Background and Etiology

The glenohumeral joint of the shoulder is a ball and socket joint between the head of the humerus bone (ball) and the glenoid fossa of the scapula (socket) or shoulder blade. The head of the humerus is large and the glenoid fossa is small, resulting in an unstable but mobile joint.

The labrum is a cartilaginous structure found in the shoulder joint. Called the glenoid labrum, it runs along the shallow socket providing extra depth to help the head of the humerus fit more securely in the joint. The labrum helps provide stability to an otherwise unstable joint, and serves as a point of attachment for several ligaments. The labrum can be damaged or torn from overuse or traumatic injury.

Labral tears can be located above (superior) or below (inferior) the socket, and can involve other structures of the shoulder joint. A SLAP (superior labrum anterior to posterior) lesion occurs along the top of the socket and may involve the nearby biceps tendon. A Bankart lesion occurs along the bottom of the socket and may involves the nearby inferior glenohumeral ligament. Labral tears can also occur in conjunction with other injuries like a shoulder dislocation.

Injuries to the labrum are typically caused by either repetitive strain or a traumatic event. The most common causes of a labral tear include:

  • Trauma like a direct blow to the shoulder
  • Fall onto the shoulder or a fall on an outstretched arm
  • Sudden strong exertion of the structures in the shoulder joint, like when trying to lift a heavy object
  • A forceful overhead reaching motion
  • Repeated overuse, especially with activities that require over the head motions, like throwing
  • Pain, particularly when performing activities that require over the head motions
  • Pain with daily activities
  • A sensation of “catching,” “popping” or “grinding”
  • Pain when sleeping, particularly on the side of the body with the effected shoulder
  • A feeling of instability or weakness in the shoulder
  • Decreased range of motion

The labrum is a soft-tissue structure, therefore radiographic tests like X-rays do not show damage. A CT scan or MRI may be useful to diagnose a labral tear, particularly if a contrast medium (dye) is injected to help show any possible tears. Your doctor will also evaluate your condition based on medical history, range of motion, and symptoms.

For less severe injuries a conservative approach that includes physical therapy may be attempted. Small tears may respond to conservative physical therapy depending on the patient’s age, level of expected activity and functional level. However most labral tears, including those that damage nearby structures, will require arthroscopic surgical intervention to decrease pain, improve range of motion and improve function. Following arthroscopic labral repair, an intensive physical therapy program will be initiated to help restore full function of the shoulder.

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis, and the goals of the patient or client.

Interventions for the labrum should be progressed based on the healing and the physician’s surgical protocol in the case of post-operative repairs. Common interventions in the treatment of Labral Tears include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, and joint mobilization by a physical therapist to modulate pain and reduce any soft tissue or tendon irritation while helping to restore motion following a period of immobilization. Movements should avoid positions that place the shoulder in the position that produced the dislocation (Apprehension Sign).
  • Therapeutic Exercises (TE) including exercises to strengthen the rotator cuff muscles in the shoulder and increase glenohumeral stability. Emphasis should be placed on the internal rotators and anterior muscles of the shoulder.
  • Neuromuscular Reeducation (NMR) to restore stability, begin retraining the upper extremity, improve proximal joint stability and improve movement technique and mechanics (for example, throwing) in daily use of the involved upper extremity.
  • Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the shoulder and tendons.
  • Home program that includes strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.

Procedures that your physician may recommend and perform in addition to physical therapy.

  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal Injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Conservative care including physical therapy to restore motion, strength, and stability of the shoulder in cases where there is a small labral tear.
  • Surgery to correct underlying pathology, including labral repairs or procedures to tighten the shoulder capsule or ligaments.

Prognosis

There are several factors that may influence the rate of recovery from a labral tear, and subsequent surgical intervention including the size of the tear, the quality of the tissue, the location of the tear, whether the tear was caused by acute trauma or overuse, how quickly the tear was treated, and if any other structures in the joint were effected. Other factors in recovery include:

  • Outcomes are better for the younger patients rather than older patients
  • Pre-injury level of function with a positive correlation between pre-surgery shoulder function and post-surgical outcomes (the better you are before you sustain an injury, the better the chance for a good outcome post-surgery)
  • Motivation of the patient to return to activities like work or sports
  • Patient compliance with physical therapy program is critical to a good outcome from labral repair.

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"Although getting released from physical therapy is a great thing, today was bitter sweet. How often do you get to rehab with your twin daughters at a place that makes you feel important, special and at home? Twin Boro Physical Therapy in Middletown has been our home away from home for the past three months. We always looked forward to our sessions because they helped us gain back the life we had before. From the phone calls with Stephanie scheduling appointments (all three of us simultaneously) to our awesome therapists: Andrew, Chris, Sydney, Brad, Justin & Anthony, to our PT assistants: Ryan, Gerard, Julian and the girls, we can't thank you enough! We couldn't even walk on two feet when we arrived. Today, we successfully completed "Boot Camp' running, hopping and jumping! We appreciate all that you have done. We will truly miss you all, but you have taught us well. We are forever grateful."

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"After my back surgery my doctor wanted me for physical therapy. He suggested Twin Boro Physical Therapy as one of the locations to go to. I checked out all the locations in the area and decided to go to Twin Boro. I stopped by on a Saturday but they were closed. Someone was at the desk doing paperwork and gave me all the information that i needed to fill out. She put the paperwork through and gave me a schedule to return on Monday for my first visit.The therapist ( Andrew ) examined me an put me through a series of work outs three times a week along with his daily exam. As each exercise became easier I was given something a little harder. They were slowly building up the strength in my lower back, core, legs and arms. After years of back pain I am now able to begin to get back to a normal life. I had a chance to work with other therapist there, they are all fantastic and there to help us return to a healthy life. The entire staff is was a pleasure to work with. They listen to what you have to say and and pay attention to what you said. I looked forward to going there, the staff was caring, kind and funny at times. I would highly recommend Twin Boro for physical therapy."

Victor S.

"Eric was an excellent physical therapist. I made tremendous improvement during my time there. Rachel & Brittany were always smiling and creating a positive environment. Highly recommend using twinboro EHT!!!"

Ella G.

“I had a tear of each shoulder and was in total pain and unable to sleep due to the discomfort. Twin Boro was able to assess my problem areas, work with me and encourage me. Now due to their expertise, knowledge and professionalism I am pain free.”

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