What is the labrum?

The labrum is a ring of soft rubber-like cartilage material located around the shoulder socket (glenoid). The labrum helps contribute to the stability of the shoulder by deepening the socket, and helps to cushion the compression across the socket. The biceps tendon attaches to the labrum at the top of the socket and the ligaments that hold the shoulder in the joint attach in the front and back.

What gets labral tears?

Anyone can get a labral tear. Injury can occur due to repetitive use, and may be more likely to occur in individuals who have instability or looseness of the shoulder joint. A special type of labral tear is called a "SLAP lesion." This is a tear of the top part of the labrum extending from in front to behind the biceps tendon (Superior Labrum from Anterior to Posterior). One of the most common causes of this type of labral tear in traction, such as in the jolt one may experience when water-skiing or when trying to reach up and grab an object overhead when trying to save oneself from falling. Another common cause of the SLAP lesion is shoulder compression, such as falling onto an outstretched arm. Often, patients may get either labral tears or SLAP lesions just from repetitive use and without any specific traumatic incident.

What happens when the labrum is torn?

When the labrum is torn, a flap of labrum can move in and out of the joint, causing shoulder pain, locking, catching, snapping, or grinding. This may be related to certain positions of the arm. If the labral tear makes the attachment of the biceps tendon loose, the shoulder joint may become unstable.

How is the diagnosis of a labral tear or SLAP lesion made?

The diagnosis of a labral tear or a SLAP lesion is made from the history, physical exam, and special studies. The patient's history may provide the first clue that the labrum is injured. There are several physical exams findings that may also suggest that the labrum is injured. X-rays will not show a labral tear or SLAP lesion but are very important in the patient's evaluation to rule out the other pathology. An MRI scan is the most sensitive non-invasive test to evaluate the shoulder for a labral injury or SLAP lesion. If the physician suspects an intra-articular injury, he may ask to have the radiologist inject a small amount of dye into the shoulder before the MRI scan in order to increase the diagnostic accuracy.

How are labral tears initially treated?

Initially, rest, ice, and gentle anti-inflammatory medicines are used. However, with repetitive use of the arm, it may be very difficult for a labral tear or SLAP lesion to heal. When this happens, surgery may be indicated.

What does surgery involve?

This depends on the extent and location of the labral tear. Many labral tears can be treated with a simple arthroscopic shaving (debridement) of the torn flap of cartilage. If the tear extends to the biceps tendon (SLAP lesion), reattachment of the labrum and biceps tendon back to the socket (glenoid) may be required. This is done arthroscopically using miniature screws and sutures. If there is extensive tearing of the biceps tendon in association with the labrum tear, the biceps tendon may need to be reattached to the bone in the upper arm (biceps tenodesis). Arthroscopic surgery is video-recorded both for the medical record and for patient education. Patients are encouraged to look at their videotape so that they understand what was done during surgery. Patients are able to go home the same day of surgery in an arm sling.

What is the usual post-operative course?

Again, this depends on the extent of the labral tearing and the surgery that was performed. If the labrum only needs to be shaved, then a quick return (within one to three weeks) to almost all activities may be possible.

If the labral tear or SLAP lesion needs to be repaired, then a more gradual return is necessary. A sling is utilized in the first few weeks after surgery, and immediate use of the elbow, wrist, and hand is encouraged. Desk work and light duty can usually be resumed within the first week or two; return to heavy labor usually takes two to four months. Athletes are usually able to return to their sport in 4 to 6 months.

Is there any physical therapy necessary after surgery?

Physical therapy after surgery is tailored to the needs of each patient. The therapist can assist in regaining motion and strength after surgery. The therapist can also work with athletes to ensure that their throwing mechanics are good.

Who can I call for more information?

Please feel free to contact us and ask one of our physicians for a referral. We will be happy to answer your questions and evaluate your shoulder in the Clinic.

Don Buford, M.D. © 2010