Shoulder Labral Tear Or Shoulder Joint Tear: Causes, Symptoms, Diagnosis, Treatment, Surgery, Rehab

Shoulder Labral Tear or Shoulder Joint Tear: Since the introduction of a miniature camera for treatment of diseased conditions of the shoulders called an arthroscope, orthopedic surgeons have come across several pathological conditions unknown to the world some time back. One such condition is an injury to a minute structure in the shoulder known as the labrum. A rupture of the labrum or a labral tear can cause severe pain in the shoulder along with a catching sensation. Labral tears are extremely difficult to diagnose.

The following article tells in detail about:

• The Causes of Shoulder Labral Tear
• The Symptoms of Shoulder Labral Tear
• The Treatment Options Available For Shoulder Labral Tear
• Exercise Routine For Shoulder Labral Tear.

To define a Shoulder Labral Tear one needs to understand the anatomy of the shoulder what exactly is Labrum.

The shoulder is consisted of three bones, which are the scapula or the shoulder blade, the humerus or the upper arm bone, and the clavicle which is the collarbone. The glenoid which is a part of the scapula constitutes the socket of shoulder. It is very shallow and flat. The labrum turns this flat surface of glenoid into a deep socket so as to fit the head of humerus. The rotator cuff joins the humerus to scapula. The rotator cuff is made up of four muscles which are the supraspinatus, infraspinatus, teres minor, and subscapularis. The tendons present in the muscles join the muscles to the bones and the muscles move the bones by pulling the tendons. The rotator cuff facilitates raising and rotation of the arms. There are times when the labral tissue gets in between the glenoid and humerus resulting in rupture of the labrum. If this rupture gets worse, it tends to become a flap of tissue which gets caught between the humerus and the glenoid causing pain and decreased mobility of the shoulders. This condition is called as a Labral Tear of the Shoulder.

Labral Tears are usually a result of a direct blow to the shoulders like in cases of falling on outstretched hands. Labral Tears can also occur as a result of repetitive activities resulting in wear and tear of the shoulder joint. Any injury to the labrum causes instability of the shoulders which may again result in tear of the labrum. Sporting activities especially which involves throwing with a considerable amount of force like baseball, hammer throw, discus throw, etc. generally causes a Labral Tear. Athletes like golfers and weightlifters are also prone to Labral Tears.

A labral tear of the shoulder typically causes an audible sharp popping as well as a catching sensation in the shoulder with certain movements which is then followed by an aching sensation which may persist for quite a few hours. There are cases in which a Labral Tear has not caused any pain at all. As a Labral Tear may cause shoulder instability, the shoulder feels loose with certain movements.

Shoulder Labral Tear may be suspected by a treating physician based on the history of the affected individual, especially if the individual fits the description mentioned above of people who may be prone to Labral Tears.

If a shoulder labral tear is suspected, a detailed physical examination will be done where the shoulders will be moved in certain directions to observe for any pain with these maneuvers like putting the arms in an overhead position or placing in the arms in front of the body.

Usually, Shoulder labral tears are extremely difficult to visualize even on an MRI or CT scan. This is where introduction of an Arthroscope has been helpful. The arthroscope is an instrument which has a minature camera and it is inserted via small incisions in the shoulders to look for damaged or torn labrum.

Labral Tears can be treated both conservatively as well as surgically.

The treating physician’s first aim is to control the pain that the individual is experiencing. This is done with rest and use of medications like NSAIDs like ibuprofen. If this treatment fails to provide relief then the next course of action is a steroid injection which usually provides good pain relief albeit temporarily.

Apart from this, the physician may also prescribe physical therapy for rehabilitation of the shoulder where the affected individual is taught exercises to improve range of motion followed by strengthening exercises to improve the stability of the shoulders. The therapy usually lasts four about six weeks and majority of the people go back to their usual activities by the end of this timeframe.

In case if all conservative treatments fail to provide any relief of symptoms, then the surgical route is taken. The most common method used for treatment is an arthroscopy in which the arthroscope is inserted in the shoulder. If the tear identified is relatively small then by simply removing any loose edges may treat the symptoms. This procedure is called as Labral Debridement.

In case if the tear identified is a relatively large tear, then the tear needs to be repaired. This is called as Labral Repair.

After adequate treatment of Shoulder Labral Tear, the next most important thing is to rehabilitate the shoulder and get it back to pre-injury status. This is required for both surgical as well as nonsurgical treatments, although the strategies employed are different.

The aim of therapy done after conservative treatment of Shoulder Labral Tear is to strengthen the muscles of the rotator cuff to facilitate smooth movement of the shoulders and make the shoulders stable. To begin with, the exercises will be done under the supervision of a physical therapist and then a detailed home program will be given so as to keep the muscles strong.

Rehabilitation post surgery is quite a complicated affair. The first thing is that the individual will have to be in a sling for several weeks till the wounds are healed. After then, the therapist designs a rehabilitation program and the individual will have to attend therapy sessions which may last for a couple of months which is totally dependent on the type of procedure done and the extent of damage. It usually takes around six months before an individual can go back to full work or sporting activities.

The start of the therapy program will be aimed at controlling pain and swelling postsurgery and will be done with use of ice, electrical stimulation, and massages.

In case of a simple Labral Debridement procedure, the rehabilitation is relatively quick starting with range of motion exercises and gradually advancing to stretching and strengthening. The program usually ends in three months with return to full work and sporting activities.

In cases of a Labral Repair, the rehabilitation progresses a bit slowly beginning with passive exercises and then gradually advancing to range of motion and stretching and strengthening. This program usually lasts for about 10 weeks.

Here are certain exercises which one can do at home as well but before starting these exercises you need to apply a hot pack to the shoulders followed by gentle stretching without aggravating the symptoms.

Sideways, Forward, and Backwards Arm Raises: Taking a light weight in hands, raise the arm in any one direction in a slow controlled manner. This should be done in sets of three with about 10 reps.

Shoulder Shrug: Again with weight in hands by the sides, try and raise the shoulders in a slow controlled manner in sets of three with 10 reps.

Seated Push-Ups: Sit on the edge of a table and then try to raise yourself off of the table by pushing on it and this also should be done in sets of three with 10 reps.

Also Read:

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• Q and A On Causes of Shoulder Pain: 13 Major Medical Conditions Causing Shoulder Pain