Are you having difficulty moving your arm because of shoulder pain? Does your arm constantly feel tired and heavy? Is it an effort to lift objects heavier than 10 pounds? Maybe your shoulder feels as if it's going to fall out of place, or it makes a lot of noise when you try and use it. If any of these describe your symptoms, you might have a labral tear.
The labrum of the shoulder is made up of a group of tissues that lend passive support to the "ball" of the joint. The labrum provides stability that is vital to secure the ball of the shoulder within the socket as your arm moves through space. Small labral tears may cause minor clicking of the shoulder, whereas major tears may cause complete dislocation.
The tissues that comprise the labrum have a poor blood supply. In fact, no research to date suggests that the labrum even have the capacity to heal, making therapy or surgery critical in avoiding long-term problems.
Labral tears have distinct signs that are unique from most other shoulder pathologies. The most common symptom is a feeling that there is nothing keeping the shoulder in place. The shoulder will feel as if it could just fall out of the socket at any moment — literally hanging by threads.
Frank weakness of the shoulder and arm often stems from problems of the labrum. While the labrum itself does not contract like a muscle would, a tear of the labrum prevents the other muscles of the shoulder from working properly.
Repetitive motion often compounds liberal tears. Given the frequency at which we use our shoulders, small tears tend to progress towards large tears. Large tears left untreated may cause catastrophic loss of arm function an ultimately result in a salvage-type surgery.
Many of the nerves that pass through the underarm are sensitive to compression. In cases of labral damage, the ball of the shoulder may slip downward, landing on top of that group of nerves. If this occurs, patients should consider it a surgical emergency as prolonged compression may cause irreversible damage to the nerves that control the muscles of the hand and arm.
The shoulder is a complex region with many structures that can mimic signs and symptoms of a labral tear. There are, however, some excellent clinical examination techniques (shown in the pictures) that will help you decide whether you should be seen by physical therapy.
Labral tears occur in patients of all ages. Younger patients tend to have isolated lesions while patients 60 years old and older may have rotator cuff tears accompany their labral issues.
In cases of severe tearing and gross instability, surgery is strongly recommended. The nature of the tear in this instance would be to progress in terms of pain and loss of function. Recovery time following surgery is typically around eight weeks, although that figure does depend directly on the amount of damage in the shoulder and the amount of repairing needed.
For patients who are not surgical candidates or wish to manage their shoulder conservatively, physical therapy can be a highly effective medium to reduce pain and restore function.
Physical therapy focuses directly on strengthening the surrounding muscles of the shoulder to provide a "muscular sling" that mimics the function of the labrum. The course of rehab can range between eight and 12 weeks, although most patients will see some manner of improvement within four weeks.
Untreated labral tears are a significant threat to the health and function of your shoulder. If your shoulder is moving in ways it shouldn't, see a physical therapist soon — he'll help you put that labral problem in its place.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly.¬ Questions may be submitted to On the Mend, c/o Salem News, 32 Dunham Road, Beverly, MA 01915 or e-mail email@example.com.