Shoulder Labrum Labral Tears – Is Surgery Necessary?

August 7, 2015
G2 Orthopedics

What is the Shoulder Labrum?

The shoulder labrum is a cartilage disc within the shoulder that is attached to the rim of the shoulder socket. It is essential to helping keep the ball of the shoulder joint in place, as well as helping to maintain movement and stability of the shoulder. Labral tears of the shoulder can happen for many reasons,

Shoulder Labrum Tears

There are many different types of tears of the labrum, and they can occur due to injury, trauma or simple repetitive motions, such as throwing a ball. Most commonly, the labrum wears out over time and becomes frayed and more susceptible to tearing.

A good example of this is with a baseball pitcher, who repetitively throws a ball over and over, putting chronic stress on the shoulder. This can eventually wear out the labrum and cause fraying of the labrum without actually detaching it. This can also be known as a SLAP tear (Superior Labrum from Anterior to Posterior).

A more extreme example is a fall onto the arm or shoulder, or an accident in which the ball of the shoulder actually pushes the labrum out of the socket. This can include a complete dislocation of the shoulder, which is incredibly painful and will almost always require surgical intervention.

Symptoms of a Shoulder Labrum Labral Tears

Symptoms of a torn labrum can include pain and aching in the shoulder area, weakness or instability in the joint, and a popping sensation. With movement and pain in certain activities, such as throwing a ball or any overhead movement, you might also hear a snapping or feel a sensation of something catching in the joint.

How is a Shoulder Labral Tear Diagnosed?

Your doctor or surgeon will do a series of tests to determine if you have torn your labrum. He or she will perform some basic movements of your arm and shoulder to determine where the pain resides. An MRI is a more accurate way to see how the shoulder labrum looks, and assess any damage.

The most accurate way to determine the extent of the injury is to use an arthroscopic camera, which will be inserted via incision into the shoulder. Upon inserting the device into the shoulder, the surgeon can look directly inside your joint and evaluate the injury. The benefit of this scenario is the surgeon can repair the damage at the same time.

Surgical Indications and Treatment Options for Labrum Tears

You may be asking yourself if surgery is necessary in the case of this type of injury. Depending of the severity of the labral tears, or the type of activity that will be following the surgery (example: a pitcher that wants to get back into it as soon as possible), surgery is often the best option for these type of injuries.

A labrum isn’t totally capable of complete self-healing and repair, and if you do decide to leave it to heal on its own, it usually won’t heal evenly. If you don’t mind the pain and don’t want to return to sports that require overhead activity, it is possible to leave the injury and simply reduce activity from that point on. However, if you do want to continue participating in sports and activities, a repair surgery will likely be your only option.

Small tears or frays in the labrum are usually done through arthroscopic surgery, which is when a small incision is made in the surgery area and a camera and tools repair and clean up the injury in a non-invasive manner. If the labrum is only slightly torn, the surgeon will just clean up the area and trim away any damaged cartilage.

If the damage is more extensive, such as destabilization or complete dislocation, the surgeon must re-anchor the shoulder, which involves a more extensive surgery.

Recovery and Prevention

After having surgery on the shoulder, you will need to keep your arm in a sling for approximately a month. You can treat pain with OTC pain medication or otherwise, depending on the advice of your doctor. Ice is helpful to reduce swelling.
Once mobility is regained, physiotherapy will be necessary to regain strength and movement. If the procedure was minor, you should be good to go around 2 months after the surgery. If you have complete repair surgery, you will need around 4 months.

The only real prevention of labral tears is to strengthen the muscles around the shoulder, and to avoid any kind of activity that would put strain on the shoulder labrum. Thankfully, most people who have this kind of injury respond very well to the surgery, and almost always return to a full level of activity.