What is the treatment for a shoulder labrum tear?

Treatment for a Shoulder Labrum Tear

The treatment for a shoulder labrum tear should begin with conservative management, including physical therapy, activity modification, and anti-inflammatory medications, with surgical intervention reserved for cases that fail to respond to non-operative treatment. 1

Diagnostic Approach

• Initial evaluation should include standard radiographs with at least three views: anteroposterior (AP) views in internal and external rotation and an axillary or scapula-Y view 1
• MRI without contrast is appropriate for suspected labral tears with negative or indeterminate radiographs 1
• MR arthrography is considered the gold standard for imaging labral tears, particularly in patients under 35 years of age 1
• CT arthrography may be appropriate if MRI is contraindicated 1

Conservative Management

• Non-operative treatment should be the first-line approach for most labral tears, with approximately 70% of patients experiencing successful outcomes 2, 3
• Conservative treatment protocol includes:
  • NSAIDs for pain and inflammation control 4
  • Physical therapy focusing on scapular stabilization exercises and posterior capsular stretching 4
  • Activity modification to avoid aggravating movements 5
• Patients who complete their rehabilitation program have significantly better outcomes (78% return-to-play rate) compared to those who discontinue early 3
• A minimum of 20 physical therapy sessions is associated with successful non-operative treatment, compared to an average of 8 sessions in those who fail conservative management 3

Surgical Management

• Surgical intervention should be considered after failure of conservative treatment, typically after 3-6 months 5, 4
• Factors associated with higher likelihood of requiring surgery include:
  • History of trauma 2
  • Positive compression-rotation test 2, 3
  • Participation in overhead activities, especially baseball pitchers 2, 3
  • Older age and longer symptomatic period 3
  • Concomitant rotator cuff injury 3
• Surgical options include:
  • SLAP repair - traditionally used for younger patients and athletes 5, 6
  • Biceps tenodesis - increasingly used as an alternative to SLAP repair with encouraging outcomes (70% return-to-sports rate) 6

Special Considerations for Athletes

• Return-to-play rates following conservative treatment vary by level of competition:
  • 69% for recreational overhead athletes 6
  • 80% for competitive/collegiate athletes 6
  • 60% for professional athletes 6
• Throwing athletes represent a special category and should receive rigorous physical therapy focused on hip, core, and scapular exercise in addition to shoulder motion and rotator cuff balance 5
• Only 66% of overhead athletes return to their pre-injury level following conservative treatment 4

Common Pitfalls to Avoid

• Failing to obtain adequate imaging can lead to missed diagnoses 7
• Overlooking associated injuries, particularly in traumatic cases 7
• Prematurely abandoning conservative treatment before completing an adequate rehabilitation program 3
• Not recognizing factors associated with poor response to conservative treatment, which may delay appropriate surgical intervention 2, 3