Over the last decade the diagnosis and description of labral tears has become better understood. The labrum is a ring of cartilage that attaches to and extends the effective area of the glenoid (the socket of the shoulder). The labrum helps to stabilize the ball‑and‑socket joint (glenohumeral joint) and serves as an attachment site for ligaments around the shoulder as well as the biceps tendon.
Causes
The labrum can be injured either by overuse or through a single traumatic event. An injury to the superior labrum, where the biceps tendon attaches, is an example of an overuse injury whereas anterior labral lesions occur usually when the shoulder is traumatically dislocated.
Symptoms
A torn labrum will often result in a shoulder that makes a clicking with particular rotational maneuvers, and sometimes leave the patient with a popping sensation. When the labrum tears there is generally a sharp pain associated with the event, but some labrum tear from overuse without a definite moment to define the tear. Patient will complain of a sense of instability with or without a frank dislocation, and often complain of apprehension with certain ranges of motion and particular activities.
Treatment
Labral injuries can be diagnosed by physical examination but commonly require further testing, such as an MRI with contrast, to fully appreciate the tear. Care of these tears is determined by the extent of problems caused by them. Constant pain or pain with specific overhead activities is common with superior labral lesions known as SLAP lesions. Shoulder instability or recurrent dislocations are common with anterior and posterior labral injuries.
Non‑operative
Conservative care to eliminate pain and restore motion is the first step in labral tear treatment. Strengthening the peri‑scapular muscles as well as the rotator cuff muscles is then begun. Depending on the size and location of the tear this is often successful. Anti‑inflammatories and relative rest are usually recommended in this type of treatment.
Operative
When conservative treatment fails surgical repair can be performed. Large tears usually require surgery to enable a return of shoulder function. This is especially so with anterior labral tears which occur in association with shoulder dislocations. The repair of the labrum in this case allows the appropriate tensioning of the anterior ligaments which consequently will lead to a stabilization of the shoulder. Superior labral tears (SLAP tears) will cause persistent problems in overhead athletes and are commonly treated surgically. These tears can only be treated arthroscopically. Anterior labral tears used be fixed through open procedures but now are most often fixed arthroscopically as well.
