The shoulder is one of the most complex joints in the body. It is made up of a total of four joints, numerous ligaments, joint capsules, muscles and other soft tissues. Movement at the shoulder is a complicated process and it relies on the controlled function of all the involved muscles and joints for that movement to be efficient and complete. Our shoulders are the most mobile joints in the body which is great for us because it means as humans we get to partake in fun activities like throwing sports, gymnastics and dancing, as well as movements we generally take for granted like being able to do up our bra’s behind our backs. This wide range of movement is only possible because the shoulder is less stable when compared to other joints in the body, leaving the shoulder prone to injury.
This information specifically focuses on an injury that relates closely to the ball and socket part of the shoulder joint. If you are into throwing sports, you may be familiar with a labral tear.
A bit of anatomy…
There are two main ball and socket joints in the body, found at the shoulder and the hip. Both work where a rounded ‘ball’ of one bone fits into a hollowed ‘socket’ of another. At the hip (the strongest joint in the body), the socket is very deep, and the ball part fits quite snuggly into it. This is a very stable joint. The socket in the shoulder is very shallow by comparison, and the ball part is still quite large. This is what gives the shoulder its lack of stability.
Both the shoulder and the hip sockets are deepened and supported by the presence of a labrum — a rounded soft-type of cartilage. In the shoulder, the labrum completely surrounds the rim of the socket creating a ring. The very top part of this ring also acts as the attachment site for one of the tendons of the biceps muscle — a powerful mover of the shoulder and elbow joints.
How does a labrum tear?
The main ways labral tears occur are:
- Repetitive movements such as overhead throwing
- Carrying heavy objects
- Dropping and catching heavy objects
A tear can occur over time as the tissues degenerate over time and become weaker, or it might be from one single, forceful event. In most cases there is usually a combination of both degeneration and a large force which becomes the ‘straw that breaks the camel’s back type of scenario. As the biceps tendon attaches to the socket through the labrum, any large force that pulls on the biceps tendon (like suddenly catching a heavy object) can lead to the tearing of the labrum itself. The most common type of tear occurs across the top of the labrum from front to back, and these are known as SLAP (i.e. Superior Labrum Anterior Posterior) tears.
Signs and symptoms
If you have sustained an injury to the labrum in the shoulder, you may notice any or all of the following signs and symptoms:
- Pain during shoulder movement (especially overhead and behind back movements)
- Restricted shoulder movement
- Popping, catching or grinding during shoulder movements
- Tenderness at the front of the shoulder
Depending on how you were injured, how severe your symptoms are, and your personal circumstances regarding work and home life, you may be sent for some imaging to confirm the tear. The tests we perform in clinic when we assess you do not always give us all the information we need to determine the best plan of action. A combination of clinical tests and imaging may give us a clearer picture of what’s going on.
Can it be treated by a physio?
Yes, but this completely depends on the severity of the injury and what your goals are. In most cases it is recommended that conservative therapy from a physiotherapist is tried first. Many athletes who have a labral tear can return to playing to some capacity with a non-surgical approach. The treatment aims to return the shoulder to full, pain-free range of motion through hands-on massage, mobilisation and rehab exercises that focus on range, control and strength of the shoulder girdle.
For severe tears, you may require the opinion of a shoulder specialist. A labrum is not great at healing itself and sometimes needs help from a surgeon to return to normal. A professional athlete wanting to return to sport may choose this pathway, but a non-athlete who has no desire to throw a ball seriously again may be able to avoid surgery altogether.
If you have a diagnosed labral tear, or have recently injured your shoulder and need help, we recommend coming to us at Philip Wood Physiotherapy where we can discuss the best course of action for you and your circumstances.