Noticed instability in the shoulder? Popping or cracking sounds? Limited range of motion? Chances are you have a labrum tear. Here’s what to do about it.
The shoulder joint connects the glenoid (the “socket”) and the humerus (the “arm”.) Unsurprisingly, the shoulder joint is called the glenohumeral joint. The joint itself is ball-shaped (humeral head)—that’s why we can move our arms in so many directions.
Stabilizing the humeral head is a piece of cartilage—a soft, spongy tissue—called labrum. It keeps the joint in place during movement. Damage to the labrum can cause tremendous pain, shoulder instability and significantly reduced range of motion.
Labral tears can occur both due to trauma or reoccuring wear-and-tear, such as sports or heavy mechanical work where you have to lift heavy objects—especially overhead. Physical therapy should always be explored when considering treatment options; surgery is employed when more immediate measures are required. Today, however, there’s a third option.
What Is a Labrum Tear?
The bit of cartilage, called the glenoid labrum, provides extra stability and support for the shoulder joint. It helps keep the humeral head in the glenoid socket upon movement.
A labrum tear is a condition when the glenoid labrum is damaged—a part of the protective cartilage is worn out or torn. A torn labrum can cause intense shoulder pain, joint instability in the shoulder and even shoulder dislocation. Likewise, a shoulder dislocation—along with other shoulder traumas—can cause a labrum tear.
The shoulder joint is best imagined as a golf ball (the humeral head) that is placed into a socket. In this analogy, the labrum would be a tight plastic layer in the socket—it fits the ball’s size perfectly (to keep it in place), yet is slick to enable frictionless rotation.
When the labrum is healthy, the ball rotates freely in all directions, while maintaining safely in place the whole time. However, when the labrum is damaged, the ball may fall out of the pocket or get stuck when rotated in certain directions. Either way, the joint becomes unstable and may cause pain.
Heavy biceps exercises often become the cause of labrum tears, since the bicep tendon tightly grips the labrum. When the bicep receives a heavy exercise load, the tendon tightens, causing damage to the labrum.
Usually, labrum tears occur due to a traumatic event—for example, a shoulder dislocation or a weight lifting accident. It is not uncommon for people whose day-to-day life involves lifting heavy objects overhead (transportation, gymnastics, construction) to suffer from damage to the labrum.
Small, repetitive injuries occur when force is exerted away from the shoulder, too—for example, hitting a nail or hitting a tennis ball with a racket. An unsuccessful fall on your shoulder can also be the cause of a labrum tear.
It is also possible to develop small-scale labrum tears due to natural shoulder instability. For example, when the muscles supporting the shoulder are weak, the labrum has to do more supportive work, which accelerates the degenerative process. Genetics play a role as well, as some people have naturally loose joints. When the joints are naturally loose, the labrum is worn out quicker. When the cartilage is thinned out and weak, even small traumatic events can cause serious damage to the labrum.
What Does a Labrum Tear Feel Like?
People often live years without realizing they have a torn labrum. It usually takes a while before the tear causes actual pain, and people usually don’t pay too much attention to the cracking or popping sounds in the shoulder upon movement—which are characteristic to labrum tears.
The pain is usually sharp and aggravated by specific movements. For example, you may feel sharp, sudden pain when lifting a bag off the table or raising your hand all the way up.
Naturally, instability in the shoulder is a clear indication of a labrum tear. Observe your shoulder when stretching or performing exercises. If you feel like the shoulder can “pop out” of its socket at any moment, it’s a strong indication that you may have a labral tear.
How to Diagnose Labrum Tear?
As we mentioned before, people only suspect they have a labrum tear after a serious traumatic injury. Many smaller labrum tears remain undiagnosed for years. This is particularly dangerous, since when the labrum accumulates many smaller injuries over the years, the joint may not receive the blood supply it needs to heal.
Even if you have the smallest suspicion that you may have a deteriorating labrum, it is highly recommended that you set an appointment for a shoulder examination. The labrum will not heal back on its own due to a limited oxygen and nutrient supply, which means that it will continue to deteriorate—and, eventually, break down, causing pain and immobility.
When you do go for a physical examination, your doctor will review your medical history to look for indications of previous shoulder joint damage. They may also ask whether any of your family members suffer from shoulder problems—as we mentioned before, labrum problems are highly dependent on your musculoskeletal structure (how well the humeral head fits into the glenoid socket.)
During the exam, the physical therapist will simulate different arm movements to detect precisely which motions cause the pain or instability. MRI and X-ray scans may be performed to get a better picture of the shoulder joint. Some labrum tears can be difficult to diagnose without arthroscopy—a surgical procedure.
Labrum Tear Treatment: Non-Surgical Options
Due to the mechanical nature of the issue, labrum tear patients can benefit tremendously from physical therapy. Naturally, physical therapy is usually employed when there’s little-to-no shoulder instability. For major traumas that result in labrum tears, physical therapy is often out of the question.
The main goal of physical therapy in labrum tear treatment is to stretch and strengthen shoulder and the surrounding muscles so that they can support the shoulder better. This way, stress is taken off the labrum and distributed across a group of connected muscles—the deterioration of the cartilage is slowed down, and the pain is reduced.
Stretching exercises also play a major role in dealing with labrum tears. Through stretching the chest and back muscles, a more fluid, frictionless arm movement is enabled. When there’s less friction during arm and shoulder movements, there’s less pressure on the labrum to keep the shoulder joint in place.
It is also important to work on your posture. Lifting your arms overhead can be seriously detrimental to the glenoid labrum when performed with bad posture.
In short, physical therapy will not “fix” the damage to the cartilage. But it will fix the “underlying pathology” that has caused the damage in the first place.
Labrum Tear Treatment: Surgical Options
When the labrum tear is serious and is causing severe pain and/or shoulder instability, more immediate measures are required. Physical therapy can alleviate the symptoms of the labral tear; surgical intervention has the potential to fix the problem, even if it does present serious health risks.
The first surgical step is shoulder arthroscopy, during which the entire labrum will be examined. Depending on the exact problem, one of several surgical options will be selected:
- If the labral tear appears to be unstable with detachment of the labrum from the socket of the shoulder, the surgeon will repair the labrum back to the socket of the shoulder.
- If the tear involves only a flap of tissue torn from the labrum without detachment of the labrum from the underlying bony socket of the shoulder, the surgeon may just shave the flap of tissue away from the underlying intact labral tissue.
- If the labral tear occurs at the site of the biceps tendon (SLAP lesion) or if the tear extends into the biceps tendon, the surgeon will sometimes need to repair the labral tear and reattach the tendon using absorbable tacks, wires, or sutures.
- In cases where the labral tear is associated with shoulder instability or dislocations, the surgeon will not only repair the labrum but will also tighten up the stretched-out ligaments of the shoulder as well as tighten up the capsule to restore joint stability.
It takes from 8 to 12 months for the labrum to heal fully. You’ll have to wear a sling for 3-4 weeks after the surgery. You’ll be instructed how to move your arms in a way that minimizes wear-and-tear to the shoulder labrum.
While the upside is appealing, surgical treatment options also have serious downsides. The most common complication is “recurring shoulder instability”, which basically means that the surgery fails to fix the problem. In such cases, revision surgeries are required.
According to this 2015 review, “recurrent shoulder instability is the most common complication after labral repair.”
Among other complications are:
- Nerve injury.
- Postoperative stiffness.
Labrum Tear Treatment: Stem Cell Therapy
Both physical therapy and surgical options have serious drawbacks. Physical therapy takes a long time to work and is mostly aimed at alleviating the symptoms, not solving the issue. Surgical options have the potential to fix the damaged glenoid labrum, but they come with serious health risks—and they do not always fix the issue.
Stem cell therapy has the potential to combine the best of both worlds through a naturally regenerative approach.
What Is a Stem Cell?
There are 7 main types of body cells:
- Bone cells. These form combinations of collagen and calcium phosphate minerals, which, in turn, form our bones and the skeletal system.
- Blood cells. Red blood cells, white blood cells and platelets ensure the proper functioning of our body—from transporting oxygen to fighting infection.
- Muscle cells. These form muscle tissue, which enables body movement and supports our skeletal system.
- Fat cells. Also known as adipocytes, these cells store energy, produce hormones and regulate blood pressure.
- Skin cells. Coming together to form dermis and epidermis (skin tissues), these cells regulate hydration, control body temperature and prevent body organs from external damage.
- Nerve cells. A basic building block of our nervous system, nerve cells transmit signals throughout our body and into the brain.
- And… stem cells. These act as the regenerative building blocks, repairing damaged tissue all over the body.
A stem cell can become any one of these cells. Once they do, they reach maturity and function as the designated cell type.
In fact, this regenerative process happens all the time without us knowing.
What Is Stem Cell Therapy?
Stem cell therapy revolves around gathering stem cells, concentrating them and then transplanting them into the injured area, where they help the body regenerate. Here’s a breakdown of the whole process.
Step 1: We Harvest Stem Cells
Depending on the chosen source of stem cells—whether it’s the patient’s bone marrow, adipose tissue (fat) or an umbilical cord—the first stage of stem cell therapy is to actually collect them.
With bone marrow stem cells:
- A needle will be placed into the bone marrow, and a sample will be harvested
- Up to 500 million stem cells can be collected from the patient’s bone marrow using a needle, typically from the patient’s Iliac crest
With adipose tissue stem cells:
- A small “liposuction” procedure will be performed, during which a sample of fat tissue will be harvested
- The amount of stem cells harvested with adipose tissue varies
With umbilical cord stem cells:
- These arrive in predetermined doses from certified partner clinics of 5, 15 and 30 million stem cells
Step 2: We Concentrate and Activate Stem Cells
There is a big myth (mouthfed by marketers) that stem cells are somehow modified before transplantation.
What exactly is minimal manipulation? Here is the answer:
- The processing of the tissue does not alter its original characteristicsc
- The processing does not alter any biological characteristics of cells and tissue
This is very important, because chemically or otherwise manipulating stem cells before transplantation means it’s virtually impossible to predict how these cells would predict once in the patient’s body.
It’s also important to emphasize that we do not multiply stem cells in the lab through manipulation.
All stem cells are naturally pre-programmed to divide a specific number of times:
- Bone marrow aspirate stem cells multiply up to 5 times
- Adipose tissue stem cells multiply up to 8 times
The multiplication itself can happen in lab conditions or in the patient’s body—but we have nothing to do with that. The cells themselves do the work.
So, then, what do we do before transplantation? Here is a quick rundown:
- Stem cells are concentrated using a double spin method in a highly specialized centrifuge and a required amount is prepared
- We activate stem cells with a small dose of Platelet Rich Plasma, which allows stem cells to thrive in the new environment
And that’s basically it! We don’t do any chemical or biological manipulation. Since stem cells already “know what to do”, there’s no reason to interfere with their biological structure without compromising safety.
Step 3: We Transplant Cells Into Treatment Area
This is where the true magic happens.
A concentrated sample of activated stem cells is transplanted right into where they’re needed most: the injury site or chronic illness area. This is what has proven transformative in chronic and acute musculoskeletal diseases, such as arthritis and spinal injury.
Once again, the procedure is really simple:
- Ultrasound and X-ray techniques are used
- A concentrate of stem cells is injected right into the target area
- The patient walks away from the procedure satisfied
Patients usually since there’s no surgical incision (stem cell therapy is a non-invasive procedure), patients usually do not experience any serious side effects. Some soreness and pain are witnessed at times.
Read our full guide about stem cell therapy here.