The shoulder is one of the largest and most complex joints in the body. The shoulder joint is formed where the humerus (upper arm bone) fits in the scapula (shoulder blade), like a ball-and-socket. The shoulder also has several other important structures, such as:
- Rotator cuff – a collection of muscles and tendons that surround the shoulder, giving it support and allowing a wide range of motion.
- Bursa – a small sac of fluid that cushions and protects the tendons of the rotator cuff.
- Labrum – a specific cuff of cartilage called the labrum forms a cup for the ball-like head of the humerus to fit into.
The labrum generally has two functions. The first function is to deepen the socket so that the ball remains in place. The second function of the labrum is as an attachment to other structures or tissues around the joint.
For instance, the ligaments that help hold the joint together attach to the labrum in certain key locations. If there is an injury to the shoulder that tears the ligaments, sometimes the labrum is pulled off of the rim of the bone as well.
A glenoid labrum tear (shoulder joint tear) is when the cartilage that lines and reinforces the glenoid labrum is torn.
Causes & Symptoms of a Glenoid Labrum Tear
When you experience an extremely painful sensation located on your shoulder from an injury, there is a possibility that you caused a labral tear. Many different mechanisms have been described as causes of labral tears in the shoulder.
Sometimes the cause is from a sudden injury, such as a forceful compression or sudden traction on the arm. However, some shoulder joint injuries are the result of repetitive injury to the shoulder, such as is the case with overhead throwing activities.
Several studies have shown that specific positions of the shoulder joint where the labrum increases the risk for a glenoid labrum injury. Depending on the activity and the position of the arm, a healthcare provider may be able to determine which type of glenoid labrum tear is the cause, such as the following:
A SLAP tear (superior labrum, anterior to posterior) is a tear of the rim above the middle of the socket that may also involve the biceps tendon. A tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart tear. Tears of the glenoid rim often occur with other shoulder injuries, such as a dislocated shoulder (complete or partial dislocation).
A Bankart tear (lesion) usually occurs when you sustain a dislocated shoulder, either partial or full dislocation. As the shoulder pops out of the joint, it often tears the labrum, especially in younger patients.
Posterior labral tears
Posterior labral tears are less common, but sometimes seen in athletes in a condition known as internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder.
The following symptoms of a glenoid labrum tear include:
- Pain with overhead motions – It is common to feel pain during overhead activities, like serving a tennis ball.
- Achy pain – Pain is typically felt deep inside the shoulder and is often described as an ache rather than a nerve-type or stinging pain. You may also feel pain in the back of your shoulder; if the biceps tendon is involved then you may feel pain in the front of your shoulder.
- Shoulder weakness – Your shoulder may feel weak, and it may feel like it could “pop out” of place.
- Clicking or grinding in your shoulder – Grinding and / or clicking sensations are reported by some patients with this injury. This is often known as ‘crepitus’.
- Weakness in sports performance – For instance, a golfer may notice a decline in golf club swinging speed.
Who gets a Glenoid Labrum Tear?
Anyone can experience a glenoid labrum tear, however, other risk factors associated with this injury include:
- Aging – Tearing or fraying labrum can develop as part of general aging. It is very common in people over 40 years old.
- Sports – Athletes participating in repetitive overhead sports (including baseball, softball, swimming, and weightlifting) are at risk of developing a labral tear over time. The labrum, or cartilage, progressively wears down because of repeated actions. Consequently, a SLAP tear can also occur.
- Traumatic event – Acute or sudden trauma can also cause this injury. Falling on an outstretched arm is a typical example. Others pulling on the arm powerfully or quickly moving the arm when it is over shoulder level.
How Does a Glenoid Labrum Tear Affect You? How Serious is it?
If a glenoid labrum tear is left untreated, shoulder joint problems may lead to permanent loss of motion or weakness and may result in progressive degeneration of the shoulder joint.
Although resting your shoulder is necessary for your recovery, keeping your shoulder immobilized for a prolonged time can cause the connective tissue enclosing the joint to become thickened and tight, which is called a frozen shoulder.
Recommended Treatment & Rehabilitation for a Glenoid Labrum Tear
It may be difficult to diagnose a glenoid labrum tear. These injuries frequently occur along with other shoulder issues, and symptoms can appear similar. Your doctor will perform a three-step diagnosis which will include a medical history, physical examination, and imaging tests, such as:
There are many topics your doctor may discuss with you during the medical history evaluation, including your symptoms and any previous treatment. Examples of discussion include particular sports or activities associated with pain, the initial cause of pain, and the location of the pain. These details can help your doctor determine the shoulder issue.
During this physical exam, your doctor inspects your shoulder strength, stability, and range of motion. The head and neck may also be examined to ensure the pain is not due to a “pinched nerve”.
A magnetic resonance imaging (MRI) scan is often done to help diagnose a glenoid labrum tear and other potential injuries to the muscles, tendons, ligaments, and cartilage in the shoulder. Also, arthroscopy is considered a recommended method to diagnose a labral tear. Arthroscopy allows detailed imaging, which a physical exam may not be accurate, and an MRI scan could miss a small tear.
After a diagnosis is done, physiotherapy may be further advised. Physiotherapy can be very successful in treating shoulder joint injuries – you would work with a physiotherapist to devise a treatment plan that is specific to your condition and goals. This treatment program may include the following:
Your physiotherapist will help you indent and avoid painful movements to allow the inflamed tendon to heal. Ice, massage, or moist heat may be applied for pain management. Therapeutic modalities, such as electrical stimulation (TENS) may be applied.
Posture education is an important part of rehabilitation. For example, when your shoulders roll forward as you lean over a computer, the tendons in the front of the shoulder can become pinched.
Your physiotherapist may recommend adjustments to your workstation and work habits. Your physiotherapist will also instruct you in ideal sitting, standing, and sleeping positions to help alleviate symptoms from a labral tear. Your therapist may suggest different ways to perform currently painful activities and show you movements to avoid while the shoulder is in a painful condition.
You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.
As your symptoms improve, your physiotherapist will help you return to your previous level of function, which may include household chores, job duties, and sports-related activities. Functional training can include working or lifting a glass into a cupboard or throwing a ball using proper shoulder mechanics.
Your physiotherapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches, to get your shoulder moving again with your shoulder blade.
Performing the right exercise for shoulder joint tears is important during recovery since these muscles are essential for everyday function. Here are some exercises for anyone to try:
Bend over at the waist and let the arm down passively. Using your body to initiate movement, swing the arm gently forward and backward and in a circular motion. Perform this pendulum exercise for several minutes, then repeat 3-5 times a day.
Isometric shoulder external rotation
Standing in a doorway with your elbow bent at a 90-degree angle and the back of your wrist pressing against the door frame, try to press your hand outward into the door frame. Hold this position for about 5 seconds, then repeat the exercise 3 times a day.
Isometric shoulder internal rotation
Standing in a doorway with your elbow bent at a 90-degree angle and the front of your wrist pressing against the door frame, try to press your palm into the door frame. Hold for 5 seconds, then do 3 more sets of 10 repetitions a day.
Stand with your arms at your sides and with your elbows straight. Slowly raise your arms to eye level. As you raise your arms, they should be spread apart so that they are only slightly in front of your body (at about a 30-degree angle to the front of your body). Point your thumbs toward the ceiling. Hold this stretch for 2 seconds and lower your arms slowly before repeating the exercise with 3 sets of 10 repetitions.
Side-lying external rotation
Lie on one side with your top arm at your side and your elbow bent to 90 degrees. Keep your elbow against your side, raise your forearm and hold for 2 seconds. Slowly lower your arm, then do 3 more sets of 10 repetitions.
Alternative & Homeopathic Treatment for a Glenoid Labrum Tear
There are several ways for you to alleviate your shoulder pain from a glenoid labrum tear. The key to this process is understanding that some movements and exercises can be very helpful, while others can harm your shoulder. Here are some homeopathic treatments to help relieve your shoulder joint pain:
Applying ice reduces blood flow, which will decrease inflammation and swelling, and alleviate pain in the process; cold therapy is recommended immediately after pain strikes, and ice packs should be applied for 15-20 minutes, up to 5 times a day.
Applying heat to a painful shoulder increases blood flow and brings in oxygen and nutrients to the area, which will accelerate the healing process and alleviate pain; this is recommended a few days after the onset of pain and can be accomplished with an added hot shower directly on the shoulder or a hot pack applied to the affected area for 15-20 minutes a day.
Some patients with mild shoulder joint tears can experience relief with pain medications that do not require a prescription, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen; NSAIDs may alleviate pain by reducing inflammation.
Sleeping on your bad shoulder can make matters much worse, so it is recommended to try to sleep on your back or the side of your body that is unaffected by shoulder pain to avoid worsening the problem.
Gently massaging your shoulder will help alleviate stress and tension in the surrounding muscles, while also improving blood circulation and reducing swelling in the process, all of which can reduce your pain levels.