Shoulder Labrum Tear and SLAP Tear
Anatomy and Function
The upper portion of the arm bone (humeral head) rests in a shallow socket (glenoid) in the shoulder blade (scapula). The labrum is a rim of fibrous tissue that encapsulates the socket (glenoid) to act as a stabilizer of the shoulder joint. Without the labrum, the shoulder joint would be inherently unstable. Furthermore, the labrum is an attachment site for various ligaments that are also important for shoulder stability and function.
Symptoms
The symptoms of a labral or SLAP (Superior Labrum Anterior to Posterior) tear in the shoulder are very similar to other shoulder injuries. Symptoms include pain that is usually aggravated by overhead activities, decreased range of motion, and weakness. Other symptoms that are more commonly seen with labral tears include catching, locking, popping, grinding, and a feeling of instability of the shoulder.
Cause
Labral tears are usually a result an acute trauma such as a direct fall onto the shoulder, a fall with an outstretched arm, or a sudden pulling or twisting of the arm or shoulder. Athletes who frequently perform regular overhead activities such as baseball players, or weightlifters are frequently diagnosed with labral tears as a result of repetitive shoulder motion that may predispose to injury. Tears of the inferior portion of the labrum are most commonly associated with shoulder dislocation.
Diagnosis
Dr. Samimi will start with a thorough clinical examination of your shoulder in addition to a review of xrays that will look for bone spurs, fracture or other abnormalities. Frequently your orthopedic surgeon may need to order an MRI of your shoulder with an injection of dye (MRI Arthrogram) to better evaluate the integrity of the labrum. However, occasionally an MRI will not be able to clearly identify a labral or SLAP tear and in those circumstances, shoulder arthroscopy is the best way to confirm the diagnosis.
Conservative Treatment
Upon confirmation of a diagnosis of a labrum tear, Dr. Samimi prefers to start with the most conservative treatments first. Activity modification is important including avoidance of overhead activities. Oral anti-inflammatory (NSAIDs) medications may be prescribed to help reduce pain and inflammation. Physical therapy may help increase range of motion and alleviate symptoms by strengthening and stretching the surrounding musculature. A steroid injection is also frequently used in collaboration with the above treatments.
Surgery
When conservative treatments fail, shoulder surgery is recommended. Dr. Samimi specializes in utilizing the most minimally invasive arthroscopic techniques to treat labral tears. Depending on the size and nature of the tear, arthroscopic surgery techniques will be utilized to remove torn flaps and repair the labrum and associated ligaments. Typically this is done using a sutures and anchors that do not need to be removed and are absorbable. If there is associated shoulder instability, a portion of the shoulder capsule may also be incorporated into the repair of the labrum in order to re-tighten the capsule and improve stability.
What happens during the procedure?
Shoulder arthroscopy is a surgical procedure used to visualize, diagnose, and treat problems inside a joint. The procedure involves making a small incision in the skin and inserting a pencil-sized arthroscope into an injured or damaged joint. The arthroscope’s tiny camera and instrumentation allow Dr. Samimi to see inside the joint in a magnified and illuminated manner to accurately diagnose the extent and pattern of the labral tear and effectively repair it.
After evaluating the shoulder joint, the surgeon places the camera in the space above the rotator cuff tendons, called the subacromial space. The orthopedic surgeon can check the area above the rotator cuff, clean out inflamed or damaged tissue, and remove a bone spur (acromion spur) that may be causing impingement of the tendon.
At the end of the surgery, the incisions will be closed with stitches and covered with a dressing (bandage). Typically patients will go home the same day in a sling followed by a course of physical theraphy. The bandage will be removed and showering is allowed 2 days after surgery. The small incisions will simply be covered by a band-aid.
Dr. Samimi will take pictures of the procedure from the video monitor to show you what was found and what was done during the labrum tear surgery. He feels it is important for you to understand the nature of the problem and exactly what was done to fix it.
Arthroscopy is almost always performed as outpatient surgery and offers such benefits as reduced risk, fewer complications, less postoperative pain, less recovery time, and far less scarring. Using this minimally invasive procedure we perform labrum tear surgery with excellent results.
For detailed information about this condition and treatments please visit: AAOS Online Service Fact Sheet - Shoulder Joint Tear (Glenoid Labrum Tear)
