Shoulder > Labral Tear

What is the Labrum?

The labrum is a thin lip of soft tissue that lines the edge of your shoulder socket. Its function is to deepen the socket so that your upper arm bone (humerus) fits comfortably and keeps the shoulder stable. The labrum is divided into four parts: superior, inferior, anterior, and posterior.

The labrum can tear if it gets caught between the humerus and the shoulder socket, which happens most commonly from an acute injury to the shoulder but occasionally from repetitive or excessive motion. A flap of the torn tissue moves in and out of the socket, causing pain and instability. When a piece of the labrum tears away from the lower front (anteroinferior) rim of the shoulder socket, it is called a Bankart lesion. There are four types of superior labrum anterior-posterior(SLAP)labral tears:

   Type 1 - The superior labrum appears frayed or degenerated, but its peripheral edge and attachment of the biceps to the labrum are intact.

   Type 2 - The superior labrum and attached biceps are separated from the shoulder socket.

   Type 3 - There is a bucket-handle tear in the superior labrum, with the central portion displaced but the peripheral attachments of the labrum and biceps are intact.

   Type 4 - A bucket-handle tear is present, and the biceps attachment is also affected.

A torn labrum usually results from a traumatic injury to the shoulder, such as a shoulder dislocation that occurs when you fall directly on your shoulder or outstretched hand. A shoulder that dislocates repeatedly also can causing tearing of the labrum. Overuse also can contribute to labral tears. Since several of your shoulder’s ligaments and tendons are attached to the labrum, a rotator cuff tear may occur in conjunction with a torn labrum.

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your physician may order.

Your physician will ask about your activities, which may have caused your injury. You will be asked when the soreness or pain in your shoulder began, and where in your shoulder it occurs, how long it lasts, and what lessens or worsens it. If you have had any prior shoulder injuries, your physician will ask about the treatments you tried in the past. Physicians also typically ask about other conditions, such as arthritis, diabetes, and allergies, and medications currently being taken. You may also be asked about your physical and athletic goals – information that will help your physician decide what treatment might be best for you in achieving those goals.

Your physician may perform several physical tests to assess your shoulder’s stability. He may raise your arm overhead to check for catching or clicking in your shoulder joint, or may test for pain by raising your arm in front of your body and pressing down on your arm.

Arthroscopy is considered the best method for diagnosing a labral tear. An arthroscope, which is a tiny camera about 3 to 4 millimeters in diameter, is inserted into your shoulder through small incisions and produces images of the tissues and ligaments that can be viewed on a TV screen. Other tests that may be used include MRI (magnetic resonance imaging) and CT (computerized tomography) scan, employing a dye that is injected into your shoulder to enable viewing of the labrum. Neither is considered as definitive as arthroscopy in diagnosing a labral tear.