Shoulder Pain: Labral Tears
What You Need to Know About The Labrum
Basic Shoulder Anatomy and The Labrum:
The labrum is the cup-shaped rim of cartilage that lines and reinforces a ball-and-socket joint. In the shoulder, this joint is composed of the glenoid – the shallow shoulder socket – and the head (or ball) of the upper arm bone known as the humerus. The labrum is the attachment site for tendons and muscles. It contributes to shoulder stability.
Humerus – Upper Arm Bone
Scapula – Shoulder Blade
Clavicle – Collarbone
Glenoid – Socket for Head of the Humerus
What does a labrum tear mean for your shoulder?
Because of the structure and function of the labrum, any damage to it may increase general instability within the joint. A torn glenoid labrum can also lead to partial or complete shoulder dislocation. Labrum tears will significantly decrease strength, especially when the arm is extended overhead. This presents problems for athletes who spend a lot of time with arm motions needed to succeed in their general sports, such as baseball, tennis, and swimming.
We discussed overactive and underactive shoulder cuff muscles in our previous post titled: The Rotator Cuff: Tear, Impingement or Imbalance?. We addressed diagnosing and possibly solving common muscular imbalance issues that may feel like a labrum tear. This post actually addresses diagnosed labrum tears that have been validated by imaging.
Causes of Injury:
- Fall or blow to the shoulder
- Weight lifting activities
- Impact in an outstretched arm position
- Most often occur because of muscle weakness or shoulder joint instability. This can coincide with our last article titled: The Rotator Cuff: Tear, Impingement or Imbalance?.
- People with nontraumatic tears tend to have more “looseness” or greater mobility throughout all their joints. Overhead athlete may also have some hyper mobility known as “joint laxity.”
What does a labrum tear feel like?
A labral tear doesn’t always cause pain. Typically it can cause general weakness, create clicking, catching, popping, or a grinding feeling when the shoulder moves into certain positions. Labral tears create a decreased range of motion, loss of strength, and a general sense of motor control through the shoulder.
Diagnosing Labral Tears:
First and foremost, go to a doctor or sports medicine specialist to receive proper care and diagnosis. Don’t use this article to self diagnose.
Your doctor will perform a number of tests on the arm to see where pain symptoms appear and if there is a decreased level of stability.
An x-ray may be recommended to see if there are any other issues that could be causing the pain. But, because x-ray imagining doesn’t show soft tissue, it won’t show if there is damage to labrum itself. For this the doctor may recommend a CT scan or MRI.
Rehab Protocol for Labral Issues:
The severity of the injury may require a greater need for a rehab process.
Some labrum injuries do not require surgery. Most doctors will prescribe anti-inflamitory medication, such as ibuprofen or asprin, to help control swelling and pain. Some may prescribe a cortisone shot to help manage pain, but this is only a temporary solution. A good rehab program will strengthen and help balance the rotator cuff muscles to tighten/straighten the shoulder and hold the head of the humerus in a better position within the glenoid or cup. Again, the timetable will be dependent on the stability, strength, pain in the shoulder, and the physical therapists’ recommendation for return to play.
If surgery is necessary, typically the arm will be immobilized in a sling for approximately 3-4 weeks before a rehabilitation program can begin. The whole process from surgery to full athletic participation typically takes 3 to 4 months. It’s a long process and atrophy in the upper body is inevitable.
Injury Prevention Should Be An Early Habit, Not A Reaction.
Labral tears are relatively new to the injury world and they were discovered with advances in modern medicine. These types of injuries have sky rocketed in recent years, not because they are new injuries, but because now we have the technology to properly diagnose the injury and intervene.
From an athletic performance perspective they are injuries that need to be addressed. Many labral injuries will go undiagnosed because they may not cause a pain. As coaches, we need to make sure that we are ensuring our athletes have stable and strong shoulders. The shoulder has the largest range of motion of any joint in our body, and a dysfunctional shoulder can not only hurt performance, but can cause injury to the shoulder as well as other areas in the body.
This isn’t just an issue for an overhead athlete such as a baseball player, swimmer, or tennis athlete. Healthy shoulders perform better and can absorb force without injury. All athletes are built differently. Addressing these differences in a very personal setting can help to stabilize a joint very susceptible to instability. Whether it is a contact sport, or just an athlete falling to the ground, a healthy shoulder will keep athletes competing and not on the sideline where they shouldn’t be.
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