Labral Tears in Sport

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What is a labrum?

First I want to talk a little about the shoulder itself. The shoulder is a ball and socket joint. The head of the humerus is ball-shaped (the ball of the joint) and it sits within a cup-shaped structure called the glenoid fossa (the socket of the joint). Being a ball and socket joint, the shoulder has more mobility than other joints. Having this much mobility allows for large movements such as being able to put your arm overhead and also to extend it backward. Having this wide range of motion is a good thing and allows for dynamic movements. However, with more mobility comes less stability.

To help improve stability the glenoid fossa has cartilage that lines its outer rim. This cartilage is called the labrum. The labrum deepens the “cup” shaped glenoid fossa, which helps keep the humeral head in place. Other structures that provide stability to the shoulder joint include the rotator cuff muscles and ligaments.

Are there different kinds of labrum tears?

There are two types of labral tears. The most common is the SLAP lesion, and the less common is the Bankart lesion. A SLAP lesion, or superior labrum anterior-posterior lesion, is more commonly seen with repetitive use. A Bankart lesion is usually seen with a traumatic event like a shoulder dislocation. Labral tears usually happen in one or two ways. The labrum can tear after having repetitive stress on it over a long period of time, or it can be one traumatic event that can cause it to tear. It is most common in overhead athletes such as baseball or softball due to the amount of stress that is placed on the shoulder.

What are the signs and symptoms of a labral tear?

Players with labral tears will usually have pain when throwing and can report painful popping, catching, or clicking when moving their shoulder. Shoulder instability or weakness is also a common symptom with labral tears.

Do you need surgery after suffering a labral tear?

Determining whether surgery is necessary depends on a few factors. The main factor is the severity of the tear. Minor tears are more likely to heal on their own while more severe tears will more often need surgical intervention. A systematic review looked at the effectiveness of nonsurgical treatment of SLAP tears. This study found that athletes who decided to do conservative care and made it through the entire rehab protocol before returning to play, had successful outcomes. Other factors that impact the choice of surgery vs conservative care is patient preference and timing of the injury (in season or off- season). Often conservative care is attempted first. If it is not improving the symptoms, surgical intervention will be considered.

How can sport chiropractors help with shoulder labral tears?

It is important to understand that not all injuries to the shoulder indicate a labral tear. Sports chiropractors can help to diagnose and walk you through your treatment options if you have a labral tear. If together you decide that surgery is the route you want to take, sports chiropractors can work with you to increase range of motion and improve strength before surgery to improve surgical outcomes. Sports chiropractors can also work with you post-surgery to improve recovery and work on rehabilitation of the shoulder.

If together you decide that you want to try conservative treatment sports chiropractors can offer a realm of options to help you recover. Some specific options would be a combination of soft tissue techniques, rehabilitation exercises, lifestyle modifications, and alterations to movements to keep you pain free. Sports chiropractors can also offer joint mobilizations or manipulations to surrounding joints to improve motion while protecting the shoulder.

Rehab exercises are extremely important for labrum recovery. Sports chiropractors will know when it is appropriate to start range of motion exercises, when to start strengthening exercises, and when to progress into sport-specific exercises.

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