PT Tip of the Month
What is the labrum?
As the genloid fossa (shoulder socket) is both small and shallow, the shoulder is inherently a very unstable joint. This allows for a greater amount of range of motion in the shoulder compared to other joints. To prevent the joint from slipping out of place, the labrum surrounds the socket. The role of the labrum is to deepen the socket to improve joint stability, reducing the chance of shoulder dislocation, without limiting motion.
How does the labrum become injured?
This labrum can be damaged or torn in many different ways. Acute trauma, such as a trip and fall resulting in shoulder dislocation, or repeated movement like swimming or pitching can damage this tissue. These tears are classified by the area that is affected. When the lower front portion of the labrum is damaged, this is called a bankart lesion. This is the most common form of ligament injury to the shoulder. In a bankart lesion, a gap is left in a section of the labrum that can leave room for the joint's ball to slide out of the socket, which is called dislocation. If the tear is large enough, recurrent dislocations can occur, which requires surgery in order to be resolved.
Symptoms of a Labral Tear
The symptoms of a labral tear are very similar to the symptoms associated with other shoulder injuries. Common complaints are pain in the shoulder, usually with overhead motion, pain when trying to sleep, decreased range of motion, and weakness. Catching, locking, popping, or grinding are also very common with a labral tear and may also be associated with a sense of instability in the joint.
If you are experiencing shoulder pain, consult a doctor or physical therapist. A clinician will take a thorough history of the injury, which will include any specific incident that occurred, pain, and limitations. Your range of motion, strength, and joint stability will then be assessed with objective testing. If you have consulted a doctor, imaging may be performed. X-rays are often ordered first, however since the labrum is soft tissue, this form of imaging will not show damage. Most commonly, an MRI is used to detect soft tissue tears, including the labrum. If a tear is seen on the middle to lower aspect of the labrum, a bankart lesion is present.
While waiting for the final diagnosis, many physicians will prescribe an anti-inflammatory medication to reduce pain. Individuals may also be referred to physical therapy for strengthening of the rotator cuff and restoration of range of motion. If the labral tear is small enough, symptoms may be controlled with physical therapy alone. However with larger tears, recurring pain or recurrent dislocations can occur. If the conservative management is not sufficient, your physician may recommend surgery.
To repair the bankart lesion surgically, a physician will use an arthroscopic scope to view the damage. When the bankart lesion is identified, the surgeon will use a stitch to anchor the labrum back down to the glenoid. Multiple stitches and anchors may be required depending on the size of the tear. In some cases, particularly with recurrent dislocation patients, the joint capsule, which encloses the joint, may also be stitched and tightened to provide additional support.
Post Operative Rehabilitation
When you wake up from surgery, a sling will be in place. The sling should be worn according to your surgeon’s recommendations. Typically, the sling is worn for four to six weeks post operatively, and is taken off only for bathing and to perform gentle exercises (if the surgeon prescribes them). Your surgeon may also prescribe pain medication as well as ice to help manage your pain levels.
After a few weeks, you will be referred to physical therapy. The first two goals of physical therapy are managing pain and gradually increasing range of motion. Six to seven weeks after surgery, the doctor will clear you to discontinue the use of the sling. At this time you can use your arm for normal function as tolerated. Heavy lifting should be avoided, and strengthening exercises can be started upon clearance by your doctor (typically eight weeks post operative). Complete rehabilitation is integral to making a full recovery to return to all normal daily and recreational activities. Many patients feel they have normal daily use of their arm by three months post op and unlimited use of their shoulder by six months. Still, recovery time can vary from person to person depending on age, health and healing, rehabilitation, and the extent of damage that needed to be repaired. In some cases, recovery may take between nine and twelve months.
If you feel that you have signs or symptoms of a bankart lesion or other labral tear, and you would like to schedule an evaluation, call 617-232-PAIN for our Brookline office, and 617-325-PAIN for our West Roxbury office.
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