Do You Have a Labrum Tear?

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 a 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 natural 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, remaining 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, 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 plays 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 of 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.

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 a Labrum Tear

Many smaller labrum tears remain undiagnosed for years. When the labrum accumulates many smaller injuries over the years, the joint may not receive the blood supply it needs to heal.

If you believe 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 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.

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 the shoulder and surrounding muscles so that they can support the joint 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:

• The surgeon will restore the labrum to the socket of the shoulder if the labral tear looks to be unstable with a separation of the labrum from the socket of the shoulder.
• If the tear is only a flap of tissue torn from the labrum and the labrum is not detached from the underlying bony socket of the shoulder, the surgeon may simply shave the flap of tissue away from the underlying intact labral tissue.
• The surgeon may need to repair the labral tear and reconnect the tendon using absorbable wires, sutures, or tacks if the tear occurs near the site of the biceps tendon (SLAP lesion) or if the rip spreads into the biceps tendon.
• In situations when a labral tear is linked to shoulder instability or dislocations, the surgeon will not only repair the labrum but will also tighten the shoulder’s stretched-out ligaments and capsule to restore stability in the joint.

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 stress on the shoulder labrum.

While the upside is appealing, surgical treatment options also have serious downsides. The most common complication is “recurring shoulder instability”, which 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
• Infection
• Chondrolysis
• Osteoarthritis
• Postoperative stiffness

Labrum Tear Treatment: Orthobiologic Methods

Both physical therapy and surgical options have serious drawbacks. Stem cell therapy has the potential to combine the best of both worlds through a naturally regenerative approach. Orthobiologic methods are non-invasive, short, and less painful than conventional treatments.

At CELLAXYS, we perform two types of orthobiologic treatments, cell-based therapies and platelet-rich plasma (PRP) therapy.

Cell-Based Therapies

Also known as Stem cell therapy, cell-based therapies involve gathering your “autologous” cells, concentrating them, and then transplanting them into the injured area, where they help the body regenerate.

Depending on your labrum tear, your doctor will go for one of the two types of cell-based therapies:

• Minimally Manipulated Adipose Tissue Transplant (MMAT). This procedure harvests cells from your adipose tissues and injects them in the injury site. If you need healing in multiple locations, your doctor can perform MMAT in all of them in one procedure.
• Bone Marrow Concentrate (BMAC). This method harvests highly-concentrated cells from your bone marrow and puts them in the damaged sites.

Both cell-based therapies are performed under anesthesia to minimize the pain. These procedures take around 1.5 to 2 hours to complete. Your doctor will use X-rays and live ultrasound to spot the exact transplant location. They are outpatient procedures, meaning you’ll go home right after the procedure.

Platelet-Rich Plasma Therapy

PRP focuses on injecting platelets into the injury site, which are the healing components in your blood plasma. Platelets perform several functions in your body. They release about 10 Growth Factors that support healthy tissue growth. They also send chemical signals to healing cells in your blood and attract them.

The most crucial job of platelets is to release a sticky web called fibrin. Fibrin produces scaffolding for the new tissues and cells to start building. More platelets in your injury site mean early recovery and healing.

PRP is a popular orthobiologic treatment for multiple sports, orthopedic, and spine-related injuries. These procedures typically take about 45 minutes to complete. Patients usually do not experience any serious side effects. Some soreness and pain may occur at the injection site but should only last for several hours.