Torn Labrum

The labrum, the cartilage around the arm socket, supports the shoulder joint and gives the arm socket sufficient depth to fit the arm bone and facilitate movement. A quarterback, baseball pitcher and tennis players are particularly vulnerable to shoulder joint tears.

Think about a quarterback's throwing motion. Rotating the arm outward when preparing to throw contracts the biceps and drags on the labrum. For the non-athlete, lifting heavy objects can result in a torn labrum.

 "The best-case scenario with surgery would be a good-as-new shoulder, but many elite throwers can have difficulty reaching their pre-injury level," says Dr. Clifford RiosBone & Joint Institute orthopedic surgeon and board-certified in sports medicine. "An injury like this can shorten career length, but not all labral tears are the same. A larger tear, or tear of the superior labrum may be more problematic."

When it happens to an athlete, the injury is often described as the shoulder popping out of socket or a feeling that something is "catching." It's a sensation than signals the beginning of prolonged inactivity.

"Depending on the size or extent of the labral tear," says Dr. Rios"you can expect 6-8 months before a throwing athlete is ready to return to play."

Because labral tears are difficult to see, your doctor will request a diagnostic test such as an MRI that will show shoulder tissues and a CT scan that uses a special dye that outlines the labrum. With a CT scan, a type of computer-enhanced X-ray, the dye reveals the outline of the labrum.

Labrum Tears

Two types of should labrum tears:

1. Superior Labral Anterior to Posterior, or SLAP: A tear often attributed to repetitive motion, normal wear and tear, age or acute trauma.

Common types of SLAP tears:

Type 1: Fraying at the top of the labrum, though it remains attached to the glenoid (part of the shoulder). Probable cause: Aging. Treated non-surgically.

Type 2: Labrum and biceps tendon separated from the glenoid's top. Usually repaired with arthroscopic surgery.

Type 3: The torn labrum can sag into the shoulder joint as the biceps tendon remains intact. Usually treated arthroscopically.

Type 4: A tear that reaches into the biceps tendon. The amount of damage to the biceps tendon determines the treatment.

Recovery/Treatment: Recovery for most patients who undergo labrum surgery is nine months to one year.

Acute pain: 4-6 weeks. (This includes difficulty sleeping.)

Strengthening/stretching: Three to four months. Continued discomfort, however minimal, in the shoulder.

Final stage: 6-12 weeks. Adjusting to a new lifestyle of maintenance exercise.

"Ongoing strength and conditioning is part of an elite thrower's workout plan" says Dr. Rios. " Once healed, he will continue his strength program as usual."

2. Bankart Tear: A byproduct of a shoulder dislocation, usually in a patient under 30 years old. This injury can be teated with rest, followed by physical rehabilitation. If surgery is required, your doctor can reattach the torn ligament to the shoulder socket. Because the labrum does not heal perfectly, this type of injury can leave you susceptible to another shoulder dislocation. 

Some players can play with a torn labrum depending the injury's severity. For some, a shoulder brace or harness can help by protecting the shoulder and limiting movement. Pain medication and over-the-counter anti-inflammatories can be helpful, too.

Labrum Surgery

A small tear that "catches" as you move your shoulder is usually removed. In this arthroscopic procedure, called a labral debridement, the frayed edges and any loose segments of the labrum are removed.

A larger tear could require repair instead of removal. Sometimes your doctor will reattach the labrum, anchoring into the bone surrounding the shoulder joint, using an arthroscope.


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