The labrum is a rubbery tissue made of fibrocartilage that lines the glenoid fossa of the scapula (the socket) in which the head of your humerus (upper arm bone) rests in.
The cartilage is primarily a shock absorber and allows for seamless gliding of the joint. It is commonly hurt in an acute injury such as sport or gym injury, but it can be less severe and overlooked as a cause of chronic shoulder pain. The injury itself can be the cartilage detaching from the bony surface, or can be from the insertion of the biceps tendon.
Labral tears aren’t often a sole injury, they happen with rotator cuff tears, instability/dislocations and impingements of the shoulder. You are at greater risk of having a labral tear if you do a lot of throwing or swimming (look out water polo players), direct trauma such as dislocations and FOOSH injuries, and also chronic instability can lead to greater incidence of injury as well. They also generally occur on the dominant arm.
These injuries are 5 times more common in male athletes compared to females.
There are 3 common types of labral tears:
SLAP Lesion
(Superior Labrum Anterior and Posterior) aka a tearing of the top of the labrum from front to back. This can occur to varying degrees like most injuries
- A simple fraying of the labrum with the bicep tendon being unaffected.
- Tear in the top of the labrum that results in instability of the bicep anchor (most common)
- A bucket handle tear (creates a flap)
- A bucket handle tear that extends to the biceps tendon.
Bankhart Lesion
A tear in the lower half of the labrum and inferior glenohumeral ligament, this is commonly seen with shoulder dislocations
Bennett Lesion
This tear is located on the posterior edge of the shoulder joint and is associated with posterior rotator cuff damage.
Symptoms
- Pain is worse with cross body and overhead activities.
- Pain is usually deep in the shoulder joint, but can be felt at the front
- Can hear or feel snapping and catching with motion.
- Occasional night pain, or with daily living activities
- A sense of instability, with decreased motion and strength
- Weakness
Treatment
In the early stages of injury, pain management and restoring movement are key factors, whilst trying to avoid positions or activities that cause pain. Anti-inflammatories may be required to help control this during the acute phase. A scan may be required to assess the full extent of the injury and this will help us identify if we do in fact need orthopedic intervention. Occasionally an arthroscope may be required for in depth investigation.
A low level labral injury we treat like most other shoulder injuries, we’ll be looking to maintain and gain strength as early as it is safe to do so, however this stage alone may take 3-6 weeks depending on the severity. Rehab is inclusive of the entire shoulder and mechanics, with particular attention paid to the biceps for strength and stability.
Our regular training principles are used, focusing on isometric strength and passive range of motion. Followed by gaining basic concentric and later eccentric strength and finally concentric power combined with sport/activity specific rehab in the final stage. Without appropriate exercise grading you increase the likelihood of it becoming a chronic problem. The average injury time we’re looking at is a minimum 3-4 months before regular sport/activity can resume.
Surgery
Unfortunately in severe tears conservative therapy doesn’t have a fantastic strike rate and some shoulders will require surgical repair, particularly if there are comorbid injuries (such as a dislocation/biceps rupture). After the wound has healed and you are out of a sling (looking a few weeks here) then the above rehab protocols will start from fresh and you’re looking at a recovery time of around 6 months.
