Labral Tear

A labral tear commonly of the shoulder commonly results from dislocation, trauma or repetitive overhead activity, causing pain, clicking and instability. 
Shoulder arthroscopy is considered when conservative treatment fails
Dr Philip Markham provides consultations and surgery for labral tears in Gosford, Wollongong and Sydney.

A Labral tear refers to a tear within the fibrous ring of cartilage that surrounds the shoulder socket (at the glenoid rim) and also the hip joint socket.
The tear usually occurs at the interface of the cartilage ring attachment to the bone.
In the shoulder, a labral tear is a damaged labrum that surrounds the glenoid (shoulder socket).
This injury can compromise shoulder stability and cause pain, particularly during overhead movements.
Labral tears can also occur in the hip – the labrum surrounds the acetabulum (hip joint socket).
Labral tears in the hip can be painful in some patients and may cause difficulty walking.
In those with hip or groin pain, the prevalence of labral tears is reported to be as high as 55%.*¹

Labral tears, especially in the shoulder, are often considered sports injuries, but that is not always the case. The most common cause of a labral tear in the shoulder is if your shoulder has been dislocated. Other reasons include:

• Falling onto your outstretched arm or shoulder
• Motor vehicle accidents
• Repetitive or sudden heavy lifting
• Overuse (especially in overhead sports)
• Age-related degeneration

In the hip, some potential causes are:

• Overuse (especially common in some sports)
• Trauma to the hip
• Other conditions causing degeneration; studies have shown that the link between osteoarthritis and labral tears is significant.*²

Symptoms are similar in both hip and shoulder labral tears.

Shoulder

• Popping, clicking, catching or grinding sensations, especially during movement
• A decreased range of motion – it may be challenging to lift your arm
• Your shoulder feels weak or unstable
• With labral tears, pain varies; you may experience it constantly or only under specific circumstances, such as lifting overhead.
• Pain is often described as being felt deep within the shoulder, but it can be hard to localise.

Hip

• A clicking or locking sensation in your hip joint
• A decreased range of motion – your hip may feel stiff
• Dull pain in the hip, particularly when walking or running. You may also feel pain in the groin or buttocks.
• Like in the shoulder, pain varies. Hip labral tears can go unnoticed for years if they cause no symptoms.

Shoulder
SLAP tear
SLAP stands for superior labrum anterior to posterior. 
SLAP tears occur at the top of the glenoid and extend from front to back and occur at the site of the insertion of the long head of the biceps tendon. 
They are common in those who participate in repetitive overhead sports, such as weightlifters or baseball players.

Bankart lesion/tear
Also referred to as an anterior labral tear, Bankart lesions occur in the front of the labrum.
They are often seen as a result of anterior shoulder dislocation.

Reverse Bankart lesion
Also referred to as a posterior labral tear, reverse Bankart lesions occur at the back of the shoulder. They are often seen as a result of posterior shoulder dislocation.

Perthes lesion
A type of Bankart tear where the periosteal sleeve over the anterior scapular remains attached to the torn labrum but is stripped away medially. It can be difficult to diagnose on a routine MRI scan without contrast injection or positioning the shoulder into an abducted and externally rotated position.

 ALPSA lesion 
ALPSA stands for Anterior Labroligamentous Periosteal Sleeve Avulsion and the labrum tears attached to a periosteal sleeve but becomes displaced and often heals in a non-anatomical position medial to the scapular rim. 

 GLAD lesion 
GLAD stands for Glenolabral Articular Disruption and is a labral tear with an attached segment of adjacent articular cartilage still attached to the labrum which becomes displaced. 

 Hip
Anterior hip labral tear
These are the more common forms of hip labral tears. 
Anterior hip labral tears involve tearing in the front of the hip joint.

Posterior hip labral tear
Involves tearing in the back of the hip joint.

“Diagnosing a labral tear typically starts with a physical examination,” says Dr Markham.
“Although in both hip and shoulder, it can be hard to diagnose with a physical examination alone.”
After a physical examination, you will undergo imaging to confirm the tear and evaluate its severity.

“Diagnosing a labral tear typically starts with a physical examination,” says Dr Markham.
“Although in both hip and shoulder, it can be hard to diagnose with a physical examination alone.”
After a physical examination, you will undergo imaging to confirm the tear and evaluate its severity.

The symptoms of a labral tear, especially in the shoulder, are known to be very similar to other conditions. Labral tears are often mistaken for: 

• Arthritis
• Tendonitis
• Shoulder instability
• Rotator cuff disorder

In the hip, a labral tear cannot heal on its own.
In the shoulder, however, labral tears sometimes can heal on their own with rest and physiotherapy.
In both the hip and the shoulder labral tears can become less symptomatic.
Before surgical options are considered, treatment is based on managing pain. 
In both cases, you will undergo a physical examination and imaging on the affected joint to determine the best treatment route for you.

“There is no overall “best” treatment for labral tears as treatment depends on the severity of your injury and symptoms, and what your imaging shows,” Dr Markham says.
In both the shoulder and hip, pain-related symptoms will initially be treated with rest and physical therapy.
Many minor shoulder labral tears heal or become asymptomatic without surgery, using non-surgical treatments such as rest, anti-inflammatory medications or corticosteroid injections.
The sole focus is on managing pain rather than repairing the tear.
If surgical treatment is pursued, you will undergo an arthroscopy.
Arthroscopies are minimally invasive and can usually be performed as day surgeries; they also have high success rates, even in the long term.
It has been found that even after 5 years, 80% of patients who underwent shoulder arthroscopy for instability surgery were satisfied with their results and were able to return to their regular activities.*³
For hip labral tears arthroscopic surgery is often reserved for younger patients (who have an absence of hip arthritis) and have failed a long period of conservative management.
Dr Markham does not currently perform hip arthroscopies, but will recommend surgeons who do if surgery is pursued.
After surgery, you will require physiotherapy to assist you in recovery.

Usually surgery will be considered if non-surgical options have been exhausted and were not effective in reducing pain. You may also pursue surgery if your labrum is torn significantly.

In both the hip and shoulder, recovery time can vary. 
It is difficult to pinpoint an exact recovery time as it differs depending on the size and location of the labral tear. It also differs between hip and shoulder.
Generally, it can take from a few weeks to a few months for a shoulder to heal from an arthroscopy. Athletes can usually expect to return to their sport between four to six months.
Recovery times for hip labral tears are generally longer due to it being harder to rehabilitate with an injury to the hip.

Disclaimer
This information is for educational purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.