The shoulder is a very mobile joint; most things that you do with your hands and upper extremity require some degree of shoulder movement. Because of this, there is not a lot of bony stability at the shoulder joint. The shoulder joint mostly relies on surrounding musculature (the rotator cuff) and other soft tissues to maintain proper alignment and stability as it moves. One of these soft tissues is the glenoid labrum. The labrum is a ring of smooth cartilaginous tissue that surrounds the socket of the shoulder joint, deepening the socket to give increased stability while maintaining mobility.
What is a Glenoid Labrum Tear?
A glenoid labral tear is a rip in the cartilage that deepens the shallow socket of the shoulder and helps hold the ball of the shoulder joint (humeral head) in place. They are typically caused by a traumatic shoulder injuries like a dislocation or separation, or by repetitive overhead movement. There a many types of glenoid labrum tears and the type you get will depend on the nature of the injury that caused it.
What are the Symptoms of a Glenoid Labral Tear?
If the labral tear is caused by one distinct event there is generally a sharp pain, pop, or catching sensation in the shoulder followed by a deep joint ache. Your shoulder may feel loose, as if you do not have complete control of the joint when you move it. Repetitive movements, especially throwing, can also injure the labrum. It is a very common injury seen in baseball players. Generally, it is diagnosed through a physical exam and can sometimes be seen on an MRI or CT scan. Often, labral tears can be hard to see clearly on MRI or CT so the official diagnosis is often confirmed with arthroscopy (using a tiny camera inserted into the joint).Types of Glenoid Labrum Tears include
- SLAP tear is a tear of the superior labrum from the anterior to the posterior aspect
- Bankart tear is a tear at the front (anterior) labrum of the shoulder
- Posterior labral tear is a at the back of the labrum of the shoulder
- Combination of SLAP, Bankart, or Posterior
- Pan labral tear (circumferential lesion) is a 360-degree tear of the labrum
Depending of the type of labral tear your symptoms may present differently so it important to start your recovery by visiting a health care professional like a physiotherapist or chiropractor. They will ask questions about your symptoms and perform tests that will give them a clear picture of your specific injury. If there is any grey area or concern, they will refer you to a Sports Medicine physician who can send you for the appropriate diagnostic testing.
How do Glenoid Labral Tears happen?
Anything that puts excessive force through the shoulder joint can cause a labral tear. Some examples of this include:
- A fall on an outstretched hand
- A shoulder dislocation or separation
- Sports that cause overuse and repetitive loading through the shoulder joint such as baseball or weightlifting
- Suddenly lifting an object that is too heavy
- Repetitive overhead movements
Treatment of Glenoid Labral Tear
Treatment depends on the severity of the tear. Many labral tears can be treated conservatively with physiotherapy or chiropractic care to decrease inflammation and restore proper movement and strength in the shoulder joint. A more severe tear may require surgery which will be followed by a period of rest and then a course of physiotherapy or chiropractic treatment so that you can achieve optimal function in your shoulder.
It is important to note that some parts of the labrum have better blood supply then others. Also, once a tear has occurred it will never bridge back attaching to the bone. It should scar down and become thicker but the detachment from the socket will most likely remain.
Physiotherapy and Chiropractic Treatment will include manual therapies to restore mobility and modulate pain. Prescriptive exercise will also be a focus in order to improve strength and stability within the shoulder as the movement is restored. The best physiotherapists and chiropractors will also take the time to educate you on what to expect, what to avoid and how to modify your lifestyle for optimal recovery. Other modalities such as acupuncture, Gunn IMS, dry needling, ultrasound and electrical stimulation may prove to be beneficial in your case. Your health care provider will make a recommendation based on their assessment findings and your treatment goals.
Best Exercises to do when you have a Glenoid Labral Tear
Exercises to help with recovery from a glenoid labral tear will consist of strengthening the rotator cuff and scapular stabilizers to optimize your shoulder stability and biomechanics.
Proprioceptive Exercises for the Shoulder
Hold a medium sized ball onto the wall in front of you with an outstretched arm. Close your eyes and slowly move the ball in small circles and progress to larger movements. Pay close attention how it feels to maintain the humeral head centered in the shoulder socket.
Rotator Cuff Strengthening
Start in neutral with your elbow at your side and as you become stronger progress to have you elbow at 45 degrees and then finally 90 degrees abduction.
Scapular stabilizers Strengthening
Build muscle strength of the middle and lower trapezius and serratus anterior muscles groups.
What Should be Avoided with Glenoid Labral Tears?
Any movement that makes your shoulder feel unstable or clunky. You will have a gut feeling of apprehension to these types of movements.
You want to avoid heavy weights, throwing, or any activity that requires power around the shoulder.
How Can I Treat Glenoid Labral Tears at Home?
Truth of the matter is, you can’t.
You can work on the exercises described above but you are most likely going to need some form of treatment by a healthcare professional to get you back to full functioning.
How Long Does It Take to Recover from a Glenoid Labral Tear?
The recovery time for a labral tear will depend greatly on the severity of the tear and its prognosis.
If your injury is one that responds well to conservative treatment in the form of Physiotherapy or Chiropractic Care then estimate 6-12 weeks. This will have to entail your commitment to exercise and also lifestyle modification.
If your injury is more severe and requires surgery you can expect it to take 6 months or longer until you are back to your lifestyle.
It can seem a bit intimidating and you might feel hopeless if you have sustained a Shoulder Labral tear. However, many clients go on to lead normal, active lives with some guided treatment. One of our physiotherapists, chiropractors, and/or sports medicine doctors can help you fully understand what is going on in your shoulder and ensure that you receive the proper care from start to finish. Contact us today!
Written By: Heather McNeil – RPT