Everything You Need To Know About Shoulder Labral Tear

Shoulder Labrum Anatomy And Functions

The shoulder connects three bones:

• The humerus, or upper arm bone.
• The scapula, or shoulder blade.
• The clavicle, or collarbone.

The primary joint in the shoulder is the glenohumeral joint, a ball-and-socket configuration that connects the top of the upper arm bone (the “ball”) with a shallow socket on the shoulder blade called the glenoid.

This design allows for a wide range of arm motion but offers limited natural stability due to the socket’s shallow depth. The labrum, a thick ring of cartilage lining the edge of the socket, helps improve this stability. It acts as a cushion that deepens the socket and helps hold the arm bone securely in place, supporting joint function without restricting movement.

Types of Labral Tears in the Shoulder

Labral tears are categorized by the specific area involved, their location within the joint, and the way the injury occurred:

• Anterior labral tear (Bankart lesion): This type of tear affects the front portion of the shoulder socket. It is commonly associated with shoulder dislocations or repeated overhead motions, which place stress on the front of the joint.

• Posterior labral tear (Reverse Bankart lesion): This tear involves the back portion of the labrum and is often caused by repeated compression or twisting forces, such as those experienced during activities like weightlifting or rowing. Posterior labral tears occur less frequently than SLAP or Bankart lesions.
• Superior labrum, anterior to posterior tear (SLAP tear): A SLAP tear impacts the upper section of the labrum, where the biceps tendon connects to the shoulder socket. This type of injury can loosen the attachment between the tendon and the shoulder blade, potentially leading to discomfort, joint instability, and limited function.

• Degenerative labral tear: This type of tear usually develops gradually due to age-related changes and ongoing joint wear. It is often associated with arthritis and tends to progress over time.

Labral Tears Symptoms

It is possible for a labral tear to be present without causing noticeable symptoms. One study using MRI imaging found that signs of labral tears were visible in up to 70% of shoulders in individuals who did not report any shoulder-related discomfort.

Pain and Swelling

Labral tears often lead to discomfort located deep within or around the shoulder. The damage to the tissue triggers inflammation, the body’s natural healing response, which can result in pain and fluid accumulation, felt as swelling.

In cases of acute injury, pain and swelling typically appear soon after the event. In other situations, mild inflammation may persist, even after the labrum begins to heal, leading to ongoing low-grade pain.

Popping, Locking, or Grinding in the Joint

A sharp injury to the shoulder may produce a noticeable popping sound, often linked to tears or dislocations. Afterward, individuals might experience locking or grinding sensations during movement.

This grinding, known as crepitus, can occur when irregular or frayed tissue disrupts the smooth function of the joint. As the shoulder moves, these surfaces can catch, causing audible or tactile sensations that may or may not be painful.

Loss of Range of Motion

Labral damage can limit movement in the shoulder due to pain, swelling, or mechanical interference from torn tissue. This restriction may make the joint feel stuck or unable to move freely in certain directions.

If the shoulder is not used normally, stiffness and reduced flexibility can develop, which may further decrease range of motion over time.

Shoulder Dislocation

Labral tears can compromise joint stability, making the shoulder more prone to dislocation. When the labrum is torn, it becomes easier for the upper arm bone to shift out of place.

This instability raises the chances of repeat dislocations. Each episode may further damage the labrum, creating a cycle where instability leads to more tears, and the tears contribute to ongoing dislocations.

When a torn labrum is believed to be contributing to recurring shoulder dislocations, a physician may consider surgery as a treatment option. However, it is important to carefully weigh the potential benefits and risks before moving forward. Surgical procedures for shoulder dislocation can involve complications such as infection, continued instability, or injury to surrounding joint structures.

Recovery following this type of surgery can also be extensive, often ranging from 6 to 12 months.

Instability and Weakness

When the labrum is torn, the shoulder may begin to feel less stable. Individuals might notice a sensation that the shoulder is slipping or giving way, especially during overhead motions or while throwing. This occurs because the damaged labrum is no longer providing adequate support to keep the joint properly aligned.

Difficulty Sleeping on the Affected Side

Pain related to a labral tear can make it uncomfortable to sleep on the injured shoulder. Lying on the affected side may place pressure on inflamed tissues, potentially increasing pain and inflammation. As a result, sleep quality may be reduced.

• Throbbing Pain in the Arm: A pulsating pain from the wrist to the arm often worsens with repetitive activities. Read More About Throbbing Pain in the Arm.

Investigating the Causes and Risk Factors

Shoulder labral tears fall into two groups

• Acute tears: These are caused by sudden injuries to the arm, such as falling on an outstretched hand.
• Degenerative tears: These develop gradually due to cartilage breakdown from aging or repetitive shoulder activity.

Causes and risk factors include:

• Frequent overhead movements: Repetitive actions like throwing or lifting can lead to small, repeated strains (microtrauma) that may eventually result in a tear.
• Poor posture: Forward head posture or slouching can place ongoing stress on the shoulder joint, increasing the likelihood of labral damage.
• Degenerative changes: Wear and tear associated with aging can weaken the labrum, making it vulnerable to tearing, even in the absence of a specific injury.
• Glenoid bone irregularities: Abnormalities in the shoulder socket structure may make the labrum more susceptible to injury.
• Connective tissue disorders: Conditions such as Ehlers-Danlos syndrome can lead to increased joint laxity, which may create excess movement and friction, contributing to labral wear.
• Scapular dyskinesis: Irregular movement patterns of the shoulder blade can increase stress on the labrum and accelerate tissue breakdown.
• Prolonged crutch use: Improper or extended use of crutches can overload the shoulder joint, contributing to cartilage degeneration over time.
• Previous shoulder surgeries: Changes in shoulder mechanics or scar tissue formation after surgery may increase the risk of future labral tears.
• Sports with high shoulder engagement: Activities like swimming, gymnastics, or occupations that require frequent overhead use may raise the risk of labral damage by accelerating joint wear.

Diagnosing a Labral Tear in the Shoulder

A physician may use multiple evaluation methods to identify a labral tear and rule out other possible causes:

• Medical history and symptom review: This includes evaluating prior dislocations, inherited conditions, or past shoulder surgeries that may contribute to joint instability.
• Physical examination: The shoulder is moved through specific ranges to identify areas of pain, weakness, or limited motion.
• MRI or ultrasound imaging: These tools allow the physician to examine soft tissue structures, including the labrum, for signs of damage or inflammation.
• X-rays: Used to detect or exclude bone-related conditions that may be contributing to shoulder pain.

Conventional Treatment Options

Conventional treatment options aim to reduce symptom intensity and improve shoulder mobility. They include non-surgical and surgical alternatives.

Non-Surgical Treatment Options

Non-surgical care is typically the first step in addressing shoulder labral tears. These approaches focus on symptom relief and functional recovery without the need for invasive procedures:

• Conservative management: Reducing or modifying activities may allow the shoulder to heal by decreasing strain, preventing further irritation, and supporting a gradual return to regular movement.
  
• Physical therapy: Targeted exercise routines led by a physical therapist can help strengthen the shoulder muscles, increase flexibility, and restore motion in the joint.

Surgical Interventions

When labral tears are more severe, causing joint instability or not responding to conservative treatment, surgery may be considered. Surgical procedures are designed to repair the labrum and improve joint mechanics:

• Arthroscopic repair: This minimally invasive technique uses a small camera and specialized instruments inserted through tiny incisions to access and repair the damaged labrum.
  
• Labrum repair surgery: In more involved cases, the surgeon reattaches the torn labrum to the bone using anchors, which provide stabilization.

Surgery carries potential risks, including infection and prolonged recovery. One study notes specific complications that can arise after labral repair:

• Anchor failure: These small devices, used to secure tissue, can malfunction if improperly placed or affected by joint movement over time.
  
• Chondrolysis: A rare condition where joint cartilage deteriorates rapidly, leading to decreased joint space and impaired function.

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How Successful Is Shoulder Labrum Repair Surgery?

Labral tear surgery often involves reattaching the biceps tendon to a different location to stabilize the shoulder. While this procedure can sometimes be effective, it typically involves risks and requires a recovery period that includes physical therapy.

In some cases, surgery may not fully resolve underlying shoulder instability, which can increase the chance of future injuries. It’s important to discuss all treatment options with your physician to determine the best approach for your condition.

Can Recovery from Tears Be Accelerated Without Surgery?

Although surgery is often assumed to offer significant pain relief, outcomes can vary. In certain cases, surgical procedures may not deliver the expected results.

A 2021 study reported complications following surgery, including subluxation, dislocation, and ongoing instability. Some individuals required revision procedures. All surgical treatments carry potential risks such as infection and lengthy recovery periods.

It’s important to note that not all shoulder labral tears require surgery. Many individuals can regain shoulder function without undergoing invasive procedures.

Rehabilitation Medicine Center of New Jersey, NY, offers the Regenexx approach, a non-surgical alternative that uses image-guided procedures with Regenexx injectates. These treatments utilize customized concentrations of interventional orthobiologics, such as bone marrow concentrate and platelet-rich plasma, to support the body’s natural healing process.

Regenexx Approach at Rehabilitation Medicine Center

The Regenexx approach, available at Rehabilitation Medicine Center of New Jersey, utilizes interventional orthobiologics to support the body’s natural healing response. Procedures using Regenexx injectates may offer a non-surgical option for individuals seeking to avoid surgery, prolonged recovery periods, or ongoing use of prescription pain medications.

The type and severity of the labral tear help the physician determine whether this treatment may be appropriate. An initial evaluation by a physician at the Rehabilitation Medicine Center of New Jersey trained in the Regenexx protocol is the first step.

Personalized treatment plans may include one or more of the Regenexx orthobiologic procedures listed below.

Regenexx SD Injectate
Regenexx-SD procedures follow a patented protocol that uses bone marrow concentrate (BMC), which contains an individual’s own mesenchymal stem cells. The Regenexx lab process consistently delivers BMC at concentrations up to 20 times higher than what is typically produced using non-Regenexx methods.

Regenexx SCP Injectate
Regenexx-SCP injectate is an enhanced form of platelet-rich plasma (PRP). A blood sample is collected and processed to separate platelets and growth factors. These are then purified and concentrated before being precisely injected into the targeted area with image guidance. This formulation contains a higher concentration of growth factors than standard PRP preparations.

Regenexx PL Injectate
Regenexx-PL injectate is a specialized PRP-based formulation designed for rapid and concentrated release of growth factors. It is often used alongside other orthobiologic components, such as platelet-rich plasma and bone marrow concentrate, depending on the individual treatment plan.

Help Improve Shoulder Function Without Surgery

Shoulder labral tears can limit movement and make everyday tasks uncomfortable or difficult. When medications don’t provide sufficient relief, surgery is not the only path forward.

Procedures using Regenexx injectates apply interventional orthobiologics to support the body’s natural healing response. This non-surgical approach may help enhance shoulder function, improve mobility, and increase joint stability.