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What to Do About a Labral Tear

The shoulder labrum is a rubbery ring of cartilage that stabilizes your shoulder joint. The labrum surrounds the rim of your glenoid, the “socket” part of your shoulder joint much like w washer or gasket. The labrum creates more depth in the glenoid, which keeps the humerus (the “ball” on the end of the upper arm) centered on the socket.

Many shoulder ligaments are attached to the labrum, as is a tendon that extends from your biceps muscle. When you tear your labrum, these ligaments / tendon have lost their attachment and  can make your shoulder joint unstable, which makes throwing painful, unpredictable, or weak.

A slight labral tear may be asymptomatic. In fact, the majority of throwers will have a painless tear, and asymptomatic labral tears are also common in nonathletes over the age of 45. However, if you’re an athlete, a symptomatic labral tear can affect your game and, without treatment, could end your career.

As team physician for the Houston Astros and Houston Texans, David Lintner, MD, is an expert in diagnosing and treating labral tears with non-operative therapies, minimally invasive arthroscopic surgery, or open surgery. If your shoulder is weak or painful and you suspect a labral tear, here’s what you should do.

Get a diagnosis

The Houston Methodist Orthopedics & Sports Medicine clinics in Houston and Baytown, Texas, are fully equipped with X-ray, ultrasound, and MRI imaging techniques that allow Dr. Lintner to take a close look inside your shoulder. The two most common types of labral tears he sees are:

SLAP tears

A SLAP tear occurs at the point where the labrum attaches to the bicep’s tendon. SLAP tears are common in pitchers and volleyball players, along with any other type of athlete who swings their arms overhead with great speed and force. If you have a SLAP tear, you may feel pain near the front of your shoulder or near the biceps particularly with throwing, serving, or similar.

Bankart tears

Bankart tears occur near the bottom of the labrum. These types of tears often occur as a result of the shoulder getting dislocated but can happen with “jamming” the shoulder or even with overuse. They’re common after a shoulder injury, such as a fall.

Once he’s diagnosed your type of tear and determined its severity, Dr. Lintner prescribes your treatment.

Start with physical therapy

Unless your labrum is severely damaged, Dr. Lintner usually begins by recommending lifestyle changes and supportive therapies that allow your labrum to heal on its own. First, he advises you to modify the way you use your shoulder during the healing period so that you don’t exacerbate the injury, while staying active. This may mean temporarily changing your position, modifying your workouts, or taking a break ( in more severe cases). 

If you have a Bankart tear with a dislocated shoulder, he puts your shoulder back into its socket. Most of the time this has already been done in the ER, but due to the risk of recurrence you have a higher risk of it happening again. He then recommends physical therapy to strengthen the supporting muscles and ligaments, and sometimes surgery if your age or activities place you at high risk of recurrent dislocation.

With SLAP tears, he may first administer anti-inflammatory medications to ease swelling and pain. He then recommends physical therapy, including exercises that increase the strength, flexibility, and range of motion of your shoulder capsule.His research shows that the large majority of professional pitchers can get back to competition without surgery! 

When needed, undergo surgery

If your tear is severe, or if conservative therapy doesn’t resolve your shoulder pain and instability, Dr. Lintner recommends surgery. He’s an expert at minimally invasive arthroscopic surgery, which uses miniature cameras and instruments to repair your labrum. If necessary, he may use traditional open surgery to repair severe tears.

After a recovery period and physical therapy to strengthen your shoulder, you should be able to return to your normal activities. Dr. Lintner’s athlete patients usually return to throwing about 3-4 months after surgery. 

To diagnose and repair a labral tear, call our office nearest you today in Houston or Baytown, Texas.

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