Welcome to Hicksville Physical Therapy’s patient resource about Labral Tears
Ever since the invention of the arthroscope in the 1960s, the study of orthopedics has grown immensely. Thanks to the new innovation, orthopedic doctors started discovering new parts in the body and conditions they previously didn’t know about. One of the important discoveries they made is about the labrum. The labrum is a piece of fibrocartilage (or rubbery tissue) attached to the shoulder that keeps the ball of the joint in place and allows for easy movement. When the cartilage is torn, the ball may slide out of the socket — this is called subluxation. If the ball slides all the way out of the socket, your shoulder will be dislocated.
We’ll go over the following on this page:
- What the labrum is, and where it’s located
- How your doctor will determine that you have a labral tear
- What you can do for your labral pain
What is the labrum?
The anatomy of your shoulder consists of three different bones: the shoulder blade (scapula), the upper arm bone (humerus) and the collarbone (clavicle).
The head of your upper arm bone contains a flat and shallow socket called the glenoid. The labrum surrounds the glenoid as a soft, fibrous tissue. Together with the glenoid, the labrum helps your shoulder with stability and shock absorption, as well as serving as an attachment site for several different kinds of ligaments.
The rotator cuff is made of muscles and tendons that keep the humerus connected to the scapula. The rotator cuff contains tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis.
ROTATOR CUFF MUSCLES
Your shoulder is responsible for many movements you may not even realize, and your rotator cuff muscles play a large role in that. The rotator cuff allows for your arm to raise and rotate, thanks to the work of tendons and muscles. Tendons help attach muscles to bones, which in turn move the bones by pulling the tendons. The rotator cuff also keeps the humerus tightly fixed in the glenoid, if you move your arm by raising it.
If the soft labral tissue is caught between the humerus and glenoid, the labrum may start to tear. If the tear gets worse, moving your shoulder can become quite painful; when the labrum tears, the shoulder becomes much less stable, and the actions you take for granted everyday can become very difficult.
What causes labral tears?
Labral tears can be caused by direct injury to the shoulder, and if the shoulder is overexerted, a condition called overuse. Your injured labrum can then lead to instability, and that instability may cause your shoulder to dislocate, which will then cause a tear.
The bicep, the large muscle on your upper arm, attaches to the frontal part of your labrum. Many sports can cause your labrum to tear, as they can cause the bicep to pull sharply against your labrum. Baseball is a common sport that can cause labral tears because throwing heavily relies on your shoulder and all its parts. Weightlifting and golfing are other sports that may cause labral tears as well.
What does a labral tear feel like?
A labral tear can be very painful! You may feel a range of sensations, including popping, locking, grinding or catching if you move your shoulder. It will be hard to move the joint, and you may lose strength in your shoulder as well. It’s also possible that the shoulder will ache for several hours, and you may feel the pain while sleeping at night.
If you think you injured your shoulder and suspect you have a labral tear, come to Hicksville Physical Therapy for a proper diagnosis. We’ll be sure to ask you extensively about your injury, and examine your shoulder to see if you specifically have labral damage.
During the examination, we’ll check to see what part of the shoulder is causing your pain symptoms. We’ll mostly ask you to do simple movements, raising your arm or holding it over your head, or having you hold your arm in front of your body, and we’ll also be pushing down on specific areas to check on your pain threshold. Once we’ve finished examining your shoulder, our physical therapists can recommend a myriad of treatments and therapies that will induce your recovery and hopefully lead you back to your active and healthy lifestyle.
Non- surgical Rehabilitation
In some cases, where the tear isn’t too severe, you may not actually need surgery but should still follow a rehabilitation program and of course, ensure you get proper rest at night. Your doctor may also recommend over the counter anti-inflammatory medication, like aspirin and ibuprofen, or temperature treatments with heat or ice for pain relief.
Shoulder instability and not moving your shoulder regularly may actually make a labral tear even worse. A physical therapy routine will try to strengthen the muscles in your shoulder, like the rotator cuffs, in an attempt to stabilize it. Our physical therapists at Hicksville Physical Therapy will work with you on a routine that’s best for you to retrain and improve your shoulder’s movements. Recovery varies, but participating in a rehabilitation program usually ranges from four to six weeks. Most people will be able to resume their daily activities and regain their arm strength in this allotted time. With enough training and routine, your shoulder should become healthy again, and we’ll then help you make a home program for yourself to keep it that way.
If your labral tear is more severe, or you’ve tried physical therapy and haven’t had much luck, surgery may be required to fix your shoulder. Rehabilitation after your surgery is a little more complicated. For weeks after surgery, you’ll probably need to wear a sling to protect and support your shoulder. After the sling is removed, we’ll help you in rehabilitation by developing a personalized recovery program. You may have to attend physical therapy sessions for a month or so, but full recovery will take much longer if you are an athlete looking to get back into your sport, ranging from four to six months.
Restoring mobility of your shoulder is important, but it’s also crucial to protect the tissues that are healing. The first few therapy appointments will focus on whatever pain and swelling results from surgery, like ice or electrical stimulation, massage, and other hands-on treatments to ease such tensions in your muscles.
Arthroscopic surgery is also known as arthroscopy. The surgery is not too invasive, basically involving small cuts to the skin and using the arthroscope to diagnose your problem and then clean up the loose parts of the labrum. You will be able to participate in physical therapy not too long after the surgery, transitioning into your exercises and stretches.
Overhand sports, such as baseball and softball, are unfortunately very prone to shoulder injuries. If you are an athlete who plays such a sport, following your routine will gradually allow you to play again; four to six weeks of physical therapy will allow participation, and you can usually play competitively again within three months.
The first exercise that is usually given after arthroscopy is considered passive exercises. With these exercises, your muscles stay in place while the shoulder joint is moved; your therapist will also stretch your arm. These exercises are easily practiced at home.
More intensive, active therapy will usually begin six weeks after your arthroscopic surgery. Light isometric exercises, such as planking, isometric pushups, and low squats, may be assigned to work your muscles without putting too much pressure on the repaired joint.
At around week ten, you may be introduced to active strengthening. These exercises focus on improvement and strengthening of the rotator cuff muscles, tightening the ball of the humerus and improving your shoulder’s stability. Stability in your shoulder is important to keep the ball of the humerus cemented in its socket.
Our trained physical therapists are here to help regain your shoulder’s working mobility while making sure it’s not put through too much stress. Our exercises will attempt to mimic your routine so that you won’t have too much of a problem going back to your everyday activities. We’ll make sure not to strain it too much, and teach you methods that will prevent future problems.
Two types of scans are used to detect labral tears: MRI (magnetic resonance imaging) scans and CT (computed tomography) scans.
An MRI is a special imaging test using a magnetic field and radio waves to create images of the body part being examined. In this case, it’s your shoulder, specifically your tendons and bones. Meanwhile, a CT scan uses X-rays to make images of the tissues in your shoulder. CT scans are less expensive than MRIs, take less time, and more commonly used, but are also an older technology. MRIs can show diseases that CT scans are unable to detect.
Though medical technology has come a long way and continues to improve, a labrum tear can be tricky and hard to see; MRIs and CT scans may have trouble detecting your labral tear. Instead, a surgeon may use an arthroscope. The surgeon will make a small incision into your joint and insert a small tube that contains a camera and light that will be used to examine your joint, the arthroscope. This is the easiest way to detect a torn labrum.
If your pain is too much to bear, your doctor may also suggest giving you a cortisone injection. You may have already heard of this treatment as it’s used for arthritis, but cortisone is an anti-inflammatory that is commonly used to treat joint problems. The effects of cortisone are usually temporary, but can still last a few months, and can provide good relief to your injury.
However, if your symptoms continue to persist, you may have to consider surgery. Research is still being done on how to effectively treat labral tears, as the injury is still relatively new in the medical world. Despite limited knowledge, the medical world is constantly making new discoveries, and your doctor will ensure you are in the best hands at Hicksville Physical Therapy.
Again, the arthroscope is specifically used to view and treat labral tears. The labral debridement procedure is a minimally invasive approach that can help reduce tearing. The procedure will simply remove the frayed edges and loose parts of the labrum, if the tear is relatively small, in attempt to assuage your symptoms.
However, if the tear is larger, a larger surgery called an arthroscopic repair may need to be performed instead. With this surgery, anchors are placed into the bone around the shoulder joint, and sutures (or stitches) are attached to the tendons, and will enable the labrum to heal by returning it to the appropriate position.
Since arthroscopic techniques have evolved and become very reliable, open procedures are now rarely used to treat labral tears. However, if your tear is recommended for an open procedure, the surgeon will need to make a larger incision in the front of your shoulder. Making this larger incision will require a longer recovery time.