Shoulder

Shoulder Labrum Tears: Treatment and Diagnosis

By October 2, 2019 October 25th, 2019 No Comments

Shoulder Labrum Tears

You’ve suffered an acute injury to the shoulder and now feel as though it is unstable. The range of motion in your arm has gone down quite a bit and now you’re worried that the problem may be serious. A shoulder labrum tear is a serious matter and rapid treatment is of the utmost concern.

Understanding the anatomy, signs, and symptoms, and treatment options available after a shoulder labrum tear can help prepare us to make an educated decision and choose the right course of action.

Anatomy of Shoulder Labrum Tears

The shoulder is a ball-and-socket joint composed of the upper head of the humerus (ball) and a pocket-shaped bone known as the glenoid (socket). Between the meeting point of these bones lies the labrum – a band of fibrocartilaginous tissue which helps to nest the ball of the upper arm bone within the shallow socket formed by the glenoid.

The labrum deepens the pocket formed by the glenoid and provides stability to arm movements by providing a smooth rim around which the head of the humerus can move. Additionally, the labrum helps to prevent injury to the cartilage which surrounds the head of the humerus and cavity of the glenoid.

Labral tears are tiny rips in the structure of the labrum. Over time, prolonged or excessive use of the arm exacerbates these tears, increasing their depth and width and eventually causing problems in the function of the shoulder and arm.

Signs and Symptoms of Shoulder Tears

Signs for any shoulder injury will be relatively similar. These include:

  • Pain when performing overhead activities
  • Popping or cracking around the shoulder
  • Grinding sensation when moving the upper arm
  • Swelling and inflammation
  • Decreased range of motion
  • Loss of shoulder strength
  • Arm and shoulder instability

The sign to be especially wary of if you believe you’ve suffered a tear to the labrum is instability. The labrum helps provide a guide for the “ball” of the upper arm bone to move within the glenoidal pocket. Thus, instable or unsmooth arm function can be a good indication of a tear in the foundation of the labrum.

Causes of and Risk Factors

Typically, labral tears form after an acute injury. Blunt trauma, especially that which involves hyperextension of the upper arm and shoulder, is an especially common cause of a labral tear. Other causes and risk factors may be:

  • The repetitive motion of the upper arm
  • Extended periods of upper arm strain
  • Falls on outstretched arms
  • The sudden jerk of the arm

While this list is not extensive, the main takeaway is that labral tears usually occur during rapid-onset incidents or after extended periods of upper arm strain.

Diagnosis of Shoulder Labrum Tears

Depending on the location of the tear, it will be diagnosed as one of 3 distinct types.

SLAP Tears or Lesions

SLAP is short for “superior labrum, anterior to posterior” which means that the injury goes from the front of the shoulder to the back. A tear in the shoulder labrum is dubbed SLAP if it is above the center of the glenoid. Damage to the bicep tendon as well as commonly performing overhead motions is risk factors for this type of injury.

Bankart Tears or Lesions

When the tear is localized to the bottom portion of the glenoid socket, this is known as a Bankart tear in the labrum. Chronic dislocation of the shoulder puts an individual at a higher risk of developing this type of tear.

Posterior Labrum Tears

If pain is restricted to the back of the shoulder joint, these types of labral tears are referred to as posterior labrum tears. These types of tears are rare due to the restricted motion of the arm towards the back of an individual’s body.

While the 3 types of shoulder labrum tears are distinct, their symptoms will be relatively the same. As these symptoms progress into a chronic issue, they may become debilitating. If this is the case, it may be time to schedule a medical intervention.

Conventional Treatments

There is a wide variety of treatment options available to those who have suffered a labral tear. The following conventional treatment options are the most highly recommended and widely accepted solutions to the problems a labral tear may cause.

Physical Therapy

A typical recovery plan will include some form of physical therapy. These therapies are aimed at relieving pain, decreasing swelling, and increasing range of motion through physical means such as massage, hot/cold therapy, guided stretches, or exercise.

A patient may find that a combination of a few of these therapies will be all they need in order to reach their functional goals. If not, physical therapy will then be combined with one of the other options listed.

Medication

A medicinal regimen for shoulder labrum tears will focus on increasing blood flow and decreasing swelling in the shoulder. Over the counter medications will typically be the first line of defense. Ibuprofen, acetaminophen, and naproxen are some of the medications a patient will be able to expect their doctor recommends.

Additionally, topical balms may be used in conjunction with these medications in order to quell soreness and stiffness.

If these regimens don’t provide enough relief over the course of a few weeks, a patient’s doctor may prescribe higher dosages of the same medications or may move on to harder drugs to relieve the pain.

Steroidal Injections

Similar to medication, steroidal injections help to reduce pain by decreasing swelling around the shoulder. As the shoulder swells in an effort to cushion the effects of a torn labrum, the nerves within the shoulder get pinched. As the nerves become more and more compressed, an individual will begin to feel their pain gradually increase. Steroid injections provide relief by reducing the body’s natural response to tear-related symptoms.

It is noteworthy to understand that while steroid injections can help in many cases, this treatment option does come with its own set of dangers. Steroids have been shown to break down the foundation of several tissues throughout the human body with prolonged use. As these tissues break down, the treatment may end up causing more damage to the shoulder than it’s worth. It’s best to talk with your doctor if you have concerns about any of these treatments.

Surgery

Surgical intervention is typically the last option patients want to consider, especially for labral tears. Not only are the recovery periods long, but the results are statistically minimal. Additionally, reduced functionality and range of motion are some of the most common side-effects of surgical intervention for shoulder conditions. While surgery may help to relieve some of the pain, it may not achieve the patient’s functional goals post-op.

These conventional treatments are not the only options available to those suffering from a labral tear in the shoulder, they are simply the most commonly prescribed. The long recovery periods, the chance of addiction (to medication), and potentially lackluster results may leave patients unsatisfied.

If these methods and their side-effects are not in-tune with a patient’s lifestyle and functional goals, there are alternatives.

Regenerative Therapy for Shoulder Labrum Tears

Regenerative therapy is the name given to a set of injections that may help to reconstruct damaged tissues. The therapies themselves are very simple. First, tissues are extracted from the patient. Next, these tissues are processed in order to isolate the active ingredients (either platelets or stem cells). Finally, the isolated cells are reinjected into the site of injury using special imaging technologies.

In Platelet Rich Plasma (PRP) therapy, the active ingredient is the platelets found in the blood. Platelets naturally form into clots when they sense an injury. As they bundle together, they send chemical signals to the body to engage its healing factors and draw them towards their location. These chemical signals not only call the body to action but amplify the body’s natural reaction to injury by providing growth factors that help it to reconstruct damaged tissues.

Stem Cell Therapy functions in much the same way. Adipose tissue is extracted from a patient whereupon the stem cells are processed into pseudo stem cells known as “mesenchymal” stem cells. Once re-injected into the site of injury, these cells not only promote healing but also create an environment suitable for the healing to happen.

When used in unison, each of these therapies amplifies the other’s reaction to an injury. Not only do they treat the pain caused by the injury, but they also treat the underlying cause of it, thereby providing longer-lasting results than conventional treatment options.

Conclusion

Shoulder labrum tears can be debilitating. Between the pain experienced and the loss of motion, an individual may feel that their problem is unfixable. While conventional treatments may help to reduce the pain, they do not treat the underlying causes of it.

By rebuilding damaged tissues, regenerative therapies offer not only a treatment for the pain, but also help to treat the tear which caused it in the first place. If you would like to learn more about regenerative therapies and how they may help your shoulder injury, contact the Cellaxys offices today.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni