Glenoid Labrum Tears
A labral tear may occur from or be the cause of an unstable shoulder joint. The term “labral” describes the cartilage ring that encircles the base of the shoulder joint, known as the glenoid labrum. The scapular bone’s small articular depression, known as the glenoid fossa, creates the socket of the shoulder’s ball and socket joint. The shoulder joint is formed when this socket articulates with the humerus head. The fibrocartilaginous complex known as the glenoid labrum border the articular cartilage of the glenoid fossa as a rim. Glenoid labrum functions include deepening and expanding the glenoid (which serves as a static stabilizer of the glenohumeral joint), resisting anterior and posterior movement, and helping to prevent shoulder subluxation and dislocation at its maximum range of motion1. When shoulder injury occurs, the labrum is often affected by either acute trauma (shoulder dislocation, for example) or more frequently, repetitive microtrauma (shoulder subluxation)2. There are various labral injuries and it named according to their location in labrum, e.g; SLAP( superior labrum anterior posterior) lesion, Anterior labral tear, Anteroinferior labral tear. Most frequent are SLAP lesions. According to varacallo et al, Eighty to ninety percent of labral conditions in stable shoulders is thought to be caused by SLAP tears; however, these tears are rarely observed in isolation and are typically observed in conjunction with other shoulder conditions.In sports medicine, SLAP tears make up 1% to 3% of all injuries.3
The most common cause of labrum injuries in an acute situation is falls onto an outstretched arm. When the collision occurs in this scenario, the shoulder is abducted and somewhat forward-flexed. Additional mechanisms of injury consist of: Throwing repeatedly, Direct trauma, inappropriate heavy lifting, and hyperextension4.
The most common cause of labrum injuries in an acute situation is falls onto an outstretched arm. When the collision occurs in this scenario, the shoulder is abducted and somewhat forward-flexed. Additional mechanisms of injury consist of: Throwing repeatedly, Direct trauma, inappropriate heavy lifting, and hyperextension4.
Symptoms
Management
If you are suffering from glenoid labrum injury, you may experience,
- Profound effect on your everyday activities and sports performance.
- A deep, aching pain in the shoulder, particularly with overhead motions, a feeling of instability or "catching" in the joint, and a noticeable loss of strength and range of motion.
- A clicking or popping sound during shoulder motions, as well as widespread rotator cuff muscles weakness and fatigue.
- Difficult to sleep on affected side.
Physical therapists, by employing a blend of patient history, physical assessment ( Inspection, Range of motion examination, motor strength examination )and special test methods ( o’briens test, apprehension test, Yergason’s test 7), will diagnose the kind of labrum tear, establishing the foundation for a focused and fruitful treatment plan. If required, sometimes we also go through imaging investigations ( MRI ). According to walton et al, The specific test that demonstrates a meaningful capacity to impact clinical decision making is Yergason’s7. The initial course of treatment for most glenoid labrum injuries is nonoperative. Cryotherapy, (cooling, ice treatment) and activity modifications are examples of initial nonoperative therapeutic techniques. If surgical procedures are there then physical therapy will be important during the post-rehabilitation phase5. In order to reduce pain and inflammation, this first entails modifying shoulder activities and then going with icing and IFC for a brief period of time. According to khiyami et al; IFC has four main actions: oedema reduction, muscle activation, pain reduction, and tissue healing acceleration6. Physical therapy treatment aims to restore normal shoulder mobility when the discomfort has gone. In order to maintain good shoulder biomechanics, the shoulder girdle muscles must be strengthened. Physical therapist will establish individual specific plans which include progressive range of motion exercises, resistance exercises, and specific drills according to need. Our experts will plan a specific treatment plan in sequential manner ( Protected motion phase, Moderate protection phase, Strengthening phase etc ). In these phases physical therapist will include various combinations of exercises e.g; Active assitive ROM exercises, PNF manual resistance exercises, Thrower’s ten exercises, Rowing activities and many more8. According to Steinmetz et al, 78% of athletes with labrum tears benefit from nonoperative therapy, particularly if they are among the patients who can finish their rehabilitation regimen before trying to resume their activities. For the majority of labrum tears, physical therapy ought to be the initial course of action9. A road to recovery with Physical therapy that is focused on the healing of patients with glenoid labrum tears can help them on a path to transformation and strength.
References:
1. Knipe H, Hacking C, Mahmud A, et al. Glenoid labrum. Reference article, Radiopaedia.org (Accessed on 07 Aug 2024) https://doi.org/10.53347/rID-27109
2. P. Clavert, Glenoid labrum pathology, Orthopaedics & Traumatology: Surgery & Research, Volume 101, Issue 1, Supplement, 2015, Pages S19-S24, ISSN 1877-0568, https://doi.org/10.1016/j.otsr.2014.06.028.
3. Chmiel-Nowak M, Sheikh Y, Feger J, et al. Glenoid labral tear. Reference article, Radiopaedia.org (Accessed on 07 Aug 2024) https://doi.org/10.53347/rID-74948
4. Powell, S. E., Nord, K. D., & Ryu, R. K. (2012). The diagnosis, classification, and treatment of SLAP lesions. Operative Techniques in Sports Medicine, 20(1), 46-56.
5. Varacallo, M., Tapscott, D. C., & Mair, S. D. (2023). Superior labrum anterior posterior lesions. In StatPearls [Internet]. StatPearls Publishing.
6. Khiyami, A., Almalki, R. S., & Khayame, N. (2023). A review of interferential therapy application in sport physical therapy. Saudi Journal of Sports Medicine, 23(1), 10-16.
7. Walton, D. M., & Sadi, J. (2008). Identifying SLAP lesions: a meta-analysis of clinical tests and exercise in clinical reasoning. Physical Therapy in Sport, 9(4), 167-176.
8. Wilk, K. E., Reinold, M. M., Dugas, J. R., Arrigo, C. A., Moser, M. W., & Andrews, J. R. (2005). Current concepts in the recognition and treatment of superior labral (SLAP) lesions. Journal of Orthopaedic & Sports Physical Therapy, 35(5), 273-291.
9. Steinmetz, R. G., Guth, J. J., Matava, M. J., Brophy, R. H., & Smith, M. V. (2022). Return to play following nonsurgical management of superior labrum anterior-posterior tears: a systematic review. Journal of Shoulder and Elbow Surgery, 31(6), 1323-1333.
“Advance Therapy blogs and clinical information are educational resources by Advance Therapy clinical employees. The content provided here represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice, and should not be relied on for making personal health decisions.”