LABRAL TEAR
TREATMENT AT GUSTAVEL ORTHOPEDICS

Causes: Labral tears can occur several different ways and can occur on any portion of the labrum. Repetitive or forceful motion of the shoulder, dislocations of the shoulder, or sometimes even normal wear and tear from an active lifestyle can cause the labrum to tear.

Symptoms: Patients experience pain in the area that corresponds to the location of the tear. Pain in the front of the shoulder can indicate damage to the anterior or superior portion of the labrum. Tears of this nature are often related to anterior dislocation or instability of the shoulder. Pain in the back of the shoulder can indicate damage to the posterior labrum often corresponding to a posterior dislocation. Weakness and a catching sensation are other common symptoms of a labral tear.

Diagnosis: After a thorough history and physical exam, x-rays are obtained to rule out any bony pathology. An MRI with contrast is helpful in determining the location of a tear and can also detect any abnormalities in the rotator cuff and the biceps tendon.

Non-operative treatment: Older patients and those that do not put as much demand on the shoulder often do well with PT, NSAIDS, and activity modification. An intraarticular injection can help to reduce pain and inflammation.

Surgical treatment: In high demand athletes, patients who use their shoulder a lot and those who do not respond well to conservative treatment, an arthroscopic shoulder procedure is recommended. In the arthroscopy, the labrum is evaluated and either debriefed or repaired. To prevent further dislocations in those patients with an unstable shoulder, a capsular shift or tightening is performed to help stabilize the shoulder. If the tear involves the biceps tendon (also known as a SLAP tear) the labrum is either repaired anterior to a posterior to the biceps or the biceps is released and reattached in a different location to reduce the strain on the tendon.

Recovery: Patients are in a sling for 3-6 weeks after surgery. Physical therapy is started around 2-3 weeks post-op depending on the severity of the tear. PT is recommended for 4-6 weeks with additional exercises to be performed at home. Return to normal activity is anywhere from 3-6 months.