Shoulder -- Torn Labrum
What: The socket of the shoulder joint is extremely shallow, and very unstable. This means that the bones of the shoulder are not held in place adequately. Thus, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone to move within. The labrum circles the shallow shoulder socket to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements.
How: The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. If you have injured your shoulder, a labral tear may be the culprit.
Treatment: Depending on the type of labral tear, and length of symptoms, you may need surgery. Most tears do not require surgery, but patients who have persistent symptoms despite more conservative treatments may need surgery.
- Common Labral Tears
- Story from Athlete Steven Zavodnick
- Interview with Dr. Colin Eakin, PAMF Sports Medicine Department
Common Labral Tears
- SLAP Tears: A Superior Labrum from Anterior to Posterior (SLAP) tear is most commonly seen in overhead throwing athletes, such as baseball and tennis players.
- Bankart Lesions: A Bankart lesion occurs when a shoulder dislocates. When the shoulder comes out of joint, the labrum is torn, and makes the shoulder more susceptible to future dislocations.
- Posterior Labral Tears: Posterior labral tears are less common, but sometimes seen in athletes in a condition called internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder.
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Story from Athlete Steven Zavodnick
Imagine a young boy tossing a baseball around in the backyard with his dad. This is the image of the "perfect" American childhood. Now imagine, that young boy wincing in pain at every throw. Not quite so perfect.
The summer before freshman year was the first time I felt that twinge in my shoulder that would become very familiar over the next three years. I initially just shook it off as not a big deal and continued to play through it. Eventually it became unbearable. I saw a doctor who diagnosed a stress fracture in my shoulder and said I would need to rehab it for several months causing me to miss my freshman high school season.
The three-year period in which I suffered a litany of arm problems, and the many subsequent rehab attempts I made, was one of the most challenging periods of my life. The question that entered my mind the most was, "why me?" Ever since I began pitching seriously, arm health was imperative. The potentially career-ending Tommy John surgery is forever looming for every pitcher. I was prescribed a complex series of stretches and strengthening exercises by some of the best coaches around. I should have been the last candidate for an arm injury.
Over the next three years I was in and out of physical therapy. I was able to play some, usually in some form of pain and rarely at peak performance. I was diagnosed with first a stress fracture, then tendonitis and bursitis, and finally a partial tear of my labrum that required surgery that made me miss half of my junior season. Physical therapy turned from an annoying imposition to a monotonous part of daily life.
Although being injured and unable to play the game you love is no fun, something good came out of it. I learned to listen to my body. Most of the time I missed could have been salvaged if I had simply listened to my body and not tried to play through pain. I'm now back throwing a baseball pain free (mostly) and having more fun than ever before. I appreciate the game more now that it has almost been taken away from me by injury.
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Interview with Dr. Colin Eakin, PAMF Sports Medicine Department
Question: What are labral tears and how do they usually happen?
Dr. Eakin: Your shoulder is a ball and socket joint where the ball is the top of your arm and the socket is your shoulder. The labrum is a ring around the socket. It's spongy, soft and squishy. If you imagine your shoulder joint as a golf ball and tee, the tee isn't flat. The labrum is that ring that makes the golf tee concave so that the ball doesn't just roll right off. The labrum stabilizes the ball in the socket. When forces cause the ball to fall out of the socket, the labrum gets damaged.
There are two types of injuries that cause the ball to fall out of the socket: a traumatic event or chronic strains. Imagine you are a water polo player and you have the ball. You're holding it above your head ready to pass it and your opponent tries to get the ball away from you by pulling on your arm. If your arm gets pulled behind your head, farther than you can normally stretch, it is a trauma for your labrum and can cause damage. A chronic strain is when there are small strains over time and small tears multiply. This makes your shoulder less stable and less likely to withstand a traumatic event.
Labral tears are most common in sports where there are a lot of overhead movements: water polo, basketball, volleyball and baseball or fast pitch softball especially for pitchers.
Question: What are the treatment options?
Dr. Eakin: Your labrum won't heal completely on its own and when it repairs itself, it doesn't always heal evenly. This leaves it more susceptible to future damage. Imagine the golf ball in the tee, again; if the golf tee is uneven, it's far easier for the golf ball to roll off.
Labral tears do not always need to be repaired. If someone does not want to return to their sport and doesn't mind difficulty with other overhead activities, it is possible to modify activity and leave it alone.
If you want to return to your sport or resume normal activity, surgery is the only way to repair a torn labrum. Luckily, the procedure is now done orthoscopically so the incisions are very tiny. If the labral tear is small and does not destabilize the joint, the surgeons will just "clean it up" and make it less irritating and more comfortable for the patient. In cases where the labrum is pulled off the rim, it must be re-anchored, which is a more major surgery.
Question: What is the recovery like?
Dr. Eakin: After having either of the procedures, the patient is in a sling for about four weeks, then needs physical therapy. For the more minor procedure, you'll need roughly two months of therapy, but for the full repair therapy takes about four months.
Question: How can it be prevented?
Dr. Eakin: Because of the nature of the injury, it just comes with the territory of some sports. It is a risk that you take when playing them. Having a strong rotator cuff diminishes the stress on the labrum and stabilizes the ball in the socket.
The good news is that people who suffer from this injury almost always return to a full level of activity.
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