What is a Shoulder Labral Tear?
The labrum is a soft fibrous tissue that deepens the socket of the shoulder to allow the ball to sit deeper in the socket. The labrum is often torn over time after repetitive overhead activities, such as throwing, lifting, and labor work.
Mechanism of Injury:
This condition commonly occurs with repetitive overhead activities. A labral tear can happen in throwing athletes, heavy weight lifters, or anyone that engages in overhead lifting. There are many different types of labral tears that can occur from chronic overuse injuries to acute dislocations of the shoulder.
Symptoms and Diagnosis:
Labral tears can lead to pain in the shoulder with overhead activities and with certain motions of the shoulder. This can also cause popping or clicking in the shoulder, loss of strength, night pain, decreased strength, decreased motion and dislocations of the shoulder joint. A proper physical examination is recommended by a trained professional. The exam will illicit pain and possibly instability with certain maneuvers. X-ray imaging is an important aspect of the evaluation. This will not show a labral tear but can help diagnose other issues in the shoulder. Advanced imaging, an MRI with or without a joint injection, can be recommended with continuing symptoms to help determine the full extent of the problem.
Treatment:
Rest, ice, anti-inflammatory medications and physical therapy (PT) often solve many of the issues of this condition. PT will work on the mechanics of the shoulder and increasing the strength of the muscles surrounding the shoulder. Cortisone injections are sometimes recommended to help with the discomfort. Lastly, arthroscopic surgery can be considered if symptoms persist despite conservative management.
For more information, please consider the following link that was produced by the AAOS.
https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-joint-tear-glenoid-labrum-tear
Symptoms of a shoulder labral tear
Labral tears are less obvious than rotator cuff problems and are frequently missed, partly because the symptoms can be vague. Common features:
- Deep pain inside the shoulder, often hard to point to precisely
- Catching, clicking or a sense of the shoulder slipping
- Pain with overhead or across-the-body movement
- For throwers: loss of velocity or control, and pain in late cocking — the “dead arm” description
- A feeling that the shoulder is unstable, particularly after a previous dislocation
- Weakness or apprehension in specific positions rather than throughout
Clicking on its own is not diagnostic — plenty of shoulders click painlessly. It is clicking combined with pain, instability or a specific injury that matters.
Types of labral tear
- SLAP tear — at the top of the labrum where the biceps tendon attaches. Typical of throwers and of falls onto an outstretched arm.
- Bankart tear — at the front and bottom, characteristically after a dislocation, and strongly associated with recurrent instability.
- Posterior tear — less common; seen in people who load the shoulder with the arm forward, such as in weight training or contact sport.
The type matters because it changes both the likely mechanism and the treatment.
Treatment
Non-surgical
Many labral tears, particularly degenerative ones in people who are not throwers, are managed successfully without surgery: activity modification, therapy focused on rotator cuff and scapular control, and anti-inflammatory measures. Age matters here — an incidental labral change on MRI in a shoulder that is not unstable is often not the source of the pain, and treating the scan rather than the patient is a real risk.
Surgical
Surgery is considered for tears causing mechanical symptoms or instability, for throwers who cannot return to sport, and where non-surgical treatment has failed. Options performed arthroscopically include labral repair, and in selected cases biceps tenodesis — moving the biceps attachment — which for some SLAP tears, particularly in older or non-throwing patients, produces more reliable results than repairing the labrum itself.
Frequently asked questions
What does a labral tear feel like?
Usually a deep, hard-to-localise ache inside the shoulder, often with catching or clicking and a sense that the shoulder is not stable. Throwers typically notice pain in late cocking and loss of velocity before anything else.
Can a labral tear heal on its own?
The labrum has a limited blood supply, so a true tear does not generally heal back down. Many people become symptom-free with rehabilitation even though the tear remains — which is why treatment aims at function rather than at the appearance of the scan.
How is a labral tear diagnosed?
History and examination first, then imaging. A standard MRI can miss labral tears, so an MR arthrogram — with contrast injected into the joint — is often used when a labral tear is suspected.
How long is recovery after labral repair?
Commonly a sling for around four to six weeks, motion restored over the following six to twelve weeks, and return to sport typically between four and six months. Overhead throwers usually sit at the longer end.
Next step
If this is limiting what you can do, an evaluation will tell you what is actually wrong and which treatments genuinely apply. Call 916-732-3005 or request an appointment. Related: shoulder instability · throwing injuries in the shoulder · biceps tendon problems.