The shoulder joint is a ball and socket joint. A ’ball' at the top of the upper arm bone (the humerus) fits neatly into a 'socket’, called the glenoid, which is part of the shoulder blade (scapula). The labrum is a ring of fibrous cartilage surrounding the glenoid which helps in stabilizing the shoulder joint. The biceps tendon is attached inside the shoulder joint at the superior labrum of the joint. The biceps tendon is a long cord-like structure which attaches the biceps muscle to the shoulder and helps to stabilize the joint.
Traumatic or overuse of the shoulder by excessive use or sports such as throwing, or weightlifting can cause a labral tear. In addition, the weaken the labrum may be weakened by the aging process, leading to injury secondary to wear and tear.
The most common types of labral tears include:
- SLAP tear: The term SLAP (superior —labrum anterior-posterior) refers to an injury of the superior labrum of the shoulder, at the attachment of the biceps tendon.
- Bankart tear: Bankart tear is an injury to the labrum that leads to recurrent dislocations and arthritis of the shoulder
- Posterior labrum tears: This type of labrum tear is rare, but may be caused by repeated internal impingement, where the extreme extension and external rotation of the shoulder joint causes pinching of the bulged part of the arm bone against the lining of the shoulder joint cavity.
Diagnosis
A shoulder labral tear injury can cause symptoms such as pain, decreased range of motion, joint instability, and/or a catching or locking sensation.
The surgeon may detect a labral tear based on these symptoms and medical history as well as the history of injury. Tests will be performed to evaluate the range of motion and stability of the shoulder. These tests include X-rays may to rule out other conditions, (CT) scan or magnetic resonance imaging (MRI) scan, with a contrast medium, to determine the presence of tears. Diagnosis of a labral tear can also be confirmed through shoulder arthroscopy.
Your doctor may start with conservative approaches such as prescribing anti- inflammatory medications and advise rest to relieve symptoms. Rehabilitation exercises may be recommended to strengthen rotator cuff muscles. If the symptoms do not resolve with these conservative measures, your doctor may recommend arthroscopic surgery.
Procedure
During arthroscopic surgery for SLAP tears, your surgeon will examine the labrum and the biceps tendon. If the damage is confined to the labrum without involving the biceps tendon, the torn flap of the labrum will be debrided or cleaned up. When the biceps tendon is also injured or detached, sutures or a bone screw will be used to repair and reattach the tendon.
A Bankart operation is performed to repair a Bankart tear. In this procedure, the Bankart tear is repaired by making a few small incisions around the joint. An arthroscope is inserted into the shoulder through one incision to visualize the inside of the shoulder joint. Other surgical instruments are inserted through the other incision to re-attach the labrum to the glenoid with sutures or anchoring devices.
Following the surgery, your shoulder is immobilized with a sling for a few days. Physical Therapy may be recommended by your surgeon using ice to control pain and swelling use ice, electrical stimulation, massage therapy, and/or other treatments. Passive range of motion exercises are also initiated in the post-operative phase. Active range of motion exercises are started about 6 weeks after the repair, to regain shoulder movement. Athletes usually may return to sports in about three to four months.