In the previous Tips from the Athletic Trainer column, there was discussion on some common shoulder injuries. This week I want to dive a little deeper into the shoulder.
Many injuries are easy to diagnose, as they are visible to the naked eye or can be touched when we evaluate the injury. The ones discussed last week – fractures, AC joint sprains and dislocations – are common and easily diagnosed usually without an X-ray or MRI. These structures are more superficial and can often be seen by the naked eye.
Today we will discuss an injury that can’t be seen or touched: labral tears.
First, a little more anatomy of the shoulder. As we know, the shoulder is a ball and socket joint. However, the socket of the shoulder, the glenoid, is very shallow and does not cover much of the ball, humeral head, to hold it in place. This shallow ball and socket allows for the large amount of shoulder motion that we have. However, it needs some help to hold the ball in place. The labrum does this. The labrum is a cup like cartilage structure that attaches to both the glenoid and the humeral head to help stabilize the shoulder joint. In addition to structural support the labrum serves as attachment points for the bicep tendon and several ligaments of the shoulder.
With excess force from stresses to the shoulder the labrum can tear. These forces can come from a fall, a hard hit forcing the shoulder in an unexpected direction, or in sports over time, with overhead repetitive motions such as throwing a baseball, serving a volleyball, hitting a tennis ball.
A tear to the labrum is sometimes referred to as a SLAP tear. This is a Superior Labral tear from Anterior to Posterior. Usually, this type of tear starts at the bicep tendon attachment and moves posterior. Many overhead athletes may have this type of tear. The other tear is Bankart tear, which occurs in the bottom portion of the labrum. Usually, this type of tear happens with a shoulder dislocation and can cause instability of the shoulder.
We will focus more on the SLAP tear today. Common among over head athletes a SLAP tear is sometimes difficult to identify. Initial symptoms can be dull or aching pain. In a thrower it is sometimes difficult to determine if it is just pain or discomfort from throwing or pain from an injury. Other symptoms could include popping or clicking in the shoulder with movement, Pain in the front of the shoulder, reduction of motion due to pain, and difficulty doing activities due to pain.
If you have these symptoms a referral to an orthopedist is usually needed and an MRI for diagnosis of the injury most likely will be done. If you are diagnosed with a SLAP tear what’s next? Depending on the size of the tear, the answer is usually some rehabilitation, or if a large tear is seen surgery.
A conservative route to try to avoid surgery is usually the first choice by most people. The rehabilitation process would involve strengthening of the shoulder musculature specifically the posterior shoulder, rotator cuff muscles and scapular stabilizers. Range of motion exercises to help improve certain motions and maintain all motion you have is also needed. This process will take several weeks, and you would not be participating in any overhead motions while going through the process. If this fails and you still have pain and can’t perform after rehabilitation surgery would be required.
SLAP repairs are done surgically through an arthroscopic procedure where small incisions are used, and the surgeon operates using their surgical instruments through these incisions. Recovery after surgery varies depending on the type of activity you are performing. For an overhead throwing athlete recovery could take between 6 months to a year for full recovery. An athlete who does not work overhead as much, like a football lineman, may recover in as little as 4 months or less.
When we think of shoulder injuries labral tears are not usually the first thing we think of. This is sometimes because the labrum is a deeper structure in the shoulder and the injury can be difficult to identify. If you have shoulder pain and it does not go away or progressively gets worse it may be time to see a healthcare provider to get answers.