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Shoulder Labral Tears
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What are Shoulder Labral Tears?
The shoulder joint, a ball-and-socket structure, is stabilised by a ring of fibrous tissue called the labrum. A shoulder labral tear refers to a tear in this labrum. The labrum’s primary role is to deepen the socket, providing a snug fit for the head of the humerus (the upper arm bone), and thus, enhancing the stability of the shoulder joint.
Labral tears can occur from a variety of causes, ranging from acute injuries to degenerative changes. These tears are not always symptomatic but can lead to pain, discomfort, and a decrease in shoulder function when they do cause symptoms.
Types of Labral Tears
The labrum can tear in several ways, and the type of tear can influence both symptoms and treatment options. The most common types of labral tears are:
SLAP Tears
Superior Labrum Anterior and Posterior (SLAP) tears occur at the top of the shoulder socket where the biceps tendon attaches to the labrum. These tears can be caused by acute trauma or repetitive shoulder motion.
Bankart Lesions
These are specific to the lower part of the labrum and are often associated with shoulder dislocations. Bankart lesions can lead to recurrent instability in the shoulder joint.
Posterior Labrum Tears
Less common than SLAP or Bankart lesions, posterior labrum tears occur at the back of the shoulder socket. They can result from a direct injury or repetitive overhead activities.
Causes
Shoulder labral tears can occur due to various reasons, ranging from acute injuries to gradual wear and tear. Some common causes include:
- Traumatic Injury: Sudden, forceful movements such as a fall onto an outstretched arm, a direct blow to the shoulder, or a rapid overhead motion can cause labral tears. This is often seen in athletes participating in sports like baseball, tennis, or weightlifting.
- Repetitive Stress: Repetitive overhead activities, common in certain sports and occupations, can lead to gradual wear and tear of the labrum.
- Shoulder Dislocations: Dislocating the shoulder can lead to a specific type of labral tear known as a Bankart lesion.
- Age-related Degeneration: As people age, the labrum can become more brittle and susceptible to tears.
- Pre-existing Shoulder Conditions: Conditions like shoulder instability can predispose an individual to labral tears.
Symptoms
The symptoms of a shoulder labral tear can vary depending on the type and severity of the tear, but common signs include:
- Pain
Often the most noticeable symptom, especially during overhead activities or when moving the arm in certain directions. - A Catching or Locking Sensation
Some individuals may feel as if their shoulder catches or locks during movement. - Decreased Range of Motion
There may be a reduction in the ability to move the shoulder through its full range of motion. - Instability
A feeling that the shoulder might ‘give out’ or is less secure and stable, particularly with movements involving lifting or rotating the arm. - Weakness
The shoulder may feel weaker, making it difficult to perform usual activities, especially those requiring arm elevation or rotation. - Decreased Athletic Performance
Athletes might notice a decline in their sports performance, particularly in sports that require precise shoulder movements.
Diagnosis
Diagnosing a shoulder labral tear typically involves a combination of clinical assessment and imaging studies. The process includes:
Medical History and Physical Examination
The orthopaedic surgeon will gather information about any history of injury, symptoms, and physical activities that could have contributed to the condition. A physical examination helps assess pain, range of motion, and stability of the shoulder.
Imaging Tests
- X-rays: While X-rays cannot show soft tissues like the labrum, they can help rule out other causes of shoulder pain, such as fractures.
- Magnetic Resonance Imaging (MRI): An MRI can provide detailed images of soft tissues, including the labrum. Sometimes, an MRI arthrogram is performed, where a contrast dye is injected into the shoulder joint to provide clearer pictures of the labrum and surrounding tissues.
Arthroscopy
In some cases, a diagnostic arthroscopy, a minimally invasive surgical procedure, may be performed. This allows the orthopaedic surgeon to see inside the joint and assess the labrum directly.
Non-Surgical Treatment Options
Not all shoulder labral tears require surgery. Non-surgical treatment options focus on relieving symptoms and improving shoulder function. These options may include:
Rest and Activity Modification
Avoiding activities that exacerbate the symptoms is often the first step in treatment.
Physical Therapy
A tailored physical therapy program can help strengthen the muscles around the shoulder, improve flexibility, and stabilise the joint. This often includes exercises that focus on the rotator cuff and scapular stabilisers.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Medications such as ibuprofen can help reduce pain and inflammation.
Corticosteroid Injections
Injections into the shoulder joint can provide temporary relief from pain and inflammation. However, their use is generally limited due to potential side effects with repeated use.
Pain Management Techniques
Other pain management techniques, such as heat or cold therapy and relaxation exercises, can also be beneficial.
Surgical Treatment Options
When non-surgical treatments are not effective or the tear is severe, particularly in younger or more active individuals, surgery may be recommended. Surgical options include:
- Arthroscopic Repair
This is a minimally invasive procedure where small incisions are made around the shoulder, and special instruments, including a camera, are used to repair the labral tear. Arthroscopic surgery often allows for a quicker recovery and less postoperative pain compared to open surgery. - Biceps Tenodesis
Sometimes, especially in older patients or those with more extensive damage, the orthopaedic surgeon may recommend a biceps tenodesis, where the tendon attachment is moved to relieve symptoms. - SLAP Repair
This surgery is designed to address SLAP tears and involves reattaching the torn part of the labrum to the bone of the shoulder socket, often using sutures or anchors. - Bankart Repair
Specifically for Bankart lesions, this procedure reattaches the torn labrum to the bone of the shoulder socket.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Prevention Strategies
While not all shoulder labral tears can be prevented, certain strategies can reduce the risk of injury:
- Regular Exercise and Shoulder Strengthening: Engaging in exercises that strengthen the muscles around the shoulder joint, particularly the rotator cuff and scapular stabilisers, can improve joint stability.
- Proper Technique in Sports and Activities: Athletes, especially those in sports involving overhead activities, should ensure they use proper techniques to avoid putting unnecessary stress on the shoulder.
- Avoid Repetitive Stress: Be mindful of activities that involve repetitive shoulder movements and take breaks or modify these activities to reduce strain on the shoulder.
- Warm-Up Properly: Before engaging in physical activity, a proper warm-up that includes stretching and a gradual increase in intensity can help prepare the shoulder for more strenuous movements.
- Ergonomic Workstations: For individuals who work at desks or perform tasks that can strain the shoulder, ergonomically designed workstations can help minimise stress on the shoulder.
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Frequently Asked Questions (FAQs)
Can a labral tear heal on its own?
A shoulder labral tear will not typically heal on its own due to limited blood supply to the labrum. However, symptoms can often be managed effectively with non-surgical treatments, improving function and reducing discomfort.
How long does it take to recover from a labral tear?
Recovery time varies depending on the severity of the tear and the chosen treatment method. Non-surgical treatments may offer symptom relief within a few weeks to months. Post-surgical recovery can take several months, with a gradual return to full activities.
Can I still play sports with a labral tear?
This depends on the severity of the tear and the type of sports. Many athletes can return to their sports with proper treatment and rehabilitation, but this should be done under the guidance of your orthopaedic surgeon.
Is surgery always necessary for a labral tear?
No, surgery is not always required. Non-surgical treatments, such as physical therapy and rest, can be effective, especially for less severe tears or in individuals with lower activity demands.