What is a labrum tear and how is it treated?

Understanding Labrum Tears and Their Treatment

A labrum tear is an injury to the cartilage rim surrounding the shoulder socket that can cause pain and instability, and is best diagnosed with MR arthrography which has 86-100% sensitivity for detection. 1, 2

What is a Labrum Tear?

The labrum is a ring of cartilage that surrounds the socket (glenoid) of your shoulder joint. It helps to:

• Deepen the socket to improve shoulder stability
• Serve as an attachment point for ligaments
• Create a suction seal to help keep the ball of the humerus in place

Types of Labrum Tears

Labrum tears can occur in different locations around the glenoid:

• Anterior tears: Occur at the front of the shoulder, often causing instability
• Posterior tears: Occur at the back of the shoulder, often causing pain
• Superior tears: Known as SLAP (Superior Labrum Anterior and Posterior) tears
• Combined tears: Involve multiple regions of the labrum

Research shows there are actually 10 distinct tear patterns, including 90°, 180°, 270°, and 360° tears, with posterior labral tears being more common than previously thought (74% of tears involve some portion of the posterior labrum) 3.

Symptoms of Labrum Tears

Symptoms vary based on the location of the tear:

• Anterior tears: Primarily cause instability (62.5% of cases) 3
• Posterior tears: Primarily cause pain (68% of cases) 3
• Common symptoms include:
  • Shoulder pain (especially with overhead activities)
  • Catching, clicking, or popping sensations
  • Decreased range of motion
  • Feeling of instability or "giving way"

Diagnosis

MR arthrography is considered the gold standard for diagnosing labral tears, with sensitivity ranging from 86-100% 1, 2. The diagnostic approach includes:

1. Initial imaging: Plain radiographs to rule out fractures and bony abnormalities
2. Advanced imaging:
   • MR arthrography: Gold standard, especially for patients under 35
   • Standard MRI without contrast: Highly effective with optimized equipment
   • CT arthrography: Third choice, only if MRI is contraindicated

Physical examination findings may include:

• Positive anterior hip impingement test
• Pain at the bicipital groove
• Limited range of motion

Treatment Options

1. Conservative Management (Non-surgical)

Conservative treatment should be the first-line approach for most labrum tears 2, 4. This includes:

• Pain control:

  • NSAIDs (if no contraindications)
  • Acetaminophen
  • Local thermal interventions (heat or cold)

• Physical therapy:

  • Scapular stabilization exercises
  • Posterior capsular stretching
  • Progressive rehabilitation program

Studies show that patients who complete a full rehabilitation program (averaging 20 sessions) have a 78% return-to-play rate, compared to only 53.7% overall 5, 4.

2. Corticosteroid Injections

• May provide short-term pain relief
• Should be limited (typically no more than 3-4 per year)
• Consider potential adverse effects on tendon biology and healing capacity 2

3. Surgical Management

Surgical consultation should be considered if:

• No improvement after 3 months of appropriate rehabilitation
• Patient is under 30 years with high athletic demands
• Evidence of significant mechanical symptoms 2

Surgical options include:

• Labral debridement: Removal of damaged tissue
• Labral repair: Reattaching torn labrum to the glenoid rim
• Labral reconstruction: For extensive tears 6

Arthroscopic repair of SLAP lesions with extensive tears has shown good outcomes, with significant improvements in range of motion, function scores, and pain reduction 6.

Recovery and Return to Activity

• Conservative treatment: Return to play generally occurs within 6 months 5
• Post-surgical rehabilitation: Follows a phased approach:
  • Phase 1: Pain control, gentle range of motion exercises
  • Phase 2: Progressive ROM exercises, light strengthening
  • Phase 3: Progressive resistance training, sport-specific training 2

Return to sports after successful treatment:

• Overall return to sports: 71% of athletes
• Return to overhead sports at same level: 66% of athletes 4

Factors Associated with Treatment Failure

Factors that may predict poor response to conservative treatment include:

• Older age
• Participation in overhead sports (especially baseball pitchers)
• Traumatic injury
• Positive compression rotation test
• Concomitant rotator cuff injury
• Longer symptomatic period 5

In these cases, surgical intervention may be more appropriate as the initial treatment.