The labrum is a c-shaped rim of fibrocartilage surrounding the glenoid (socket) that serves two vital functions within the shoulder joint. The first function is to deepen the socket so the shoulder remains in place while in motion, while the second function is an attachment site for the biceps tendon and the glenohumeral ligaments. A number of shoulder injuries have the potential to cause the labrum to peel off the socket’s rim. When this happens, shoulder instability may occur and lead to a partial or complete dislocation. A torn labrum is a common shoulder injury found in the active population and is usually caused by a fall on an outstretched arm or from repetitive overhead motions. The two most common types of labral tears seen by Dr. Jonathan Ticker, Long Island, Brooklyn, Queens and NYC area orthopedic shoulder specialist, are SLAP and Bankart tears.
A SLAP (Superior Labrum Anterior to Posterior) tear, a specific type of labral tear, involves the attachment site of the biceps tendon located at the top of the shoulder joint. A Bankart tear describes a torn labrum where the humeral head shifts toward the front of the body, as an anterior labral tear. The humeral head can also shift toward the back of the body and, if excessive, result in a posterior labral tear. SLAP and Bankart tears are generally caused by a traumatic event, such as a collision or fall during sporting activities, or from repetitive overuse to the shoulder joint in overhead athletes.
Symptoms of a Labral Tear, SLAP Tear & Bankart Tear
The main symptom of a torn labrum is a sharp pop or catching sensation in the affected shoulder during specific movements. This may be followed by a painful ache for several hours. At other times, the labral tear may not cause patients substantial pain. Shoulder instability from a damaged labrum may also occur in certain patients and cause the shoulder to feel loose.
SLAP and Bankart tears may make it difficult for certain patients to perform normal, everyday movements involving the shoulder, such as getting dressed or grasping for an object overhead. Patients who have sustained a Bankart tear may also feel a sensation that the shoulder may dislocate or slip out of place while in motion.
Diagnosis of a Labral Tear, SLAP Tear & Bankart Tear
Dr. Ticker will perform a complete physical examination and medical review in order to diagnose any form of labral tear. It is critical he determines if the torn labrum is connected to pre-existing shoulder instability or if the tear occurred during a traumatic event or from overuse of the joint. A series of x-rays and an MRI scan are commonly performed to rule out other potential shoulder injuries associated with SLAP and Bankart tears.
Treatment of a Labral Tear, SLAP Tear & Bankart Tear
Treatment for a torn labrum, such as SLAP and Bankart tears, takes several factors into consideration, including type of labral tear, severity of tear, previous episodes of shoulder instability, patient’s age and patient’s activity level.
Non-Surgical
Dr. Ticker commonly recommends a conservative, non-surgical approach in cases of a mildly torn labrum, for example. Non-surgical measures include a combination of rest, ice, medications and a physical therapy program designed to restore functional movement in the shoulder and strengthen the surrounding muscles to help stabilize the shoulder joint.
Surgical
Arthroscopic shoulder surgery may be recommended by Dr. Ticker if conservative measures fail or if the labral tear is too severe. Age, tear location, and bony involvement are also factors. He will determine the appropriate surgical procedure based on type of labral tear, severity of tear, condition of the biceps tendon and associated shoulder injuries that are present at the time of surgery.
Dr. Ticker commonly performs these arthroscopic shoulder surgeries:
- Arthroscopic debridement- This procedure is typically recommended for SLAP tears that do not involve the biceps tendon and requires Dr. Ticker to smooth out the damaged area.
- Anterior or posterior labral repair- An anterior or posterior labral repair is performed by Dr. Ticker to restore stability to the joint, most commonly found in cases associated with chronic shoulder instability or a torn labrum in the lower half of the socket.
- SLAP repair- A SLAP repair is the most common procedure for symptomatic SLAP lesions and involves the labrum being reattached to the socket using strong sutures, commonly reserved for young, overhead athletes who want to remain active in sports.
- Bankart repair- During this arthroscopic procedure, the labral tear is repaired to the bony socket, and the stretched anterior shoulder capsule is made to lie on top to make it shortened, typically performed in patients with chronic shoulder instability.
- Biceps tenodesis-A biceps tenodesis involves removing the injured biceps tendon from the torn labrum and reinserting it into a different area of the shoulder, decreasing the SLAP region’s pulling forces.
For more resources on a torn labrum, such as SLAP and Bankart tears, or for additional information on labral tear treatment options, please contact the orthopedic practice of Dr. Jonathan Ticker, proudly serving the greater Long Island, Brooklyn, Queens and NYC communities.