HO Labral Tears

7/28/2019 HO Labral Tears

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Labral Tears

What is it?The shoulder joint is a ball and socketjoint, with the humeral head (upperarm bone) as the ball and the glenoidas the socket. The glenoid (socket) is ashallow bone that is encircled withtissue called the labrum. (See Figure1) The labrum acts as a stabilizer forthe head of the humerus as it deepensthe socket in which the humerus rests.Throwing athletes and overheadathletes such as swimmers are atincreased risk for having labral tears.

Labral tears can be classified based onwhere the tears are located. If thesuperior or upper portion of the labrumis detached it is classified as a SLAPtear. (See Figure 2) If the lowerlabrum is separated from the bone it isclassified as a Bankart tear. (SeeFigure 3) Labral tears can occur inconjunction with shoulder

impingement syndrome or rotator cuffinflammation.

What can it cause?Labral tears can cause increasedmotion within the shoulder joint,which can cause inflammationelsewhere in the shoulder.

What are the symptoms?Patients may notice anterior, posterior

or lateral shoulder pain. Patients mayalso notice pain with throwing oroverhead activities.

Fig 1: Intact labrum and biceps tendon

Fig 2: Superior labral tear/ SLAP tear

Fig 3: Bankart tear


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What is the treatment?Treatment involves both surgical andnon-surgical options. An MRI may

also be obtained to evaluate thelabrum, shoulder joint and rotator cufftendons.Non-surgical treatment isrecommended prior to surgicalintervention.

Non-surgical treatment:1. Rotator cuff strengtheningexercises strengthen the muscles andtendons surrounding the shoulder joint

and act as secondary stabilizers. Theyalso decrease inflammation in therotator ruff tendons. These exercisescan be done at home, at a gym or witha physical therapist. (See Fig 4- )2. Anti-inflammatory medicationshelp decrease inflammation as well astreat pain.3. Cortisone injection into thesubacromial space may decreaseinflammation and overall shoulder

symptoms in combination with RotatorCuff Exercises.

Surgical treatment: Shoulder surgeryis always done via arthroscopy(surgery guided by video imaging asopposed to open surgery). Surgerystabilizes defects in the labrum. Labralrepair occurs with placement of asmall anchor into the glenoid. Suture isattached to the anchor and used to

secure the tissue back to the glenoid.

Surgical photos are available atwww.pamf.org/sports/staff/king.html

What are the exercises?Rehabilitation exercises focus onstrengthening the shoulder, specificallythe rotator cuff, and upper back.Rotator cuff strengthening exercisesinclude internal rotation, externalrotation and supraspinatus. Exercises

can be done with therabands, hand weights or cablepulleys at a gym which are adjusted to theappropriate height.

Each exercise should be done PAIN-FREE, andfor 3 sets of 20 repetitions. If the patient is unableto do 20 reps, then either the weight or theresistance should be decreased.See Fig 4-16.

Fig 4: Supraspinatus exerciseswith hand weightsand therabands. Always have your thumb pointingto the floor, your arm out 45 degrees, and keepyour arm below shoulder height.

Fig 5: Internal Rotation. Hold a small ball ortowel between arm and side and slowly rotateforearm across body. Return to start and repeat.


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Fig 6: External Rotation. Hold asmall ball or towel between arm andside while holding a weight or band;slowly rotate forearm away from side.Return to start and repeat.

Fig 7: Scapular Elevation, Shrugs.Stand with arms at side in straightstanding posture, shrug or raiseshoulders up towards ears. Brieflyhold, return to start and repeat. Ahand weight can add difficulty.Secondly, pull shoulder blades orscapula together in the back, hold, and

then relax shoulders forward. Repeat.

Fig 8: Scapular Protraction. Lie on back holding ahand weight. Keep elbows straight push hands uptowards the ceiling, hold, return to start and repeat.

Fig 9: Shoulder Extension. Lie on stomach andwith arm hanging off the side of the bed. Hold ahand weight and slowly raise your arm up until it islevel with side and next to body, hold, slowly returnto start and repeat.


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Fig 10: Shoulder Flexion. Whilestanding holding a hand weight or

resistance tubing, slowly raise armoverhead, hold, slowly return to startand repeat. Motion should be painfree. Avoid shrugging the shoulder.

Fig 11: Scapular Retraction. Anchortubing to a fixed object and hold endsof tubing in each hand. Squeeze andpinch your shoulder blades together,pulling your arms back. Hold, slowlyreturn to start and repeat.

Fig 12: Shoulder Extension. Anchor tubing to fixed

object and hold ends of tubing in each hand. Slowlypull hands down to the side while squeezingshoulder blades together. Hold, slowly return tostart, and repeat.

Fig 13: Horizontal Abduction. With a hand weight,lie on stomach and start with the arm hangingdown. Keep the elbow straight, slowly raise arm upand out from side. Hold, slowly return to start andrepeat. With a band, hold one end in each hand infront of body. Keep elbows straight, pull armsapart, or out to the side at shoulder height. Hold,slowly return to start and repeat.


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Fig 14: Scapular Retraction andExternal Rotation. If using a weightlie on stomach, with arm out to theside hanging down with elbow bentat 90 degrees. Upper arm should besupported by the bed. Turn and rotate

arm towards the ceiling while keepingthe elbow bent at 90. Squeeze theshoulder blades together, hold, slowlyreturn to start. If using a band, bendeach elbow at 90 degrees at shoulderheight and squeeze shoulder bladestogether. While squeezing shoulderblades, raise hands above shoulderheight as shown. Hold, slowly returnto start and repeat.

Fig 15: Scapular Retraction and Elevation. Holdone end of the band in each hand at shoulderheight. Squeeze and pinch shoulder blades togetherand while keeping both arms straight slowly raisearms overhead. Try to keep thumbs in a thumbs-up position. Hold, slowly return to start andrepeat.

Fig 16: Horizontal Adduction. With weights- lie onback holding weights with elbows bent. Slowly raisearms towards ceiling straightening elbow. Hold,slowly lower and repeat. With bands anchoredbehind, slowly push arms out in front straighteningelbows. Hold, slowly bend elbows and repeat.

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HO Labral Tears