The shoulder is a ball and socket joint. Most shoulder movement occurs where the ball at the top of your arm bone (the Humerus) fits into the socket (the Glenoid). The socket is part of the shoulder blade (Scapula) which is where the rest of the movement comes from and plays a key role in the functionality of our upper limbs.
The socket is deepened and stabilised by the Glenoid Labrum. The Glenoid Labrum is a firm rim structure that forms a ring around the glenoid cavity (the cup of the ball and socket shoulder joint).
The Labrum’s functions:
A common symptom of a shoulder Labrum tear is pain. A person may also experience the following symptoms:
If the Labrum is torn, the shoulder can become unstable. This is what happens in shoulder dislocations and instability. Different injury mechanisms cause different tears in various sites around the Labrum. These are given specific descriptive names (below). We also define the site of the tears by describing the glenoid face as a clock, where the top is 12 o’clock, 3 o’clock is at the front and 9 o’clock is at the back (for ease of use this applies to both left and right shoulders).
If the tear is at the front of the shoulder, 3 o’clock to 6 o’clock. Bankart lesions or tears are common in younger people who dislocate their shoulder. This type of torn Labrum occurs in the lower portion of the glenoid socket. A person who has sustained a Bankart tear may feel as though their shoulder could fall out of place if they move their arm in a certain way.
SLAP tear (Superior Lesion Anterior to Posterior)
When the tear is at the top of the shoulder, 1 o’clock to 11 o’clock. SLAP tears go from the front to the back of the cartilage in the middle of the glenoid.
Reverse Bankart Lesion
Posterior tear, 6 o’clock to 11 o’clock.
270 degree tear
When a tear is a combination of Bankart, Reverse Bankart tear and SLAP tear.
For more information on Labrum tears, please click here which takes you to website of Professor Lennard Funk who is a Shoulder & Upper Limb Specialist and Consultant Orthopedic Surgeon in the UK. All of these tears account for approximately 5–10% of all shoulder instability injuries. They can occur due to a severe injury or if a shoulder dislocates posteriorly. Also, tear can take place indirectly as a result of other injuries or symptoms, such as electrocution or seizures, which cause sudden shoulder movements.
A Hill-Sachs lesion can also occur which is a compression fracture or “dent” of the posterosuperolateral (top, rear portion of the ‘ball’) humeral head that occurs in association with anterior instability or dislocation of the Glenohumeral joint. Yiannakopoulos et al. (2007) found Hill-Sachs lesions in 65% of acute dislocations and 93% in patients with recurrent instability.
A fall onto an outstretched arm is the most common way to injure the glenoid labrum. This causes the head of the humerus to be forced upwards which leads to a compressive force being placed on the labrum. Damage to the labrum also commonly occurs when the humerus (upper arm bone) is pulled downwards. Among athletes, a SLAP tear is more likely to occur in those who play tennis, baseball, or softball, as these sports involve quick snapping arm movements over the top of the shoulder. Direct trauma can also lead to labral damage as well as heavy lifting.
Diagnosing a labral tear is most often done by taking a thorough case history. If it is known that a heavy trauma has occurred, this makes it more likely that a Labral tear has occurred. Also, if the patient is younger and played a competitive overhead sport, this could also be suggestive of labral tear. A comprehensive physical examination will help to produce an accurate diagnosis and assist in collaboratively deciding on the best treatment and management options, with your best interests at the forefront of those decisions. Having a timely diagnosis will ensure the best possible outcomes are achieved.
The team may recommend an MRI scan which can identify and confirm more severe labral tears, however, smaller Grade I labral tears are often not visible on a normal MRI.
Upon obtaining your diagnosis, your Physiotherapist will teach you about your injury and will discuss effective strategies to help manage your symptoms and support recovery. Your clinician may offer recommendations on anti-inflammatory medications to help relieve symptoms, consulting your GP where appropriate. In the early stages following injury, you will be advised to rest the shoulder so that healing can commence. Ice will commonly be recommended as a useful way to further reduce inflammation and pain. Your Physio will also give advice on how you may be able to perform certain activities in ways that avoid symptom aggravation and help you to maintain function. Regular re-assessment will help keep your treatment and management optimal and can ensure that you are making progress towards your goals. As you move forward through recovery, you will be given ongoing advice and support.
Exercise rehabilitation is a crucial element of your recovery. Your Physiotherapist will be skilled and experienced in exercise prescription and will create a specialised exercise plan for you that will be adapted in line with your progress. Initial exercises will focus on restoring range of motion and maintaining strength in the surrounding soft tissues. The exercises will evolve in to more strength focused and then eventually for a return to sporting activity where applicable. Rotator cuff muscle strength is vital to provide stability, strength and function to the shoulder. Athletes are often able to begin partaking in sport-specific exercises 12 weeks after the surgery, but it normally takes four to six months for the shoulder to heal fully.
Your clinician will also be skilled in hands on treatment and may use manual therapy techniques and acupuncture to help alleviate pain and restore movement & function. These adjusts will form part of your multi-faceted treatment plan.
In severe cases where there is significant loss of function and joint stability, surgical intervention may be required. The procedure aims to tighten and/or repair the over-stretched and injured ligaments, rim of cartilage/Labrum and shape of socket. Different types of operation can achieve this. The surgical options are discussed by the Orthopaedic team with your best interests at the forefront of the decision making. Your post-operative rehabilitation will depend on the specific operation performed however our Physiotherapists can help you through this regardless.
Yiannakopoulos CK, Mataragas E and Antonogiannakis E. (2007). A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy: The Journal of Arthroscopic & Related Surgery 23(9): pp.985-90.