Shoulder labrum tears are relatively new to the sports medicine injury list mainly due to the continued advancement of arthroscopic surgical techniques according to the EOrthopod website. Shoulder labrum tears occur in sports that involve repetitive overhead throwing or movement or by direct trauma, such as landing on your shoulder while diving to catch a ball. Shoulder instability following a subluxation or dislocation can lead to an eventual labral tear.
The shoulder is the most mobile and flexible joint in the body. This freedom of movement unfortunately makes it susceptible to injury and instability. Three bones make up the shoulder joint, the scapula, or shoulder blade, the humerus, or arm, and the clavicle, or collarbone. Although the joint is considered a ball and socket joint, the glenoid cavity of the scapula that receives the head of the humerus is considered relatively flat. The labrum, which is a soft fibrous cartilage, acts as an extension of the glenoid cavity and forms a ring to increase its contact area and provide added support to the shoulder joint. Several shoulder ligaments and muscle tendons attach to the labrum for additional support.
Symptoms and Injury Classification
Symptoms of a labral tear include a catching sensation during overhead movements with pain, weakness, loss of range of motion and shoulder instability. The discomfort is usually difficult to localize and there is no visible swelling. Labrum tears are classified by the area in which they occur. According to the American Association of Orthopedic Surgeons, or AAOS, a SLAP tear, or superior labrum anterior to posterior, occurs on the upper half of the labrum from anterior to posterior. A Bankart tear is the opposite, a tear on the bottom half of the labrum from anterior to posterior. SLAP lesions are usually the result of repetitive injuries and can include the inflammation of the biceps tendon. A Bankart tear is more often associated with an anterior-inferior subluxation or dislocation that can also tear the inferior glenoid ligament.
After a positive diagnosis of a labral tear by magnetic resonance imaging, or MRI, treatment initially will involve physical therapy to reduce pain and discomfort and regain normal movement and strength. Depending on the demands of your sport or work, surgery may be required to repair the tear and stabilize the shoulder. Surgery is performed arthroscopically and involves suturing the labrum back into place. Any additional damage noticed during surgery to the tendons and ligaments will also be addressed.
Rehabilitation Protocol and Exercises
Following surgery, your doctor will provide you with a treatment protocol to properly rehabilitate your shoulder. Each surgeon will have his own protocol but it generally includes four stages. First is immobilization, for up to four weeks. Second is recovery, lasting four to six weeks post-surgery. Third is the strengthening stage, six to 12 weeks post-surgery. Finally you return to work or your sport anywhere from four to six months post-surgery.
During the immobilization phase the sling or shoulder stabilizing brace should be worn at all times except during hygiene and at physical therapy. To begin with your therapist will start you on passive range of motion exercises which involves no muscle activation. Your shoulder surgery should not limit you from doing normal range of motion and strengthening exercises for the hand, wrist and elbow. Exercises like squeezing a ball, grip strengthening and light weight biceps curls with shoulder by your side can be done with little or no pain in your shoulder. Isometric exercises will be started in this phase. Pressing your elbow against the wall to strengthen the abductor muscles is a common exercise.
During this phase the sling should no longer be required and you will begin active range of motion exercises in all planes. walking your fingers up the wall or using a stick to aid and guide the arm as you raise it above your head are two typical exercises. Your therapist will actively assist you through some range of motion exercises to ensure proper muscle activation and reduce compensation. Progressive strengthening exercises of the shoulder using tubing and pulleys weight in all directions against resistance will also be part of this rehabilitation phase. Continue with your wrist, hand and elbow strengthening exercises.
Full range of motion both actively and passively are expected by this phase of your rehabilitation.
Strengthening exercises with the pulleys will get progressively harder and the introduction of free weight shoulder exercises will begin in this phase. A major component of rehabilitation is proprioceptive exercises. Proprioceptive exercises are reactionary type exercises like the underhand tennis ball toss or rebounder exercises using a mini-trampoline that force the shoulder to react instinctively.
Return to Work or Sport
Full range of motion is a requirement or return to work or sport. Strength, power and endurance levels should be comparable to the uninjured arm and the introduction of sport or work specific exercises for eventual return is essential to prevent reinjury.
Depending on the demands of your work or sport, your recovery could be anywhere from 4-6 months post surgery. Following the surgical protocol with the aid of your physical therapist will ensure a safe and injury-free return to work or play.