Instability and Labral Repair of the Shoulder

Like the hip, your shoulder is a ball-and-socket joint. Unlike the hip, however, the socket of the shoulder is very shallow, almost like a golf tee. This configuration is ideal for mobility, and the shoulder joint is the most mobile joint in the body. However, this fantastic mobility comes at the expense of a certain amount of stability, or your shoulder’s ability to stay in place.

The labrum is a soft tissue that encircles the socket like an O-ring or gasket. It provides stability to the shoulder while preserving its mobility. However, to do this, the labrum cannot be as firm or strong as the surrounding bone, and it can be torn as a result of a traumatic accident (a shoulder dislocation being the most common) or as a result of repetitive overuse (like a baseball pitcher).

The type of injury sustained typically determines where the labrum tears. If your shoulder dislocates, the most common place for a labral tear to occur is in the front, or anterior portion of the socket (also called the glenoid). Rarely, a shoulder can dislocate out the back, or posterior aspect of the glenoid and the labrum tears there. When a labrum tear results from repetitive overhead activities, such as throwing, the tear occurs near the top and back part of the glenoid. Sometimes this type of tear, also called a SLAP (superior labrum anterior to posterior) tear, can involve damage to a tendon from the biceps muscles that inserts right at the top of the labrum of the shoulder joint.

The symptoms of a labral tear depend on what caused the labrum to tear. If your labrum tore as a result of dislocation, your shoulder might dislocate over and over, or you may experience frequent feelings of your shoulder “wanting” to dislocate again. If your labrum tore as a result of overuse, you are more likely to experience pain when participating in various overhead activities or athletics. Based on the type of labral tear, physical therapy can be a very effective treatment, and surgery may be avoided (more often for SLAP-type tears).  However, surgery may be the best option if physical therapy cannot relieve your pain or if you are young, active, and have instability.

What is a Labral Repair Surgery?

In a labral repair procedure, Dr. Pace reattaches the torn labrum to its proper place on the shoulder blade. Like many orthopedic surgeries, a labral repair may be accomplished either arthroscopically – passing instruments through a tiny incision – or in the conventional open fashion. While total healing time is the same between either approach, arthroscopy offers less postoperative pain and better early rehabilitation. As such, arthroscopic repairs constitute the vast majority of labral surgeries.  However, there is still a role for open surgery from time to time.

Associated Injuries with Instability

It is important to know that not all shoulder dislocation problems can be addressed with a simple labral repair. Sometimes, bony fractures of the socket or impaction injuries of the ball (think a golf club taking a divot out of the ground during a bad swing) can occur during a dislocation or after someone experiences several dislocations. In these situations, the instability can still be corrected but may require certain bone transfer procedures to correct the fractured bone off the socket or a procedure to fill the divot with a tendon from the rotator cuff.

Multidirectional Instability

This type of shoulder instability is different from instability due to an accident and does not typically cause a labral tear. An example of multidirectional instability is the person who can voluntarily move their shoulder out of place. Often, this sort of excessive shoulder mobility does not cause the patient any problems. However, some people experience pain from this type of instability. For the vast majority of patients, this pain will resolve with a physical therapy shoulder strengthening program. This can sometimes be supplemented by injections of pain-relieving medication into the shoulder. This program can take months to take effect, but it does work.

For a few patients, therapy will not be effective and surgical intervention may be required. Any excessively loose tissue in the shoulder is tightened up during this surgery. This procedure is typically performed arthroscopically, but it may need to be done in an open fashion through a larger incision in some instances.

Dr. Pace is a board-certified orthopedic surgeon and offers surgical treatment for many joint problems, including labral tears of the shoulder. Contact us at (860) 837-9220 to learn more.

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