The labrum is a ring of fibrous cartilage around the edge of a surface of a joint.
In the shoulder, it is called the glenoid labrum. The glenoid labrum runs around the cavity of the scapula in which the head of the bone of the upper arm (the humerous) fits. In the hip, it is called the acetabular labrum. The acetabular labrum runs around the cup of the hip joint.
A labrum is like a cuff on a sleeve. It extends the socket of a ball and socket joint to make it more stable. A labrum gives more support to hold the bones in their proper places. The ligaments that help hold the joint together attach to the labrum. It also provides cushioning to the joint.
Injuries, falls, repetitive movements, overuse or degeneration from diseases such as arthritis can cause the labrum to tear.
Glenoid Labral Tears
Acetabular Labral Tears
Golfers or softball players who do a lot of sudden twisting or pivoting movements are prone to acetabular labral tears. Contact sports such as football, hockey or others can cause a hip dislocation and labral tear. Impingement syndrome that affects the hip joint may also cause a labral tear.
Symptoms of a Labral Tear
When a labral tear occurs, it causes a locking, clicking or catching sensation in the joint. There usually is pain. Where the pain is felt depends on where the tear is. The joint may be stiff or have a limited range of motion.
Treating a Labral Tear
Typically, before treatment, the doctor will first take a history of the patient's injury, including how it happened. Then he or she will do a thorough physical exam. The physical exam will help find out if there are other conditions or injuries that are causing the symptoms.
The doctor will check for stiffness in the joint as well as instability. (It is important to find out whether the labral tear is associated with instability of the shoulder joint. If it is, both conditions need to be treated at the same time.) The precise pattern and location of the symptoms also tells the doctor much about the kind and location of labral tear.
If necessary, an X-ray may be done to rule out problems such as arthritis, a fracture, impingement syndrome or a tumor. A magnetic resonance imaging (MRI) scan preceded by an arthrogram is used to confirm a diagnosis of a labral tear.
Conservative Care for Labral Tears
Because the labrum has a rich supply of blood, some labral tears heal on their own.
For some types of labral tears, physical therapy may be helpful. This is especially the case if the tear is associated with impingement where the rotator cuff rubs on the labrum. Physical therapy can help strengthen the muscles outside the joint that help rotate the shoulder. Sometimes the joint capsule can be stretched with the help of a physical therapist. This opens up space inside the joint for easier movement without harming the labrum.
If symptoms go on even after more conservative treatment, however, surgery may be needed. Because of how much we depends on our arms and shoulders, it may not be possible for some labral tears to heal on their own.
When conservative care does not heal the tear, surgery may be needed to treat a labral tear.
Minimally Invasive Treatment of Labral Tears
The arthroscope has meant a great advance in the treatment of labral tears and other orthopaedic conditions. The arthroscope allows a surgeon to insert a tiny camera into the joint. This allows him or her to clearly see injuries to the joint and labrum. If repairs are needed, instruments can be inserted into the arthroscope to make them.
Arthroscopic treatment is almost always done for simple labral tears that are not associated with instability of the joint.
In this process, the damaged portion of the labrum is removed. This includes any flaps of cartilage that keep the joint from moving easily. In some cases where muscles have been detached from their anchors around the joint, it may be necessary to reattach them to the bone. This procedure is called a tenodesis. A tenodesis is more likely to be done if the patient is older.
Following simple labral surgery, physical therapy is used to regain strength and range of joint motion.
If a tenodesis is necessary, it may be necessary to immobilize the joint for about four weeks so that the tendon can heal back to the bone. After that, physical therapy can start.
People who play tennis or softball may need to wait up to six months before they are able to regain full endurance and speed in overhead movements.