What is the Labrum?

The labrum in the shoulder  is a cartilage disc attached to the socket of the shoulder that aids in maintaining stability of the shoulder — so that the shoulder stays in its proper place. The labrum is firmly attached to the socket, and the shoulder ligaments which connect the bones of the shoulder together insert or attach to the labrum. Therefore, if I’m making myself clear, it should obvious that if a labral tear occurs,l   the ligaments of the shoulder may no longer be functioning properly.   

 What is a labral tear?  

 There are many different types of tears of the labrum.  Or perhaps a better way to think about it is that these tears can occur from different type of trauma or stress.   There are tears of the labrum that occur because of trauma.  There are tears of the shoulder labrum that occur because of repetitive use. Perhaps the most common form of labral tears are those that occur simply because our labrum has worn out over time.  A labral tear is simply a detachment of the cartilage disk or the glenoid labrum from the bone. If you fell down and your arm dislocated— then the ball of the shoulder actually pushed the labrum off of the socket. In overhead athletes such as pitchers or volleyball players, the source of a labral tear is usually repetitive stress. That means every time you throw you put stress on the labral attachment and eventually it may separate from the bone (Peel Back Lesion)  Now, in our most common group, the labrum simply wore out and is usually just frayed,  and not actually detached.

Do Labral Tears Require Surgery?

 Once again is critical to keep this in mind. Physicians should endeavor to treat patients and not their MRI findings. A recent article in the New York Times show that nearly 90% of professional athletic had MRI findings consistent with tears or other problems in their shoulder, despite the fact that they had absolutely no pain. Therefore, it is of critical importance that the history or story that you give your physician about the pain that you’re experiencing matches the findings on your physical examination and your physician feels that your labral tear is the possible source of your pain. I will tell you quite clearly, in many, many people, the source of your shoulder pain is not your labral tear. Some labral tears produce “mechanical” symptoms. That can include catching, popping (not simple clicking),  pain during certain overhead activities such as pitching or volleyball.  Certain tears of the labrum can produce events such as a shoulder dislocation. Those are very clear signs and symptoms of a labral tear which is producing a problem in your shoulder. If you are 45 to 70 years old. You have a 90% chance that your labrum in your shoulder is torn or wearing out, and in the vast majority of circumstances your labral tear is not the source of your pain.

 I’m worried about my labral (labrum) tear surgery? 

There are many reasons why this is one of the most frequent questions that I field from e-mails through my website, or with patients whom I am interacting with the my office. Virtually every patient is nervous about surgery. That’s normal. Perhaps the issue that you are worried about, and perhaps quite accurately, you worry whether or not the labrum is the source of your pain — and the surgery you are about to undergo is necessary.  You also worry about the time off it needs to heal, and if you will be able to return to your prior level of activity.  As I’ve mentioned before, if you are an overhead athlete and have pain during throwing and  found to have a labral tear, and do not respond to physical therapy – – – there is a good chance that the surgery is indicated, however, recent scientific literature has shown that you may not return to your prior level of pitching ability. If you have have fallen and  your shoulder is dislocated, and your shoulder continues to dislocate, then your surgery is well indicated.  

If you are 50 years old have difficulty raising your arm, have pain at night, have pain when you trying to work out in the gym, or work out in the yard, it is almost certain that the labral tear found on your MRI is not the source of your pain.

Again, your history, your physical exam, and your MRI, must all correlate to create a clinical “story” or a situation where the surgeon is nearly certain that the labral tears the source of your pain. We can never be 100% sure… but we should be almost certain  

Assuring “success” after Labral Tear Surgery: 

The recovery from labral tear surgery is long, and quite annoying. Most of you who are undergoing a labral repair or labrum reconstruction are having the cartilage tissue sewn back against the bone. Although we put anchors into the bone and utilize them to reattach your labrum you need to wait until the labral tear actually heals back to the bone – – – which takes a minimum of 8 to 12 weeks – – – before you can start to put any significant stress onto your shoulder. Surgery on the labrum generally involves a period of immobilization or the use of a sling. It may involve very light, gentle physical therapy if the surgeon finds that your shoulder might be getting stiff, however, you should not stress full range of motion of your shoulder, nor should you return to any overhead activities or weightlifting, until you have been given the go-ahead to do so by your surgeon. Many failures are the result of noncompliance (you not listening to your doctor ) — and not following the instructions of your surgeon, or therapy that has become too aggressive, too soon.  

Even when you do follow your physician’s instructions,  and even if a repeat MRI shows that the labrum is healed, you may still have some residual symptoms (pain). Many times, that’s because there was probably something else that was bothering you shoulder – – – or simply the fact that restoration of “normal” function – – – following a labral repair, is frequently not possible.

IF you live outside of Westchester or Dutchess Counties in NY, feel free to click the link below to book an online virtual discussion

IF you live in Dutchess or Westchester County, NY, feel free to click the link below to book your an appointment online to explore your options — or call 914-789-2735 

Video Transcript: 

Today we’re going to talk about labral tears. L- A-B-R-A-L.  What is the labrum?  The labrum is a cartilage disc and today we’re talking about the labrum in the shoulders.  That cartilage disc provides a very important function; it helps maintain stability of the shoulder joints. Many people will develop labral tears due to repetitive stress. Those are typically overhead athletes. Some people will develop labral pathology or tears because of overuse in the gym and working out.  Some people will develop tears of the labrum because of a fall and the shoulder dislocates and you simply push the labrum off of the shoulder. The last group is the largest group who have labral tears; those are the people where the labrum has simply worn out.

Now, if for some reason you go and have an MRI, there is a very strong likelihood that some form of labral pathology (tear) or problem will be identified. Is that the source of your pain? Well, that’s for your surgeon to determine based on your complaints, your story, your history, and your physical examination. If you dislocate, and your shoulder keeps dislocating frequently, then the labral tear is the source of your issue. If you’re an overhead athlete, and have pain in certain positions, then that labral tear may be an issue. We’re typically talking about the age group of around 15 to 35, beyond that, most of us have labral tears simply because the labrum has worn out — and the labral tear is probably not a source of your pain.

More importantly now, if you should choose to have surgery,  proper rehabilitation involves immobilization, not using that arm, letting the sutures which are holding the labrum in place do their job, so that labrum heals back in place. I see many people that are unfortunately started therapy or motion too soon, or they have not listened to their physician— which can all lead to a recurrent or a new labrum tear.

So, simple take home message,

Many/most labral tears or tears of the labrum do not require surgery … 

1) Labral tears exist and are a problem in certain populations. The labrum is found to be torn in the vast majority of people over the age of 40. Those tears typically do not require treatment or certainly suturing at the time of an arthroscopy. Your pain sources is more than  likely due to something else.

3) If you choose or require labral surgery, listen to your physician, follow the instructions. Do not be too aggressive otherwise, you may find yourself back in the operating room.

There’s a lot more to learn about the labrum and labral tears. Please feel free to check out my website if you have any questions, there are lots of ways to reach out to me and communicate to me through my website. Have a great day.