Shoulder Labral Tears

What is a labral tear?

The labrum is a ring of firm cartilage around the edge of the shoulder socket (the glenoid). It makes the socket deeper, acts like a bumper for the ball, and is where the shoulder ligaments and the long head of the biceps attach. Two kinds of tears are common:

• SLAP tears (superior labrum, anterior to posterior) occur at the top of the socket where the biceps tendon attaches. They come from overhead throwing, heavy lifting, a fall on the arm, or a sudden pull.
• Bankart tears occur at the front-bottom of the socket, usually after a shoulder dislocation. See shoulder instability.

Labral changes also appear on MRI in many people with no pain, particularly after age 35, so a tear alone does not prove it is the source of pain.

What does a SLAP tear feel like?

People describe deep, vague pain in the shoulder, catching or popping, pain when throwing or reaching overhead, and a sense that the shoulder is weaker or tires faster. Pain may worsen when carrying heavy objects at the side. The symptoms overlap with rotator cuff and biceps problems, so a careful exam is important.

Do I need surgery?

Often not. Many SLAP tears improve with rest from aggravating activity, therapy for the shoulder blade, cuff and the back of the shoulder, and sometimes an injection. The evidence for surgery is mixed. In a trial of patients with type II SLAP tears, repair, biceps tenodesis and a sham operation produced similar improvement at two years, which suggests that part of the benefit of surgery may come from rehabilitation and time.¹ Surgery is more likely to help in a young overhead athlete whose tear is clearly the problem, or when the tear is part of an instability problem.

When is surgery considered?

Dr. Stepanyan considers surgery when:

• You have persistent mechanical symptoms and pain after a committed course of therapy
• You are a young throwing or overhead athlete with a clearly identified tear
• A Bankart tear goes with recurrent dislocations
• The labral tear travels with a rotator cuff or biceps problem that also needs treatment

What happens in surgery?

Surgery is done arthroscopically. A SLAP repair secures the labrum to the bone with small suture anchors. In patients over about 35 to 40, or when the biceps tendon is damaged, biceps tenodesis is often used instead of repair, because repairs in older patients tend to leave more stiffness. A Bankart repair reattaches the front labrum and tightens the capsule. Dr. Stepanyan will recommend the procedure that suits your age, activity and the pattern of the tear.

Should I get a second opinion?

If you have been told that an MRI finding of a labral tear explains your pain and surgery is the answer, or if you have had labral surgery without relief, a second look is worthwhile. Request a visit and bring your MRI.

Where can I see Dr. Stepanyan?

Dr. Stepanyan sees shoulder patients in Glendale, East LA and Santa Fe Springs.

What does recovery look like?

These are typical stages after a SLAP or labral repair. Your own plan may differ.

1. Weeks 0–4

   Protect the repair

   You wear a sling and avoid active use of the arm and rotation that stresses the repair. Elbow, wrist and hand exercises start right away.

2. Weeks 4–8

   Restore motion

   The sling comes off and motion is gradually increased. Elbow bending against resistance is delayed after a SLAP repair.

3. Weeks 8–16

   Build strength

   Strengthening starts with light resistance and progresses to the cuff and shoulder blade muscles.

4. Months 4–6+

   Return to sport

   Throwing and overhead sports resume in a staged program. Full return can take six months or longer.

The exact restrictions depend on which part of the labrum was repaired and whether other procedures were done.

Sources

1. Schrøder CP, Skare Ø, Reikerås O, Mowinckel P, Brox JI. Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. Br J Sports Med. 2017;51(24):1759-1766. PubMed