Shoulder Labrum Repair
The shoulder is a ball and socket joint which is similar to the hip joint. However, the socket of the shoulder joint is not very deep which makes it essentially unstable, which results in the bones of the shoulder not being adequately held in place. In order to gain stability, extra support is required, and this is provided by the labrum.
What is the Labrum?
The labrum is a piece of rubbery cartilage and is essential for the proper functioning of the shoulder. It circles the shallow shoulder socket (glenoid) and cups the ball-shaped joint at the top of the upper arm bone (humerus), connecting the two joints.
The group of 4 muscles called the rotator cuff helps the labrum keep the ball in the socket which in turn allows the upper arm to rotate. The range of movements the shoulder can make far exceeds any other joint in the body, but repetitive motion and injuries can tear the labrum, often causing pain.
Types of Labrum Tears
The are 3 main types of labrum tear. They are as follows:
SLAP tear or lesion
A SLAP tear affects both the front and back parts of the labrum. SLAP stands for Superior Labrum, Anterior (front) to Posterior (back). This is the most common of all labrum tears and is very common amongst athletes, particularly sports which involve a lot of overhead movement such as baseball, tennis and volleyball. They can also occur through injury, such as a sudden fall where the shoulder is extended to break the fall, dislocation of the shoulder and general wear and tear. They can also occur with damage to the biceps tendon.
Bankart tear or lesion
Bankart tears occur when the top of the arm bone moves forward or backward in its socket and the lower part of the labrum tears. Bankart tears are more common in younger people; they leave the shoulder very unstable, often causing shoulder dislocation.
Posterior Labrum tears
A posterior tear occurs at the back of the labrum and is sometimes recognised in athletes as a shoulder impingement. This is caused by the rotator cuff and labrum pinching together in the back of the shoulder. Posterior tears are rare and make up approximately 5% – 10% of all shoulder injuries.
Symptoms of a Shoulder Labrum Tear
Typical symptoms of a labrum tear depend on where the tear is located. However, common symptoms include the following:
- A locking, catching, grinding or popping sound when you move your shoulder
- Reduced range of motion in the shoulder
- An aching sensation in the shoulder
- Pain with specific activities
- Stiffness in the shoulder
- Potential of shoulder dislocation with a Bankart tear
- Weakness in the shoulder
Causes of a Labrum Tear
Labrum tears are most common in sportspeople who perform overhead movements such as basketball players, tennis players and weight lifters. The labrum can also be torn if you fall or hit your shoulder with force. Other causes include:
- Gradual wearing down of the labrum as you age
- Shoulder dislocation
- A sudden tug on the arm
- A violet blow while reaching overhead
- A direct hit to the shoulder
Diagnosing a Labrum Tear
A detailed history of the injury will be taken by your doctor. It is important that you provide as much information as possible, including when and where the injury occurred, and the level of pain you are currently experiencing. Your doctor will also carry out a physical examination of the shoulder to determine its stability, strength, range of motion and pain level. This will enable your doctor to detect the different types of tears.
Diagnostic tests are often carried out in addition to a physical examination. An MRI is usually the best form of imaging to detect a labrum tear, but an X-ray is often performed in order to rule out any bone fractures. If there is a specific concern regarding the injury, an MRI is performed by injecting gadolinium enhancement dye in the shoulder joint. This significantly improves the accuracy of the MRI in detecting the tear.
Treatment for a Labrum Tear
Treating a torn labrum depends on the type of tear you have incurred. Generally though, there are 2 approaches for the treatment of a labrum tear. This can either be non-surgical (conservative) or surgical treatment. Doctors will usually begin treatment by using conservative techniques, allowing the body to try and heal the injury and for inflammation to subside. This includes:
Over the counter or prescribed medication may be taken to decrease pain and swelling in the shoulder. Cortisone (steroid) injections can also assist with pain relief.
Your doctor may refer you for physiotherapy to help improve the strength of the shoulder muscles in order to take the stress off the damaged labrum in the shoulder. Your physiotherapist will demonstrate a range of exercises and stretches which you can perform at home. You will also be shown what positions and activities to avoid.
Most labrum tears do not require surgery, but in patients who have persistent symptoms despite exhausting conservative treatments, surgery may be required. Your Consultant will discuss your options with you.
Labrum tears that require surgery are usually treated using a minimally invasive arthroscopic technique known as keyhole surgery. The surgeon will place a small camera in your shoulder joint which sends images to a large screen in the operating theatre. By using small tools, the surgeon can remove and repair the damaged part of the labrum. This can include cutting off any flaps or damaged cartilage which are preventing full range of motion.
Post-surgery, you will be required to wear a sling for the first 4 weeks in order to keep your shoulder immobilised. Once the swelling has subsided, you can begin to move it with guidance from your physiotherapist.
You will be given a programme of physical therapy which will start with range of motion exercises, and gradually progress to stretching and strengthening.
Labrum surgery typically takes 6 – 9 months to completely heal, depending on the type and severity of the tear. Most patients regain full use of their shoulder and are able to return to their normal level of physical activity. Athletes may not be able to fully return to their sport for at least 6 months, although most do eventually get back their ability to play.
At One Healthcare we can book you in to see a specialist Orthopaedic Shoulder Surgeon for an initial consultation, usually within 48 hours. Labrum tear repair surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.
You can use your private medical insurance or pay for your Shoulder Labrum Repair treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance please do contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.
Why One Healthcare
- Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
- Fast access to diagnostics including MRI, Xray and Ultrasound
- Private, spacious, en-suite rooms
- Specialist Physiotherapy and nursing teams
- Little or no waiting time
- ‘Ultra clean air’ theatres
- Freshly prepared food
- Calm, dignified experience
Mr Jai Relwani
Consultant Orthopaedic Surgeon; Clinical Lead - Shoulder & Elbow Service
One Ashford Hospital
Mr Rajeev Sharma
Consultant Orthopaedic Surgeon - Upper Limb Surgery (Shoulder, Elbow, Wrist and Hand)
One Hatfield Hospital