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The Diagnosis and Treatment of Shoulder Labrum Tears

by | Nov 3, 2017 | Shoulder Injuries, Shoulder Physical Therapy | 0 comments

Shoulder injuries can come from either repetitive motion ‘wear and tear,” or from a sudden fall when the arm is bracing too much force. A torn labrum in your shoulder joint can be painful but often recoverable with proper physical therapy.

The labrum is a ring of firm tissue (similar in nature to cartilage, but more flexible. Think of it as “caulk” around your shoulder joint) that helps the ball and socket joint of your shoulder remain in place. A tear or rupture of this tissue, or gradual fraying over time in the upper aspect, is referred to as a SLAP injury (SLAP stands for “superior labrum, anterior to posterior”).  When the bottom of the labrum is injured it is often in the form of a Bankart Tear.

The shoulder is made up of a complex network of ligaments and tendons; in order to move dynamically, the joint uses a lot of different moving pieces. The labrum ensures that the bones aren’t rubbing against each other and that all the tendons and ligaments are able to do their work by acting as a cushion and slowing the force of movement. It also provides some additional stability to an otherwise comparatively unstable joint.  As one of the most mobile parts of the body, the labrum and shoulder are also prone to different varieties of injuries. There are several forms of a shoulder injury, some of which require surgery for the patient to recover full range of motion.

  • Tier 1 injuries are when the labrum is frayed, but not completely severed. The humerus (upper arm bone) is still in the shoulder socket. This occurs with slow wear and tear over time and is typically found in older patients.
  • Tier 2 is the most common labrum injury. The labrum and the biceps tear away from the glenoid (the shoulder socket where the humerus sits in the shoulder joint). For a torn labrum here, arthroscopic surgery is normally performed.
  • Tier 3 injuries consist of a handle-like tear in the labrum, causing the torn piece to hang into the should joint. The tendons attaching the biceps to the bone remain intact; however arthroscopic surgery is required in this case, too.

⦁Tier 4 injury is almost like a tier 3, except in these cases, the tendons on the biceps are torn, as well. Treatment is the same, and the surgery a bit more complex.

Someone can experience a torn labrum by repetitive motion (such as a baseball player, or someone in a physical occupation) as the tissue wears down over time.  Aging is also a factor in this type of injury. A sudden rip, tear, or acute injury can also cause labrum damage.  A forceful pull on the arm, or a fall where the arm has braced too much of the body weight force are common injuries that can damage the labrum. Many shoulder injuries mimic each other, so a true diagnosis is typically achieved with an MRI. Consult your doctor if any of these symptoms are present:

  • Pain when moving, or keeping the shoulder in certain positions, such as over the head, or when throwing a ball or hitting with a tennis racket
  • Decline in sports performance or range of motion limitations
  • Discomfort or pain when lifting arms overhead
  • Deep, aching shoulder pain, especially in the back of the shoulder
  • Popping, locking or grinding in the glenoid when moving the shoulder
  • Shoulder weakness or unsteadiness – like the arm will fall out of the socket.

Many physicians and physical therapists prefer to treat a torn labrum non-surgically first. This treatment includes activity restrictions and use of anti-inflammatory medication. It also uses physical therapy exercises, designed to increase shoulder muscle strength and improve shoulder motion with stretching.

If the tear is severe, or the physical therapy is not getting the results desired by patient and doctor, arthroscopic surgery is commonly performed. This minimally invasive surgery uses smaller cuts, versus larger ones, and the bicep and shoulder are further evaluated at this time. The shoulder is repaired, allowed to heal, and then physical therapy begins after that.

When it comes to addressing the cause of shoulder labrum tears and the complications that result from it, the professionals at Buffalo Back and Neck Physical Therapy are second to none. Contact us to set up a consultation so that you can explore the wide variety of physical therapy treatment plans that we offer to our clients in the Western New York area. Our staff of experienced medical professionals have the ability to assess the source of your shoulder pain and to devise a physical therapy plan that works for you.


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