What is the treatment for a torn shoulder labrum?

Treatment for a Torn Shoulder Labrum

The treatment for a torn shoulder labrum should begin with nonsurgical management including NSAIDs, activity modification, and physical therapy for most patients, with surgical intervention reserved for those who fail conservative treatment after 3 months or meet specific criteria for early surgical referral. 1

Diagnosis Confirmation

Before initiating treatment, proper diagnosis is essential:

• MR Arthrography is the gold standard for detecting labral tears (86-100% sensitivity), especially in patients under 35 years 1
• Standard MRI without contrast is highly effective with optimized imaging equipment 1
• Plain radiographs should be obtained first to rule out fractures and other bony abnormalities 1

Treatment Algorithm

1. Initial Nonsurgical Management (First-Line Treatment)

• Pain Control:

  • NSAIDs for pain management (high level of evidence) 1
  • Local cold therapy and temporary immobilization for comfort 1
  • Ice, heat, and soft tissue massage may provide additional pain relief 1

• Physical Therapy (Phased Approach):

  • Phase 1: Pain control measures, gentle range of motion exercises, proper positioning education 1
  • Phase 2: Progressive ROM exercises, light strengthening for rotator cuff and periscapular muscles, scapular stabilization exercises 1
  • Phase 3: Progressive resistance training, advanced scapular stabilization, sport-specific training 1

• Special Considerations for Athletes:

  • Throwing athletes require specialized rehabilitation focused on hip, core, and scapular exercise in addition to shoulder motion and rotator cuff balance 2
  • Nonsurgical management can be successful in 53.7% of all athletes and 52.5% in elite athletes 3
  • Success rates increase to 78% in athletes who complete their full rehabilitation program 3

2. Follow-up and Assessment

• Initial follow-up at 1-2 weeks after treatment initiation 1
• Clinical reassessment at 6 weeks to evaluate progress 1
• Rehabilitation progress evaluation at 3 months 1

3. Indications for Surgical Referral

• No improvement after 3 months of appropriate rehabilitation 1
• Patient under 30 years of age with high athletic demands 1
• Evidence of significant mechanical symptoms 1
• Participation in high-demand or contact sports 1
• Evidence of significant Hill-Sachs lesion or Bankart tear on imaging 1
• Clear traumatic episode with symptoms of instability 2

4. Surgical Management Options

• Age < 40 with traumatic injury and instability: SLAP repair 2
• Age > 40 with traumatic injury and instability: SLAP repair with biceps tenotomy or tenodesis 2
• Overuse etiology without instability: Biceps tenotomy or tenodesis 2
• Throwing athletes who fail rehabilitation: Peel-back SLAP repair, Posterior Inferior Glenohumeral Ligament release, and treatment of any partial infraspinatus tear 2

Outcomes and Prognosis

• Successful nonsurgical treatment results in significant improvements in pain, function, and quality of life 4
• Return to sports is possible in many cases, though only 66% of overhead athletes return to the same level 4
• Factors associated with failure of nonsurgical management include:
  • Older age
  • Participation in overhead sports (especially baseball pitchers)
  • Traumatic injury
  • Positive compression rotation test
  • Concomitant rotator cuff injury
  • Longer symptomatic period 3

Important Considerations and Pitfalls

• Pitfall #1: Inadequate physical therapy duration. Patients who discontinued rehabilitation after an average of 8 sessions had poorer outcomes than those who completed approximately 20 sessions 3

• Pitfall #2: Missed diagnosis. Anterosuperior labral tears can be subtle and difficult to diagnose clinically, requiring careful evaluation and appropriate imaging 5

• Pitfall #3: Overuse of corticosteroid injections. While they may provide short-term improvement, they should be limited (typically no more than 3-4 per year) to avoid potential tendon weakening 1

• Pitfall #4: Inappropriate surgical referral timing. Surgical consultation should be considered if there is no improvement after 3 months of appropriate rehabilitation, not sooner unless specific criteria are met 1