The Shoulder Labrum
Quality Care from an Adelaide-Based Orthopaedic Surgeon
The glenoid labrum is a fibrocartilaginous rim that deepens and stabilizes the shoulder socket (glenoid), enhancing joint stability and serving as the attachment point for ligaments and the long head of the biceps tendon .
When this essential structure is injured, patients may experience pain, instability, or catching sensations in the shoulder.
Causes of pathology
Several factors can contribute to the development of shoulder labrum pathology. These may include:
Labral tears typically occur due to sudden trauma, repetitive motion, or long‑term degeneration:
- SLAP Tears (Superior Labrum Anterior–Posterior) result from repetitive overhead motions—common in baseball pitchers, tennis players, or swimmers, and can also follow acute stretching or fall injuries.
- Bankart Lesions occur when the shoulder dislocates, tearing the lower front part of the labrum (often seen in younger athletes), leading to recurrent instability.
- Posterior Labrum Tears, though less common, may develop from falls or forceful pushing movements, causing pain during shoulder extension or weight-bearing actions.
Labral degeneration is also possible with age and chronic overuse, particularly in people involved in prolonged overhead activity.
Symptoms
Pathology of the shoulder labrum can manifest in various symptoms, including:
Early detection of a shoulder labral tear is crucial to prevent long-term instability, pain, and loss of function:
- A deep, aching shoulder pain, worsened by overhead or lifting activities, or sometimes by lying on the affected side.
- Mechanical sensations—catching, locking, clicking, or grinding—with movement, especially in SLAP and Bankart injuries.
- A feeling of instability or slipping, particularly with anterior labral injury and history of dislocations.
- Weakness during pinching or throwing, or difficulty performing overhead motion due to a SLAP tear affecting the biceps anchor.
Types of pathology
Diagnosis & Types of Labrum Tears
Diagnosis includes a detailed history, physical examination, and imaging to identify tear location and severity. MRI with contrast (arthrogram) is the gold standard for confirming labral tears, though arthroscopy may be required in some cases.
There are multiple tear types:
- SLAP Tears (Types I–IV):
- Type I: Fraying without detachment
- Type II: Detachment of the biceps-labrum complex (most common)
- Type III: Bucket-handle tear with intact biceps tendon
- Type IV: Tear extending into the biceps tendon
- Bankart Lesions, including bony Bankart tears involving the anterior–inferior rim, typically from dislocation. These often co-occur with Hill–Sachs lesions.
- Posterior tears involve the rear rim, often from falls or reverse-force trauma.
Other less common injuries include GLAD lesions (glenolabral articular disruption), which affect both the labrum and underlying cartilage.
Treatment options
Non-operative treatment
In many cases, non-surgical treatment is effective, especially for minor SLAP tears or stable symptoms. This involves rest, anti-inflammatory medication, possible cortisone injections, and a gradual course of physiotherapy focusing on rotator cuff and scapular muscle strengthening.
Rest and activity modification: Avoiding activities that exacerbate symptoms and allowing the labrum to heal.
Physical therapy: Specific exercises and stretches to improve shoulder strength, stability, and range of motion.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation.
Shoulder bracing: Wearing a shoulder brace or sling to immobilise the joint and promote healing.
Operative treatment: Arthroscopic labral repair
Surgical repair is recommended when instability persists, labral detachment is significant (e.g., Type II SLAP or Bankart lesions), or if conservative treatment fails. Arthroscopic techniques are preferred; these allow direct reattachment of the labrum to the glenoid using suture anchors, with faster recovery and reduced complications compared to open procedures.
Arthroscopic evaluation: Dr Oscar Brumby-Rendell uses a small camera (arthroscope) inserted through small incisions to visualise the shoulder joint and assess the labral tear.
Labral repair: Using specialised instruments, Dr Oscar Brumby-Rendell reattaches the torn labrum to the glenoid using sutures or anchors. This restores stability to the shoulder joint and promotes healing.
Rehabilitation: Following surgery, a comprehensive rehabilitation program is essential to regain strength, stability, and range
Frequently Asked Questions
Yes. Sometimes even small tears or fraying that seem “mild” on MRI or arthrogram can cause significant symptoms.
This is often because of altered joint mechanics, irritation of nerve endings, or inflammation in surrounding tissues. Pain and dysfunction don’t always correlate perfectly with imaging severity.
How Dr Oscar Brumby‑Rendell Can Help
At the Adelaide Shoulder & Upper Limb Clinic, Dr Oscar Brumby‑Rendell provides expert evaluation and treatment of shoulder labral injuries.
Labral tears typically occur due to sudden trauma, repetitive motion, or long‑term degeneration:
- SLAP Tears (Superior Labrum Anterior–Posterior) result from repetitive overhead motions—common in baseball pitchers, tennis players, or swimmers, and can also follow acute stretching or fall injuries.
- Bankart Lesions occur when the shoulder dislocates, tearing the lower front part of the labrum (often seen in younger athletes), leading to recurrent instability.
- Posterior Labrum Tears, though less common, may develop from falls or forceful pushing movements, causing pain during shoulder extension or weight-bearing actions.
Labral degeneration is also possible with age and chronic overuse, particularly in people involved in prolonged overhead activity.
Ready to learn more?
Ready to learn more about Shoulder injuries? Watch our video about Shoulder Arthritis & Replacement by Dr Oscar Brumby-Rendell.
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