The labrum is a piece of cartilage that surrounds the glenoid (socket) of the shoulder joint. The labrum provides stability to the shoulder joint and is a site of attachment for several ligaments and the biceps tendon. There are various types of labral tears which are classified according to the location of the tear. When the labrum gets torn, the best treatment option is usually surgery because the labrum typically does not heal on its own. The labrum is usually repaired with minimally invasive techniques such as a shoulder arthroscopy.
- Shoulder pain
- Clicking or catching in the shoulder
- Possible shoulder joint instability
- Possible biceps pain
- Physical Therapy - A formal course of physical therapy can help patients regain their strength and range of motion. By strengthening muscles around the shoulder, this can also provide some stability in the case of a shoulder dislocation.
- Injections - Steroid injections into the shoulder are rarely used in cases of a labral tear because steroids can interfere with healing if surgery is needed and don’t eliminate the tear. Steroid injections are usually reserved for patients who cannot have surgery.
- Anti-inflammatories - Nonsteroidal anti-inflammatory medications such as Ibuprofen or Aleve can help decrease inflammation and pain caused by a labral tear. This can be beneficial in addition to physical therapy, so patients can have less pain while regaining their motion and strength. Prescription-strength anti-inflammatory medications are occasionally prescribed if over-the-counter medications are not working.
- Surgery - Because the labrum has a poor blood supply, it infrequently heals on its own. When the labrum is torn, the ligaments that attach to the labrum become loose and can predispose to recurrent instability. To prevent further damage to the shoulder from recurrent dislocations, surgery is usually recommended to stabilize the shoulder by reattaching the labrum and re-tensioning the ligaments. This is often the best option to alleviate pain and help patients regain their function and quality of life.
Labral tears often lead to a painful clicking in the shoulder when lifting or reaching across the body or above shoulder height. In some cases, labral tears result from a dislocation of the shoulder and can lead to recurrent dislocations or shifting of the shoulder joint. After taking a detailed history and performing a thorough exam, if a labral tear is suspected, an MRI with IV contrast is usually ordered. An MRI evaluates soft tissue structures such as the rotator cuff tendons and labrum.
Most labral tears need surgery because the labrum infrequently heals on its own. Several factors are considered when determining if a patient should have surgery, which include the size of the labral tear, patient age, patient activity level/demands, recurrent shoulder instability, and failure of more conservative treatment.
The most common risks are stiffness, persistent pain, and weakness. Patients with a labral tear commonly use their injured arm less, which causes the shoulder muscles to weaken and can create tension in the muscles around the shoulder from the altered shoulder mechanics. In cases of recurrent instability, irreversible damage to the ball and socket as well as the cartilage in the joint can occur, which can lead to arthritis.