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Labral Tear

February 26, 2010


What is a labral tear of the shoulder?
How does it occur?
What are the symptoms?
How is it diagnosed?
What is the treatment?
When can I return to my sport or activity?
How can I prevent a labral tear?

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What is a labral tear of the shoulder?
The shoulder joint is a ball and socket joint. The labrum is a lip of connective tissue where the shoulder ligaments connect to the edge of the socket that holds the ball of the upper arm bone into the socket of the shoulder blade.

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How does it occur?
The labrum can be torn by:
– Dislocation your shoulder
– Falling onto your arm
– Having your arm jerked away from your body
– Using your to break a fall
– Lifting a heavy object
– Use of your shoulder in sports with a repetitive, high velocity overhead movement, such as throwing or tennis serving

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What are the symptoms?
The symptoms of a labral tear are:
– Arm and shoulder pain
– Shoulder weakness
– Arm weakness
– Pain overhead movements of the shoulder
– Clicking or grinding when moving your shoulder

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How is it diagnosed?
Your doctor will perform a physical exam and check your shoulder for pain, tenderness, loss of motion or laxity as you move your arm in all directions. Your doctor will ask you whether your shoulder pain began suddenly or gradually. An x-ray may be ordered to see if there are any fractures in the shoulder. Your doctor may recommend that you get an MRI (magnetic resonance imaging) of your shoulder, a special test that can see bone, a special test that can see bone, ligaments, cartilage and muscle. The MRI may be done with an arthrogram. A special dye is injected into the shoulder to outline the structures within the joint, and allows a better look at the labrum. Your doctor may perform an arthroscopy, a surgical procedure in which a small fiberoptic instrument is inserted into your shoulder joint so your doctor can see all the structures in your shoulder. Many times labral tears are finally diagnosed when arthroscopy is performed to look inside the persistently painful or symptomatic shoulder.

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What is the treatment?
Large labral tears usually need to be fixed in surgery. The tear in the labrum may be reattached or trimmed away. If there is scar tissue, it may be removed. Torn ligaments may be re- attached. Small labral tears may become painless by avoiding uncomfortable activities. Initially you will be treated by:
– Applying ice packs to your shoulder for 20  30 minutes 3 to 4 times a day
– Taking anti-inflammatory medications such as ibuprofen
– Doing shoulder rehabilitation exercises

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When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon, you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity is determined by how soon your shoulder recovers, not by how many days or weeks it has been since your injury occurred. You may safely return to your sport or activity when your injured shoulder has full range of motion without pain your injured shoulder has regained normal strength compared to the uninjured shoulder. In throwing sports, you must gradually build your tolerance to throwing. This means you should start with gently tossing and gradually throw harder. In contact sports, your shoulder must not be tender to touch the contact should progress from minimal contact to harder contact.

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How can I prevent a labral tear?
May labral tears are cause by accidents that cannot be prevented. However, it is important to use good form while throwing, playing racquet sports or lifting heavy objects.

Pierre Rouzier, M.D. THE SPORTS MEDICINE PATIENT ADVISOR

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