Our shoulder is a ball and socket joint. However, the ball in our shoulder is much bigger and it is considered to be a very unstable joint. The ball can easily slip out of the socket, resulting in shoulder pain and dysfunction.
Nevertheless, this shoulders’ set-up allows you for a lot of mobility to occur at the shoulder joints. Meaning to say, you can move your arms in many directions.
The Torn Labrum and Its Cause
The glenoid labrum (often shortened to the labrum) is a vital ligament in the shoulder. It is a band of cartilage that travels around the edge of the socket in your shoulder. It serves to add depth to the socket of your shoulder joint as well as an attachment point for other structures in your shoulder. In fact, some of the ligaments that support your shoulder attach to the labrum. One of the two biceps tendons attaches to the top portion of it.
As important as the labrum is in shoulder rotation usage, it is also highly susceptible to tearing because of the same reason.
The glenoid labrum can be injured in numerous, different ways. These include, but are not limited to:
- A forceful blow to the shoulder
- Motor vehicle accidents
- Sports injuries
- A repetitive lifting of heavy items
- Repetitive overhead motions like throwing
- Falling onto an outstretched hand or onto the side of your shoulder
As you have read, a torn labrum is a shoulder problem that may cause pain and debilitation to the shoulder, frequent dislocations of the shoulder, or problems with properly using the arm. It often happens in sports featuring hits to the shoulder or in a situation where there is a constant motion of the arms. It may decrease the strength and range of motion in the shoulder and simple movement become very painful. Muscles are also unable to exert as much force because of the damaged ligament.
There are three types of a torn labrum namely bankart tear, SLAP tear, and posterior labrum tear.
- Bankart Tear. It occurs near the front and the bottom portion of the labrum, and frequently occurs when the shoulder dislocates.
- SLAP Tear. SLA stands for superior labrum, anterior to posterior. This tear refers to the torn upper portion of the labrum where the long biceps tendon attaches.
- Posterior Labrum Tear. This is a rare case of a torn labrum. It occurs at the back of the shoulder labrum and may cause the shoulder to dislocate toward the back of the body.
The Symptoms and Diagnosis
Since there are many muscles and ligaments in the shoulder, a torn labrum may be difficult to diagnose. But some symptoms may include shoulder pain, difficulty lifting your own shoulder, a catching sensation in your shoulder, and a feeling that your shoulder is coming out of your joint.
To diagnose if a shoulder labrum is torn, a doctor or a physical therapist may perform shoulder special tests. The relocation test and apprehension test are common tests to determine if your shoulder is unstable and a labrum tear may be existing.
The doctor or physical therapist may also require an x-ray or MRI for a better diagnosis. X-ray, for instance, can diagnose a recent traumatic event that causes the shoulder problem; while MRI may determine a labrum tear by visualizing the inside of your shoulder. MRI, additionally, may show what kind of labrum tear you do have.
Therapy and Rehabilitation for Labrum Treatment
A torn labrum may require physical therapy. It may be necessary to help a patient decrease the pain, improve mobility, and regain the normal use of the arm after a labrum tear. Heat or ice may be applied, or electrical stimulation like TENS may be used to help decrease the pain. A patient should be cautious in using passive modalities as many studies indicate that active involvement in one’s care is the best form of treatment.
Surgery is usually required to repair the labrum, and with surgery comes extensive rehabilitation to get the strength and motion back. Torn labrum rehabilitation has several stages. Each of which has various exercises and levels of intensity.
This phase will eliminate movements in the joint so your shoulder and arm will be in a sling for a few weeks after surgery. The purpose of omitting the joint’s movement is to keep the shoulder immobilized so you do not accidentally jerk it and re-tear the labrum.
You will not be allowed to do many exercises during this phase of the rehab. Your therapist may instead encourage you to perform very small exercises with the hand, such as strengthening your grip. This will constantly get the strength back in your arm, at the same time, will result in a very slight movement to your shoulder ligaments, causing training to your arms without a dangerous level of motion.
The Next Several Weeks
By this stage, the sling in your arm will be removed and movements will become more intense than the hand gripping practice done the first few weeks. If healing confirmed to be progressing, you can begin with a more intense rehab exercise. Active usage of the shoulder muscles rather than handgrip exercises should be the focus of the exercise.
You may try standing on one end of an exercise band and hold the other with your arms flat at your side. Slowly extend the arm straight outward and then back down. The band will create resistance to help strengthen the rotator cuff and regain motion in the joint.
Another exercise that can be done is by lifting the arms straight above your head. Do it as far as you can without experiencing any pain. Stop if you feel the labrum tightening, and just hold your arms on that position for about ten seconds before gently lowering them. Repeat this a few times and the joint will slowly start to lose and regain the pain-free motion it had before the injury.
Several Months After
This stage will focus on weighted exercises and higher intensity. Once the danger of re-tearing the glenoid labrum has passed, the goal will be to have the shoulders’ full strength and range of motion back. You should continue doing the stretching exercise that utilizes resistance bands mentioned earlier. But you should add shoulder extensions to the mix as well. This can be done by holding a small dumbbell in each hand.
Rowing exercises are also a great way to work the shoulder through its full range of rotation while adding some muscle-building endurance. As you continue doing these exercises, the pain and feelings of tightness will disappear completely and you will be able to go back to your old exercise routine.