> 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
1 - The superior labrum appears frayed or degenerated,
but its peripheral edge and attachment of the biceps
to the labrum are intact.
2 - The superior labrum and attached biceps are separated
from the shoulder socket.
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.
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.
| Orthopedic Evaluation
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.
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.