Shoulder Labrum Tears

SLAP tears is an injury to the labrum at top of the shoulder socket where the biceps tendon attaches to the shoulder called the superior labrum. SLAP tears extend from the front to the back of the biceps tendon attachment point. Thus, the biceps tendon may also be injured.

A SLAP tear most commonly occurs in athletes who perform an overhead throwing motion, such as tennis and baseball players. Symptoms include pain, weakness, and a feeling of instability in the shoulder.

Labrum tears can result from a variety of factors, including:

• Trauma: Direct injuries such as falls onto an outstretched hand, car accidents, or a direct blow to the shoulder can cause labrum tears. Injury may also result from a forceful pulling on the arm or rapid forceful arm movements when the arm is above shoulder level.
• Repetitive overuse: Athletes and individuals involved in activities that require repetitive overhead motions (e.g., throwing sports, swimming, weightlifting) are at a higher risk of developing labral tears due to the constant stress on the shoulder joint.
• Shoulder dislocation: When the shoulder dislocates, it can pull or tear the labrum away from the bone, often resulting in a Bankart tear.
• Degeneration: As part of the natural aging process, the labrum can weaken and tear due to gradual wear and tear. Fraying and tearing of the superior labrum can be seen in adults over the age of 30.

Symptoms of a shoulder labrum tear can vary depending on the type and severity of the tear but commonly include:

• A deep, achy pain in the shoulder, particularly with overhead activities or when the shoulder is in specific positions.
• Some individuals may feel a catching, popping, or clicking sensation in the shoulder during movement.
• Weakness in the shoulder, particularly during lifting or pushing activities.
• Difficulty moving the shoulder, especially during overhead motions or reaching behind the back.
• A feeling that the shoulder may slip out of place or “give way,” particularly during certain movements.

Dr. Cinque will review your medical history and injury history, and inquire about how you injured your shoulder, your symptoms and when symptoms began. He will perform an orthopedic physical examination, where he may perform specific maneuvers to test shoulder stability and to pinpoint the source of pain.

While standard X-rays can help rule out bone abnormalities, they cannot detect labrum tears. Magnetic Resonance Imaging (MRI), particularly with the use of a contrast dye (MRI arthrogram), is the most effective tool for visualizing labral tears and assessing the extent of the damage.

In some cases, shoulder arthroscopy may be necessary for a definitive diagnosis. This minimally invasive surgical procedure involves inserting a small camera into the shoulder joint to directly visualize the labrum and any associated injuries.

The treatment for a shoulder labrum tear depends on factors such as the type, size, and severity of the tear, as well as the patient’s age, activity level, and overall health. In most cases initial treatment is conservative nonsurgical management.

Nonsurgical Management

• Rest and activity modification: Avoiding activities that exacerbate the pain, particularly overhead or heavy lifting, is crucial to allow the labrum to heal.
• Physical Therapy: A tailored physical therapy program focuses on strengthening the shoulder muscles, improving range of motion, and enhancing shoulder stability. Specific exercises may help alleviate symptoms and restore function.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.
• Injections: Corticosteroid injections into the shoulder joint may provide temporary relief from pain and inflammation.

Surgical Options

When conservative treatments fail to alleviate symptoms or when the tear is large and affects shoulder stability, surgery may be recommended. Dr. Cinque will determine the best treatment for each patient.

• Arthroscopic surgery: Arthroscopy is a surgical technique use to repair labral tears. During this minimally invasive procedure, Dr. Cinque uses small instruments and a camera to remove frayed tissue, reattach the torn labrum, and address any other issues within the shoulder joint. Labral repair involves suturing the torn labrum back to its original position to restore shoulder stability. This is commonly performed in cases of SLAP and Bankart tears. In cases where the tear cannot be repaired, Dr. Cinque may remove the damaged tissue to alleviate symptoms. This is called debridement.