Shoulder Surgery – Labral Tear
Injuries to the labrum of the shoulder can effect both the athletic population and workplace. They are common athletic injuries in the younger population who play baseball, tennis, or volleyball. These injuries can occur from either acute trauma or repetitive motions and are commonly seen in patients whose arms are frequently in overhead positions. When the labrum is torn, the shoulder may be more susceptible to dislocation and can become unstable as well as painful.
The shoulder is the most mobile joint in the body. The joint is formed at the junction of three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). The head of the humerus rests in a socket in the shoulder blade called the glenoid. The labrum is the disk of cartilage that surrounds the glenoid and stabilizes the shoulder joint by keeping the bones in place. It is also the attachment site for multiple ligaments.
Diagnosis of these injuries is often made clinically. X-rays and magnetic imaging studies (MRI) can also be helpful in confirming the diagnosis. Once a diagnosis is made both conservative and operative treatment options can be exercised.
Conservative treatment involves rest, muscular strengthening and anti-inflammatory medications to help minimize pain and stabilize the shoulder. It is an effective form of treatment for those not experiencing instability from normal activities. This option is also optimal for patients who are older, less active, and not planning on returning to sports. In patients where stability and pain relief are not obtained after a thorough rehabilitation program, surgical options offer a better alternative in preventing recurrent instability and return to function.
Surgical management of these injuries involves arthroscopic or open surgery of the shoulder. There are two common types of tears that can happen to the labrum: a SLAP lesion or a Bankart lesion. A SLAP lesion (Superior Labrum Anterior to Posterior) is a tear of the top rim of the labrum that goes from the front of the shoulder to the back and can involve the biceps tendon. Surgical repair varies among patients but involves reattaching the torn labrum or biceps tendon using sutures and bone anchors. (Watch a video of this surgery.) A Bankart lesion is the most common ligament injury affecting the shoulder and is a tear of the labrum and attaching ligaments at the front of the shoulder socket. Surgical repair involves sewing the torn ligaments and labrum back together at the rim of the socket. (Watch a video of this surgery.) Treatment expectations and results vary depending on the location and severity of the tear. The goal of these procedures is to restore shoulder stability so that the patient can successfully return to full athletic activity at 4 – 6 months. A general guideline of labral tear rehabilitation can be found within the Rehabilitation Protocols.