The Shoulder Labrum
Quality Care from an Adelaide-Based Orthopaedic Surgeon
The shoulder labrum is a ring of fibrous cartilage that surrounds the socket (glenoid) of the shoulder joint. It deepens the socket, providing stability and support to the upper arm bone (humerus). The labrum also serves as an attachment site for ligaments and tendons, enhancing joint function. However, various pathologies can affect the shoulder labrum, leading to pain, instability, and limited shoulder function.
Causes of pathology
Several factors can contribute to the development of shoulder labrum pathology. These may include:
- Trauma: Direct trauma or shoulder dislocation can cause labral tears. The labrum may become torn or detached due to a fall, sports injury, or motor vehicle accident.
- Repetitive overuse: Repetitive overhead motions or activities that place excessive stress on the shoulder joint can result in labral degeneration, leading to labral tears or damage.
- Shoulder instability: Pre-existing shoulder instability, such as recurrent dislocations or subluxations, can strain the labrum and increase the risk of labral tears.
- Aging and degeneration: As individuals age, the labrum may undergo wear and tear, becoming frayed or weakened, which can result in labral tears or damage.
Symptoms
Pathology of the shoulder labrum can manifest in various symptoms, including:
- Shoulder pain: Persistent or intermittent pain deep within the shoulder joint, which may worsen with overhead movements, lifting, or certain arm positions.
- Shoulder instability: A sensation of the shoulder "slipping" or feeling loose, leading to recurrent subluxations or dislocations.
- Clicking or popping sensation: Some individuals may experience clicking, popping, or grinding sensations in the shoulder during certain movements.
- Limited range of motion: Reduced ability to move the shoulder through its full range of motion, particularly in overhead or rotational movements.
Types of pathology
Labral tears: Labral tears can occur in different locations within the shoulder joint, such as SLAP tears (Superior Labrum Anterior to Posterior) involving the upper portion of the labrum, or Bankart tears involving the lower portion. These tears can cause pain, instability, and limited shoulder function.
Labral degeneration: Over time, the labrum may undergo degenerative changes, becoming frayed or weakened, which can lead to pain and instability.
Treatment options
Non-operative treatment
Non-operative approaches are often attempted initially to manage shoulder labrum pathology. These may include:
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
In cases where non-operative treatment fails to alleviate symptoms or in more severe cases, surgical intervention may be considered. One common surgical technique is arthroscopic labral repair. This procedure involves:
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
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