- common shoulder problems
- labrum tear
Written by:cloe wilsonBSc (Hons) Physiotherapy
Reviewed by:SPE Medical Review Board
A labral tear in the shoulder is a common cause of shoulder pain and instability.
The shoulder labrum is a special ring of cartilage that deepens the shoulder joint and helps improve the way the shoulder bones fit together.
Also known as the glenoid labrum, it is supported by various ligaments and tendons to increase the stability and function of the shoulder.
Damage to the shoulder labrum causes pain and instability, which can lead to a partial or complete dislocation of the shoulder or make the shoulder more prone to other injuries such as impingement syndrome.
Here we look at the common causes, symptoms and treatment options for different types of shoulder labrum tears and how to achieve optimal recovery from a torn labrum.
What is shoulder lip?
To understand the meaninglabrum glenoideoand the potential impact of a labral shoulder injury, we need to know something about it firstshoulder anatomy.
The shoulder is a ball-and-socket joint, known asglenohumeral joint, composed of:
- humeral head:a round head on top of the humerus
- Fossa glenoidal:a shallow depression on the side of the scapula
The shoulder "socket" is very shallow, and the "ball" is very large in relation to it, with an area about 4 times larger. Imagine a soccer ball lying on a golf tee! All this means is that there is very little bone overlap, known as congruence, in the joint.
The advantage of this is that it allows for a lot of movement. In fact, the shoulder is the most mobile joint in the entire body. It can move in a wide range in multiple directions. But the problem is that it also makes the joint very unstable. And that's where the glenoid labrum comes into play.
The glenoid labrum is a special ring of cartilage that surrounds the edge of the shoulder socket. It is thicker, stronger and more fibrous than normal cartilage, providing a flexible but firm grip on the head of the humerus. The glenoid labrum increases the surface area of the joint and deepens the cup by about 50%, helping the ball and cup fit together better, greatly improving joint congruence and stability without losing flexibility.
number ofshoulder ligamentsgrotator cuff tendonsIt attaches to various points on the glenoid labrum, helping to strengthen it and providing even more stability.
Causes of shoulder labral tears
Damage to the glenoid labrum is known as a labral tear of the shoulder. A labral tear can occur from a single injury or repeated wear and tear of the glenoid labrum.
Common causes of shoulder lacerations include:
- Direct attack:on the shoulder, p. Sports equipment
- Cair:especially when landing with an outstretched arm
- Sudden pressure:on the hand, p. lift something heavy
- sudden stop:to achieve something quickly, p. so you don't fall
- repetitive friction:in the labrum, usually from too much overhead work
- air sports:such as racket sports, throwing sports and weightlifting
- Degeneration:wear and tear of cartilage due to aging
Symptoms of a torn lip on the shoulder
Common symptoms of a torn shoulder labrum include:
- Shoulder pain:aching pain around shoulder that worsens with overhead activities
- Instability:the shoulder may be wobbly or as if you do not trust him. In severe cases, the shoulder can be partially or completely dislocated.
- Acute pain:when moving the arm if the labrum is compressed
- Unusual feelings:Grinding or pricking sensation when moving the arm
- Strange sounds:Audible click or pop with shoulder movements
- Weakness:the shoulder may not feel as strong as usual
- Rigidity:Shoulder movements may be limited.
Symptoms of a torn shoulder labrum will depend on which part of the labrum is damaged, the severity of the tear, and whether other structures are damaged at the same time.
Types of shoulder labral tears
There are three main types of labral shoulder tears, depending on where the damage is:
- Impact tears:a tear in the upper part of the glenoid labrum that goes from front to back (anterior superior labrum to posterior). SLAP injuries are usually associated with biceps tendon injuries.
- Bankart's lesion:tear at the base of the glenoid labrum. Bankart lesions are usually associated with shoulder dislocations.
- Rear lip laceration:a tear in the posterior part of the glenoid labrum, also known as a reverse Bankart lesion. This is the rarest type of shoulder labrum tear.
Shoulder tears may occur:
- In or along the edge of the glenoid labrum:the most common type of rupture of the glenoid labrum, especially after the age of 40. It cannot cause any visible symptoms
- Where the biceps tendon attaches:on top of the glenoid labrum
- Where it joins the bones:the labrum may separate completely and a small piece of bone may come out with it. More common when the shoulder is subluxed or dislocated
Each type of labrum shoulder tear will present slightly differently depending on the extent of the damage; get more information abouta tear slapgbanker's injuryarticles.
Diagnosis of glenoid labral lesions
If your doctor suspects that you have a labrum tear, he or she will perform a physical exam and may perform several tests, such as an active compression test, a speed test, or an O'Brien test.
They may also refer you for an MRI arthrogram or CT scan. These tests are not always accurate, and in some cases, the best way to diagnose a torn shoulder labrum is through arthroscopy, a minimally invasive surgery in which a camera is inserted into the joint.
Treatment of labral glenoid rupture
Treatment for a shoulder labral tear will depend on the type of injury, the severity of the injury, and whether other structures around the shoulder are also damaged.
Treatment for a shoulder labral tear usually includes:
- Drug:analgesics and anti-inflammatory drugs
- Rest:avoid aggravating activities
- Rotator Cuff Exercises:It is very important to strengthen the rotator cuff muscles after a shoulder labral tear to help you regain shoulder stability and mobility.
- Scapular stabilization exercises:The scapular muscles play an important role in shoulder stability, so exercises that target the muscles around the scapula are very important for a torn shoulder labrum.
If there is only a small glenoid labral tear or minor wear and tear, it can usually be treated non-surgically. However, if there is a large tear in the glenoid labrum, if it separates from the bone, or surrounding structures such as the biceps tendon or shoulder ligaments are also damaged, surgery may be necessary.
Do I need surgery?
Many cases of labrum tears heal naturally, but in some cases, surgery will be required to reattach the torn labrum, ligaments, and tendons to the bone. Surgery for a torn shoulder labrum is more common in younger people who want to return to sports.
Surgery for labrum labrum rupture can be recommended for:
- Ongoing symptoms:if shoulder pain and instability persist after 3 to 6 months of rehabilitation
- Recurrent dislocation:if the shoulder continues to partially or completely dislocate, surgery is recommended
- High level athletes:who compete in aerial sports may need surgery
The operation is performed arthroscopically: a minimally invasive operation in which the surgeon removes the damaged parts of the lip and, if necessary, attaches them to the bone. You may need to wear a sling at first and you will go through a progressive rehabilitation program with a physical therapist working inrotator cuffgshoulder stabilization exercises. Lip shoulder surgery has an excellent success rate and full recovery usually takes 3 to 6 months.
You can find much more about what happens during surgery and the recovery process in the following articles:
- Impact tears:Causes, treatment, surgery and recovery
- Bankart's lesion:Causes, treatment, surgery and recovery
Shoulder labral injury summary
A shoulder tear is where there is damage to a special ring of cartilage that sits around the edge of the shoulder socket.
A glenoid labral tear can cause permanent problems with shoulder pain and instability.
The tear is the apex if the glenoid labrum is known as aa tear slap.
A tear at the base of the glenoid labrum is known asbanker's injury.
Many cases can be treated at home with a combination of rest, medication, and a rehabilitation program.
If glenoid labral tear symptoms persist, surgery may be required.
rotator cuff exercisesgscapular stability exercisesthey are a vital part of rehabilitation after a shoulder labral tear, whether you need surgery or not.
Last page update: 24.05.2022
Date of the next review: 24.05.2024
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Medical and scientific references
- British Medical Journal.Outcomes in patients with glenoid labrum injuries: a cohort study.M. Zughaib, C. Robbins, B. Miller, J. Gagnier
- John Hopkins Medicine:Lip laceration on the shoulder
- National Library of Medicine:Superior labral tears of the shoulder: pathogenesis, evaluation and treatment.J. Keener i R. Brophy
- World Journal of Orthopedics:Anteroposterior lesions of the upper lip shoulder: current diagnostic and therapeutic standards.D. Popp and V. Schöffl