Anatomy and its Function
The uppermost part of the arm bone is known as the humeral head. It rests in a shallow socked called the glenoid in the scapula, which is what the shoulder blade is called. There is rim of fibrous tissue at that envelopes the glenoid socket that is called the labrum, and it functions as a stabilizer for the shoulder joint. The shoulder joint would be unstable in an obvious way if the labrum wasn’t there. There are a variety of ligaments that are vitally important parts of shoulder function and stability that stem off of the labrum as well.
Many of the symptoms of a SLAP (Superior Labrum Anterior to Posterior) tear in the shoulder happen to be quite similar to the symptoms of many other shoulder injuries. These symptoms can include a smaller range of motion, weakness, and a feeling of pain that is usually brought on by performing activities that that involve lifting your arms. Some of the other commonly seen symptoms of a labral tear include popping, locking, catching, grinding, and a general instability felt in the shoulder.
Usually, the cause of a labral tear is some kind of acute trauma like a fall with your arms stretched out in front of you, falling directly on your shoulder, or the sudden twist or pull of the shoulder or arm. The constant repetition of overhead motions commonly cause athletes that lift weights or play baseball to frequently incur labral tears. Shoulder dislocation is the most common cause of tears that affect the inferior portion of the labrum.
The Diagnosis Process
The first step in the diagnosis process is a thorough clinical examination that will focus on your shoulder. It will include a few x-rays that will assist by exposing fractures, bone spurs, and other abnormalities. Another possible test is called an MRI, which is a process where dye will be injected (an MRI arthrogram) that will help your doctor get a better image of your labrum’s health. Unfortunately, the MRI will not be able to identify a problem like a labral or SLAP tear. In those instances, the best way to make sure that the diagnosis is correct is through shoulder arthroscopy.
The Conservative Treatment
Once the diagnosis has been confirmed as a labrum tear, it’s best to start with looking at the more conservative treatments. One of the most important changes in daily life should be less overhead activity. Anti-inflammatory medication (NSAIDs) can be taken orally if prescribed in order to reduce inflammation and pain. Another treatment is physical therapy, which will help you gain more control over the range of motion in your shoulder. It works by stretching and strengthening the affected muscles while making the symptoms lessen. In addition, a steroid may be injected to assist in the healing process.
The Surgical Options
Surgery is the recommended alternative when conservative treatments fail. The nature and size of the tear will define what the treatment should be. The arthroscopic surgery technique usually uses anchors and sutures to fix the labrum and get rid of torn flaps. These tools don’t need to be taken out because they are designed to be absorbed. Sometimes the conditions caused by the injury will cause shoulder instability, and in those cases a part of the shoulder capsule will be used in the process of repairing the labrum so that the capsule will re-tighten and stability will improve.
What does the procedure look like?
The surgery known as shoulder arthroscopy is used in order to diagnose, visualize, and help treat problems that can be found inside of a joint. In order to begin the procedure, a small incision must be made in the skin and then a small, pencil-sized arthroscope will be inserted into the injured joint to assess the damage. There’s a tiny camera at the end of the arthroscope that will allow the doctor that uses it to see inside of the joint. The image shown will be magnified in a way that will help them accurately diagnose the strength of the damage done to the labral tear. During this procedure, steps can be taken to repair the damage as well.
The first thing that the doctor will do is evaluate the shoulder joint itself, and once that is done the camera will be slid into the space right above the rotator cuff tendons. This is also known as the subacromial space. From there, the orthopedic surgeon will be able to look at the space above the rotator cuff, which will allow them to remove a bone spur (known as an acromion spur) that might be the cause of an impingement to the tendon and clean out damaged or inflamed tissue.
Like most surgeries, when this one is over the incision will be stitched up and closed, then covered with a bandage. Usually, most patients are allowed to go home on the same day as their surgery. They’re given a sling and a schedule for physical therapy. Showering is allowed after two days, which will give the incision time to heal, and the bandage can be removed. From then on, the small incision can be covered simply by a band-aid.
In order to show the patient what the damage was, pictures will be taken on a video monitor during the procedure. These pictures will also feature the labrum tear and how it was repaired through the surgery. Many doctors believe it is vitally important for their patients to be involved enough in the process to know what was done.
The majority of arthroscopy is considered outpatient surgery. It offers the patients benefits, like fewer complications, a generally reduced risk factor, less pain after the surgery, a shorter recovery period, and much less scarring than other alternatives. This labrum tear surgery is categorized as minimally invasive and the procedure provides excellent results.
For detailed information about this condition and treatments please visit: AAOS Online Service Fact Sheet – Shoulder Joint Tear (Glenoid Labrum Tear)
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