NYU Langone doctors create treatment plans based on the type of shoulder labral tear you have. Tears can occur at several different locations along the shoulder labrum, which is a ring of cartilage that lines the edge of the shoulder socket.
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Tears may sometimes occur in conjunction with tears of the rotator cuff, which is a group of four tendons and muscles that help support the shoulder and allow you to lift and rotate your arm.
A superior labrum anterior and posterior tear, also known as a SLAP tear, occurs at the top of the labrum, where the biceps tendon attaches. The biceps tendon connects the biceps muscle, located in the front part of the upper arm, to the labrum and shoulder socket. A SLAP tear also extends to both the front, or anterior, and back, or posterior, of the labrum, on either side of where the biceps and labrum meet. The tear can cause the biceps tendon to move back and forth like a windshield wiper as you move the shoulder, causing irritation and pain.
This injury tends to occur due to repetitive motion in athletes such as pitchers and javelin throwers, whose sports require lots of overhead arm motion. People who use overhead resistance training and weight lifting are also at risk of this injury. Traumatic injuries can also lead to a SLAP tear.
Some people experience pain and discomfort with this injury while working out or playing sports, while other have no symptoms at all. People younger than age 30 are much more likely to experience symptoms from a SLAP tear than people in their 50s or 60s. Many individuals can’t recall any single event that may have caused the tear.
Management for SLAP tears typically starts with nonsurgical treatment and moves to surgery if medical therapies are not effective.
Bankart tears typically occur with shoulder dislocation and are more frequent in younger athletes than in older athletes. Shoulder dislocation can occur during a collision in contact sports such as football, hockey, or basketball. As the ball of the upper arm bone, or humerus, moves out of the shoulder socket, it tears the lower portion of the labrum that connects to the inferior glenohumeral ligament, a band of fibrous tissue that runs to the top of the upper arm bone.
Most Bankart tears cause an anterior dislocation, meaning the ball of the upper arm bone moves toward the front of the body and tears the front lower portion of the labrum. Nonsurgical treatment may sometimes be used to treat a labral tear caused by a Bankart tear with an anterior shoulder dislocation. However, recovery needs to be closely monitored because the shoulder can be easily reinjured. If your shoulder does not improve, your doctor may recommend surgery.
Sometimes, the top of the humerus moves to the back of the body, an injury known as a posterior dislocation of the shoulder. This injury can occur in defensive linemen after being pushed from the front and in bodybuilders who bench press. A posterior dislocation can tear the back lower part of the labrum.
If you have a posterior dislocation with a Bankart tear and don’t play sports, your doctor may recommend nonsurgical treatments. If you are an athlete, your doctor may prescribe nonsurgical therapies and protect your shoulder with a brace designed for a posterior shoulder dislocation as you continue the playing season. You may consider having surgery in the off-season, because the likelihood of reinjury is high without it.
Some people have a condition in which the shoulder ligaments are more elastic than usual, causing them to stretch out and to become unstable. The condition, known as multidirectional instability, may also be caused by repetitive sports injury to the shoulder. Labral tears may occur as the ball moves without support in the socket or the shoulder dislocates. In these patients, tears can occur anywhere on the circumference of the labrum, but often involve the posterior labrum.
Multidirectional instability associated with a shoulder labral tear is managed with physical therapy and education on how to properly move the shoulder to avoid injury. In some people with shoulder instability, the labrum and shoulder capsule—the group of ligaments that surrounds the shoulder joint—may be severely stretched but not torn.
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