Shoulder Labrum Tears

The shoulder labrum is a ring of cartilage that surrounds the shoulder socket in the shoulder blade, where the head of the humerus (upper arm bone) sits. The labrum deepens the socket and provides stability to the shoulder joint while allowing for a wide range of motion. The labrum also serves as an attachment site for various ligaments and the biceps tendon, which further support the joint.

There are several types of labral tears, each with different causes and effects on shoulder function. The most common types include:

SLAP Tear (Superior Labrum Anterior and Posterior Tear)

A SLAP tear occurs at the top of the shoulder socket where the biceps tendon attaches. This type of tear is commonly found in athletes who engage in repetitive overhead motions, such as baseball pitchers, swimmers, and weightlifters. SLAP tears can result from acute trauma, such as a fall on an outstretched hand, or from chronic overuse.

Bankart Tear

A Bankart tear occurs at the front of the shoulder socket, at the bottom. It is commonly associated with shoulder dislocations. Bankart tears are usually found in younger people who sustain a traumatic shoulder dislocation, especially in contact sports like football, rugby, and wrestling.

Posterior Labrum Tear

A posterior labral tear occurs when the back part of the labrum is damaged. It is often caused by repeated stress on the shoulder joint, such as in weightlifting or activities that involve pushing movements.

Degenerative Labral Tear

As people age, the labrum naturally undergoes wear and tear, which can lead to degenerative labral tears. While they may not always cause symptoms, they can contribute to shoulder pain and stiffness.

The symptoms of a labral tear vary depending on the type and severity of the injury. Some individuals experience mild discomfort, while others may have significant functional limitations. Common symptoms include:

• Shoulder pain: Pain may be felt deep in the joint, particularly with overhead movements or certain activities.
• Clicking, popping, or grinding sensations: A torn labrum may cause abnormal movement in the shoulder, leading to these sensations.
• Shoulder instability: Some individuals feel as if their shoulder may “give out” or dislocate.
• Decreased range of motion: Difficulty moving the shoulder, particularly with lifting or reaching motions.
• Weakness: A labral tear may result in weakness when lifting objects or performing overhead activities.

Symptoms can worsen over time, especially if the tear is not treated or if the individual continues to engage in activities that strain the shoulder.

A shoulder labrum tear can result from various causes, including:

• Trauma: A direct impact to the shoulder, such as a fall onto an outstretched hand, a car accident, or a sports-related collision, can cause a labral tear.
• Repetitive overuse: Athletes who perform repeated overhead motions, such as throwing, swimming, or weightlifting, place significant stress on the labrum, leading to gradual wear and tear.
• Shoulder dislocation: When the shoulder dislocates, the labrum can be torn as the head of the humerus moves out of its socket.
• Aging: Over time, the labrum can naturally weaken and develop small tears, particularly in individuals over the age of 40.

A shoulder labral tear is diagnosed through a combination of medical history, physical examination, and imaging studies.

Medical history and physical examination

Dr. Gazzaniga will begin by reviewing the patient’s medical history, including any prior shoulder injuries or activities that may have contributed to the symptoms. During the physical examination, he will assess shoulder strength, range of motion, and stability. Specific tests, such as the O’Brien test or the crank test, may be performed to identify labral pathology.

Imaging Studies

• X-rays: While X-rays do not show soft tissue injuries like labral tears, they can help rule out fractures or other bone-related issues.
• MRI: An MRI with contrast dye (MR arthrogram) is the most effective imaging test for detecting labral tears. The contrast dye highlights soft tissue structures, allowing for a clearer view of any damage to the labrum.
• CT scan: In some cases, a CT scan with contrast may be used to evaluate the shoulder joint, particularly if other imaging tests are inconclusive.

Diagnostic Arthroscopy

In certain situations, if the diagnosis remains unclear despite imaging, Dr. Gazzaniga may recommend arthroscopy. This minimally invasive procedure involves inserting a small camera into the shoulder joint to provide a direct view of the labrum. If a tear is identified, treatment can often be performed during the same procedure.