What is a Torn Labrum in the Shoulder?
The shoulder joint is comprised of the upper portion of the arm bone (humeral head) sitting in the shoulder socket (glenoid, which is connected to the shoulder blade or scapula). The labrum is a fibrous bumper of tissue that attaches around the edge of the oval shaped glenoid. The shoulder capsule and ligaments attach to the labrum. Together these structures help stabilize the ball in the socket. The fibrous labrum increases the stability of the humeral head in the glenoid by as much as 50%. However, our shoulder joints are inherently unstable joints, as the glenoid is a shallow socket, unlike a hip joint socket for instance which is a deep socket and therefore offers a lot of bony stability.
A traumatic injury to the shoulder and repeated overhead motions can result in tearing of the labrum. The labrum typically pulls away from the edge of the bony glenoid. There are two main types of labral tears:
- SLAP tears, or superior labral from anterior to posterior tears
- Bankart tears
These two types of injuries are defined by the location and nature of the labral tear. These injuries, along with any injury to the labrum, can cause symptoms such as pain, catching, and feelings of shoulder instability. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating Bankart and SLAP tears for patients in Vail, Summit County, Aspen, and Denver, CO.
What is the Most Common Labral Tear in the Shoulder and What causes these Tears?
The most common type of shoulder labral tear is a SLAP tear. SLAP refers to the fact that the labral tear is along the top or superior aspect of the labrum and these tears progress from anterior to posterior or from front to back. SLAP tears are significant, as this portion of the labrum is also where the long head of the biceps tendon attaches, so there is commonly associated tears of the biceps tendon where it attaches to the top of the glenoid.
SLAP tears are most commonly the result of wear and tear over time. Patients over 40 may have fraying along the edges of the superior labrum as a normal part of aging. Younger patients typically develop a SLAP tear due to an acute injury or due to high demand overhead sports such as being a baseball pitcher.
The term “Bankart tear” typically refers to tears of the anterior and inferior labrum as a result of an anterior shoulder dislocation, which usually occurs following a hard fall on an outstretched arm. Anterior shoulder dislocations are the most common type of shoulder dislocation. In these injuries, the humeral head dislocates out the front and bottom portion of the glenoid socket, tearing the labrum off the rim of the bony glenoid in this area.
Does a SLAP Tear Require Surgery?
Typically, non-surgical treatments are the initial course of action with a SLAP tear. In older patients, nonsurgical methods usually relieve symptoms. These remedies include the use of an anti-inflammatory medications like ibuprofen to ease the initial pain. A prescribed program of physical therapy may also be recommended. The goals of therapy will be to strengthen the muscles stabilizing the shoulder.
If the condition does not improve or worsens despite good nonsurgical management, surgical repair is considered. In young patients (ie. less than 30), SLAP tears are repaired arthroscopically. This is done by abrading the bony attachment site to get healing cells out of the bone and then using small bone anchors to sew the labral tissue back into place so it can heal. In older patients (ie. over 40), there is often poor healing potential of the labral tissue as the tissue is degenerative (has seen lots of wear and tear). Thus, in older patients, torn flaps of labral tissue are cleaned up arthroscopically and if there is associated tearing of the biceps tendon attachment on the top of the glenoid, then a biceps tenodesis is performed.
A biceps tenodesis is done arthroscopically or open depending on a number of factors. In a biceps tenodesis, the diseased and torn portion of the upper biceps tendon is removed and then in the area where the biceps tendon becomes normal, the tendon is secured to the humerus bone. In this way, the biceps tendon is attached further down the arm where the tendon is normal. The diseased, torn, portion of the tendon that is causing pain is removed from the shoulder.
How Long is the Recovery for a Torn Labrum in the Shoulder?
With labral tears that can be treated non-surgically, patients may begin to experience improvement as soon as 4 – 6 weeks. Achieving full strength of all the muscles that support the shoulder and returning to all activities may take 3-4 months.
Following both arthroscopic SLAP repair surgery and biceps tenodesis surgery, patients are placed in a sling for 4-6 weeks, but can start gentle shoulder range of motion exercises immediately after surgery. Physical therapy is started within a few days after surgery. Strengthening exercises are not started until 6 weeks from surgery, as it takes this long for the repaired tissue to securely heal to the bone. It can take 4 months from surgery to regain most strength. Most patients who have had biceps tenodesis surgery are back to all activities by 4 months from surgery, but it could take 6 months from the time of a SLAP repair surgery for a baseball pitcher or other overhead athlete to resume their sport. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating SLAP tears and Bankart tears for patients in Vail, Summit County, Aspen, and Denver, CO.