Labral Injury
What is it: The labrum is a rim of cartilage surrounding the glenoid that functions to increase the stability of the shoulder. The SLAP tear and the Bankart tear represent two of the most commonly encountered types of labral tears.
How does it present: Labral tears often present with shoulder pain that may be very similar in presentation to a rotator cuff injury. SLAP tears most often occur with repetitive overhead activities, such as with athletes in throwing sports, but can also occur with a fall on an outstretched arm. SLAP stands for superior labrum anterior and posterior. The tears occur in the region of the proximal biceps tendon attachment. In addition to complaints of pain similar to rotator cuff injuries, these patients may complain about painful popping or catching in their shoulder, and test positive for a biceps injury by way of a Speed's Test. Bankart tears are usually associated with shoulder dislocations. In these cases the part of the labrum involving the inferior glenohumeral ligament is torn. Patients who have had a shoulder dislocation and sustained a Bankart lesion are more likely to re-dislocate and may sense instability of the shoulder as noted in the Apprehension and Relocation Test.
Common exam findings: Many tests for rotator cuff pathology may be positive in evaluation of a labral tear and these are often initially diagnosed as rotator cuff injuries. However, patients may also have a positive O'Brien's Test, Crank Test, and SLAPprehension Test. In the case of the SLAP tears, biceps pathology may be suspected with a positive Speed's Test or Yergason's Test. In the Bankart tears,the apprehension-relocation tests may also be positive.
Tests and treatment: Depending on the clinical case, initial x-rays may be indicated to evaluate for dislocation and/or appropriate reduction. In cases of acute dislocation, x-rays may also show a Hill-Sach's lesion, which is a depression in the humeral head noted on x-ray from the compression of it against the glenoid during the dislocation process. Otherwise, for evaluation of the labrum, a MRI arthrogram of the shoulder is indicated. Tears of the labrum do not generally heal spontaneously, but physical therapy can improve pain and function. Surgery may be needed to repair symptomatic labral tears. Bankart tears that are not repaired surgically have a higher occurrence of re-dislocation.