Labrum Surgery

Advances in medical technology are enabling doctors to identify and treat injuries that went unnoticed 20 years ago. For example, physicians can now use miniaturized television cameras to see inside a joint. With this tool, they have been able to identify and treat a shoulder injury called a glenoid labrum tear.

The shoulder joint has three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade called the glenoid. The head of the upper arm bone is usually much larger than the socket, and a soft fibrous tissue rim called the labrum surrounds the socket to help stabilize the joint. The rim deepens the socket by up to 50% so that the head of the upper arm bone fits better. In addition, it serves as an attachment site for several ligaments.

Cause

Injuries to the tissue rim surrounding the shoulder socket can occur from acute trauma or repetitive shoulder motion. Examples of traumatic injury include:

• Falling on an outstretched arm
• A direct blow to the shoulder
• A sudden pull, such as when trying to lift a heavy object
• A violent overhead reach, such as when trying to stop a fall or slide
• Throwing athletes or weightlifters can experience glenoid labrum tears as a result of repetitive shoulder motion

Symptoms

The symptoms of a tear in the shoulder socket rim are very similar to those of other shoulder injuries. Symptoms include:

• Pain, usually with overhead activities
• Catching, locking, popping, or grinding
• Occasional night pain or pain with daily activities
• A sense of instability in the shoulder
• Decreased range of motion
• Loss of strength

Treatment

Until the final diagnosis is made, your physician may prescribe anti-inflammatory medication and rest to relieve symptoms.

Rehabilitation exercises to strengthen the rotator cuff muscles may also be recommended. If these conservative measures are insufficient, your physician may recommend arthroscopic surgery.
During arthroscopic surgery, your WBJ surgeon will examine the rim and the biceps tendon. If the injury is confined to the rim itself, without involving the tendon, the labrum is still stable. The surgeon will remove the torn flap and correct any other associated problems. If the tear extends into the biceps tendon or if the tendon is detached, the labrum is unstable. The surgeon will need to repair and reattach the tendon using absorbable tacks, wires, or sutures.

Tears below the middle of the socket are also associated with shoulder instability. The surgeon will reattach the ligament and tighten the shoulder socket by folding over and “pleating” the tissues.

Surgery to repair the torn labrum is sometimes necessary. The purpose of the surgery is to reattach the torn labrum to the socket of the shoulder. Large labral tears that are the result of trauma generally need to be fixed in surgery.

The success rate of this surgery is quite good, with over 90 percent of patients returning to their normal activities without any further dislocations. In many cases, this surgery is performed arthroscopically; however, there are some individuals who should have a Bankart (labral) repair performed through an open incision.

With a small labral tear, the patient may be directed to avoid vigorous activities that cause shoulder pain, rather than undergo surgery. Your orthopedic surgeon is best qualified to determine which procedure is most suitable.