Bones of the Shoulder
The shoulder joint is made up of two bones and their associated features. The humerus and the scapula. These bones make up the glenohumeral (shoulder) joint.
The Scapula (shoulder blade)
- This bone has many features on it given its unique shape. It is located on the back and makes up the posterior shoulder girdle.
- The “socket” is called the glenoid and is a feature of the scapula bone which helps form one part of the shoulder joint. The socket is a smooth surface.
The Humeral Bone (arm bone)
The humeral bone forms a head or ball which is smooth as well. This completes the second half of the shoulder joint. The ball articulates or moves on the socket forming the true shoulder joint. Think of this joint as a golf ball resting on a golf tee.
What is the Labrum?
Surrounding the rim of the smooth socket (glenoid) or golf tee is called the labrum. Think of this structure as a gasket O-ring covering OR an alley bumper on a bowling alley. The labrum is essential for helping to keep the ball of the humerus in the socket. It is consider a static stabilizer as it does not move. Some shoulder injuries such as dislocations can cause the labrum to tear.
Labral Tear Classifications:
The three most typical types (locations) of labral tears are below. Picture a common clock face. This will help identify exactly where the tear occurs.
- Anterior tear (Bankart); occurs in the 2-6 o’clock position.
- Posterior tear (reverse Bankart); occurs in the 7-10 o’clock position.
- Superior Anterior to Posterior tear (SLAP); occurs in the 10-2 o’clock position.
Common symptoms of labral tears
- Shoulder instability
- Chronic dislocations
- Catching, clicking, popping, locking
These tears will never heal by themselves as the shoulder joint (along with all synovial joints in your body) has minimal to no blood flow to promote healing.
Diagnosing a Torn Labrum
A proper medical evaluation needs to be performed by a trained professional. Examination of the shoulder begins with history gathering to determine the extent and timing of your injury. Next, a physical exam is performed. Patients will demonstrate weakness or pain with tests of the labrum. Clicking and catching will also be determined at this time for positive findings of a labral tear. If a labral tear is suspected, we will next order an MRI. Magnetic Resonance imaging (MRI) is considered the gold standard for diagnosing soft-tissue injuries pre-operatively. The image to the right will demonstrate tears of the labrum.
Treatment for a Torn Labrum
The recommended treatment for a labral tear depends on the nature of the tear, size of the tear, acute versus chronic tears and the individual patient.
For labral tears that tend to be chronic or a slow wearing out of the tissue, there are several non-operative choices one can make. Patients can attempt a cortisone injection which help reduce the inflammation in the shoulder as well as pain. Patients can also begin taking over the counter anti-inflammatories (NSAIDs). Physical Therapy is also an option to help build up strength of the shoulder musculature so the function of your shoulder does not rely so heavily on the static stability of the labrum.
For acute labral tears that most commonly occur from a traumatic shoulder injury such as a dislocation, surgery is typically recommended. Surgical repair is offered as the structural integrity of the labral will not heal itself as it has poor blood flow. It is also recommended for younger patients, more active patients and individuals with large tears. Physical Therapy can be attempted if it was a patients first dislocation and the tear is small. The goal again is to increase the strength of the shoulder musculature to ease the load on the labrum. However, the likelihood of a second or future dislocations increases significantly as the shoulder joint has laxity and can no longer stabilize the ball of the shoulder within the socket.
How Does Dr. Carofino Repair the Labrum?
We perform a minimally invasive arthroscopic labral repair. This means a camera and instruments are placed into the shoulder joint through small incisions and used to repair the Labrum. Labral repair surgery can also be performed via a larger open incision but is rarely used to date.