help relieve the symptoms. When a labral tear is present and conservative treatment has not improved the symptoms, surgery may be necessary. In the past, operative treatment of shoulder instability consisted of open surgery with large, painful incisions and slow recovery.
Recent advancements in shoulder arthroscopy have allowed Bankart and SLAP repairs to be performed via small, arthroscopic incisions, which speed recovery and minimize postoperative pain and stiffness. The labrum is re-attached with sutures that also repair the torn shoulder ligaments and tendons. Rehabilitation after surgery is aimed at strengthening the muscles around the shoulder to aid in the overall strength and stability of the shoulder.