Sports Medicine
Sports Injury Prevention & Rehabilitation

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Labral Tear - Shoulder

(Also known as a Shoulder Labrum Tear, SLAP Lesion, SLAP Tear, Glenoid Labral Tear)
What is a labral tear of the shoulder?
A labral tear of the shoulder is a condition characterized by tearing of the cartilage tissue within the shoulder joint known as the labrum.
The shoulder joint is a ball and socket joint - the ball arising from the top of the humerus (upper arm bone) and the scapula (shoulder blade) giving rise to the socket. The relative depth of the socket of the shoulder joint is increased by cartilage, known as the labrum, which attaches to the rim of the shoulder joint. This cartilage helps improve the congruency of the bones (i.e. improved 'fit') and, therefore, aids shoulder stability.
The labrum also aids shock absorption, cushioning the impact of the humerus on the scapula during upper limb weight bearing. Normally the surface of the labrum is very smooth allowing easy movement of the humerus on the scapula. Occasionally, however, the labrum can be torn or damaged so that the surface is no longer smooth. When this occurs, the condition is known as a labral tear of the shoulder.

Causes of a labral tear of the shoulder

A labral tear of the shoulder usually occurs suddenly due to a high force going through the labrum beyond what it can withstand. This may be due to heavy or awkward lifting, a fall onto an outstretched hand, point of the shoulder or an elbow, during heavy pushing or pulling, or a forceful throw. A labral tear also commonly occurs in association with a dislocated shoulder.
Occasionally, a labral tear of the shoulder may develop over time due to gradual wear and tear associated with overuse. This may cause gradual degeneration and weakening of the labrum predisposing it to further injury. These labral tears of the shoulder typically occur due to repetitive weight bearing activities, lifting or overhead activities and are most common in the older population. In athletes, labral tears are commonly seen in throwing sports (such as football or baseball), swimming, racquet sports (such as tennis) or weight lifting.

Signs and symptoms of a labral tear of the shoulder
Patients with a labral tear of the shoulder may report that, at the time of injury, they heard an audible sound, experienced a tearing sensation or felt the shoulder joint move out of place.
Pain is usually felt in the front, back or side of the shoulder and may radiate into the upper arm (often the biceps), upper back or neck. Symptoms may increase with certain, often quite specific, movements of the upper limb, such as arm elevation and lifting (especially overhead), weight bearing activities through the upper limb (such as push-ups or dips), or pushing and pulling movements of the shoulder (particularly when combined with rotation). Patients may also experience pain when lying on the affected shoulder, or, during certain sporting activities, such as throwing, serving in tennis or butterfly stroke in swimming.
In minor cases of this condition there may be little or no immediate symptoms. In these cases, symptoms may develop gradually over time, typically with an increase in use of the shoulder and arm. In more severe cases, there may be severe pain and significant restriction in shoulder range of movement. Intermittent locking, clicking sensations, and episodes of giving way or sudden weakness of the shoulder, may also be present.

Diagnosis of a labral tear of the shoulder
A thorough subjective and objective examination from a physician is important in identifying the likelihood of a labral tear of the shoulder. Investigations such as X-ray and MRI are often used to confirm diagnosis, assess the severity of injury and (along with other investigations, such as ultrasound) exclude the presence of other injuries in the shoulder. In rare cases, where an MRI has proven inconclusive, an investigative arthroscope may be performed to assist diagnosis.

Treatment for a labral tear of the shoulder
Most patients with a minor labral tear of the shoulder will have an excellent outcome with appropriate physical therapy. Most moderate to severe labral tears require surgery for an optimal outcome.
  • The success rate of treatment is largely dictated by patient compliance. A vital aspect of treatment is that the patient rests sufficiently from any activity that increases their pain until they are pain free. Activities which place large amounts of force through the labrum should also be minimized. These may include: overhead activities, lifting, upper limb weight bearing, heavy pushing or pulling, lying on the affected side and throwing. The use of a sling (or collar and cuff) may also be required for a period of time. Once the patient is pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
  • Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the labrum altogether. Immediate appropriate treatment in all patients with a labral tear of the shoulder is vital to ensure an optimal outcome.
  • Anti-inflammatory medication and regular icing may be beneficial in the initial phase of the injury (first 72 hours) or when inflammatory signs are present (i.e. morning pain or pain with rest). Anti-inflammatories may hasten the healing process by reducing the pain and swelling associated with inflammation.
  • Manual "hands-on" therapy from the therapist such as massage, trigger point release techniques, dry needling, joint mobilization, stretches, and electrotherapy can assist with hastening healing and improving range of movement, pain and function.
  • Patients with a labral tear of the shoulder should also perform pain free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. Particular emphasis is placed on improving scapula stability, posture and rotator cuff function. The treating therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
  • In the final stages of rehabilitation for a labral tear of the shoulder, the therapist can devise an appropriate return to sport or activity plan. Returning to activity too soon or without adequate rehabilitation will often lead to further injury and inflammation of the labrum.

Surgery for a labral tear of the shoulder
Generally, most patients with a significant labral tear of the shoulder will require surgery to ensure an optimal outcome. Surgery for labral tears is generally minimally invasive, involving arthroscopy. During this procedure, the surgeon either removes or repairs the torn tissue enabling the shoulder joint to move freely once again. In cases of a large labral tear with bony damage, surgical fixation of the bony fragment and labrum may be indicated. The treating therapist and doctor will refer to a specialist if surgery may be indicated. Physical therapy and rehabilitation is then required following surgery to ensure an optimal outcome and enable a safe return to sport or activity.

Prognosis of a labral tear of the shoulder
Those patients with a minor labral tear of the shoulder that responds well to conservative management can usually return to sport or activity in approximately 2 - 8 weeks.
For minor tears that are managed surgically, patients can sometimes return to sport or activity within 4 – 12 weeks, although most patients (especially when the tear is moderate to severe) will require a significantly longer rehabilitation period (usually between 3-12 months).
It is important that patients with a labral tear of the shoulder are managed appropriately, as inappropriate treatment may lead to the development of early shoulder osteoarthritis.

Physical therapy for a labral tear of the shoulder

Physical therapy treatment is vital to hasten the healing process and ensure an optimal outcome in all patients with a labral tear of the shoulder, regardless of whether they have surgery. Treatment may comprise:
  • soft tissue massage
  • electrotherapy
  • joint mobilization
  • stretches
  • dry needling
  • hydrotherapy
  • the use of a sling
  • ice or heat treatment
  • postural correction
  • activity modification advice
  • anti-inflammatory advice
  • education
  • progressive exercises to improve flexibility, strength and posture
  • a gradual return to activity program
  • technique correction (such as swimming stroke or throwing technique etc)
For those patients who require surgery for their labral tear, physical therapy and rehabilitation should commence prior to surgery. This may include: treatment to reduce pain and swelling; flexibility, strengthening and postural exercises; and the use of a sling. Following surgery, physical therapy and rehabilitation is essential to assist the healing process and ensure an optimal outcome.

Other intervention for a labral tear of the shoulder
Despite appropriate physical therapy management, some patients with a labral tear of the shoulder fail to improve either conservatively or following surgery. When this occurs the treating therapist or doctor can advise on the best course of management. This may include further investigations such as X-rays, MRI or CT scans, pharmaceutical intervention, corticosteroid injection, hydrodilatation, or further surgery.