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Glenoid Labrum Tear

Glenoid Labrum Tears

Glenoid labrum tear is a split in the fibrocartilaginous structure surrounding the glenoid, also known as the shoulder joint socket. The tear can be caused by injuries like direct a fall on the shoulder or recurrent overhead raising of the shoulder as in pitching. It can involve either the superior, anterior or posterior part of the labrum. Manifestations include pain and restriction of shoulder mobility. History, clinical examination, and imaging studies are performed to confirm the diagnosis.


Presentation

The socket of the shoulder joint is lined by a fibrocartilage which is known as the glenoid labrum. Chronic shoulder movements such as raising the hand above the head as done by baseball pitchers and weight lifters or a direct injury with fall on an outstretched arm can result in a glenoid labrum tear.

Patients present clinically with shoulder pain while raising the arm above the head, a sensation of shoulder joint instability, locking or popping or grinding of the joint, nocturnal shoulder pain with diminished strength. In the case of superior labral tears, patients complain of posterior shoulder pain with a sensation of popping and clicking.

A superior labral tear from anterior to posterior is called a SLAP tear and can manifest as pain in the posterior part of the shoulder during abduction and external rotation, with the patient becoming fatigued easily during throwing movements. Dead arm syndrome comprises of all these symptoms. A tear of the anteroinferior part of the glenoid labrum can cause glenolabral articular disruption (GLAD) with avulsion of the articular cartilage.

During a physical examination, several tests [1] devised to assess shoulder mobility are employed e.g. Speed's test, Jobe's test, O'Brien or active compression test [2] [3] [4], anterior slide test [5], biceps tension test I [6], and biceps tension test II [6].These are especially important in athletes as their ability to internally rotate the shoulder during abduction is affected and they are therefore at risk of developing a dead arm syndrome [7]. In an anterior type II SLAP tear, the Speed's and O'Brien test are positive while the Jobe's test is positive in posterior type II SLAP tears [8]. However, none of these tests have been found to be very reliable [9] [10]. Approximately 40% patients with SLAP lesions are also likely to suffer from rotator cuff tears and therefore, signs of rotator cuff impingement should be looked for [10] in patients with glenoid labrum tears.

Falling
  • The tear can be caused by injuries like direct a fall on the shoulder or recurrent overhead raising of the shoulder as in pitching. It can involve either the superior, anterior or posterior part of the labrum.[symptoma.com]
  • Examples include: Falling on an outstretched arm A direct blow to the shoulder A violent overhead reach, such as when trying to stop a fall or slide Activities where the force occurs at a distance from the shoulder, such as striking a hammer, swinging[baptisthealth.com]
  • Examples include falling on an outstretched arm, a direct blow to the shoulder, sudden pull or a violent overhead reach, such as occurs when trying to stop a fall or slide.[ucsfhealth.org]
  • Causes A labrum tear can be caused by a fall or direct blow to the shoulder, or it can be caused by repetitive trauma to the joint. Sports such as baseball, tennis or weight lifting, which require repetitive overhand motions, are common culprits.[centralcoastortho.com]
  • Causes of labrum tear A labrum tear can be caused by a fall or direct blow to the shoulder, or it can be caused by repetitive trauma to the joint.[mocnyc.com]
Weakness
  • The patient may experience weakness and instability in the shoulder with specific tenderness over the front of the shoulder. Pain may be reproduced on resisted flexion of the biceps or bending the elbow against resistance.[sportsinjuryclinic.net]
  • .: like the shoulder is going to “pop out” Limited range of motion Weakness SLAP Tear SLAP stands for “Superior Labrum Anterior to Posterior.” This means that the upper rim of the labrum has been torn from front to back.[kcbj.com]
  • Common causes of a labral tear include shoulder injuries from car accidents, falls, heavy lifting that puts excess strain on shoulders, poor posture while bending or standing, and weakness in shoulder muscles due to joint problems or poor bone health.[injuredshoulder.com]
  • Weakness and instability Anti-inflammatory medication and rest helps to relieve symptoms. Rehabilitation exercises to strengthen the rotator cuff muscles may also be recommended.[sgbonedoctor.com]
Fatigue
  • A superior labral tear from anterior to posterior is called a SLAP tear and can manifest as pain in the posterior part of the shoulder during abduction and external rotation, with the patient becoming fatigued easily during throwing movements.[symptoma.com]
  • .; care; task, 4.115; effort, activity, of man, 11.425; adventure, enterprise, 2.385; burden, 2.708; fatigue, difficulty, hardship, 1.330; struggle, danger, distress, misfortune, calamity, woe, suffering, 1.10, et al.; hard fate, 12.727; an eclipse, 1.742[dcc.dickinson.edu]
Limited Mobility
  • Symptoms Symptoms can include pain, clicking, popping or grinding sensations, limited mobility, loss of strength, and a feeling of instability in the shoulder.[centralcoastortho.com]
  • Glenoid labrum tear symptoms Symptoms can include pain, clicking, popping or grinding sensations, limited mobility, loss of strength, and a feeling of instability in the shoulder.[mocnyc.com]
Pneumonia
  • Seite 71 - BL, et al: Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate. ‎[books.google.de]
Heart Disease
  • If you develop shoulder pain with exercise or exertion, please contact your physician as this may be a sign of heart disease.[painspot.com]
Shoulder Pain
  • Patients present clinically with shoulder pain while raising the arm above the head, a sensation of shoulder joint instability, locking or popping or grinding of the joint, nocturnal shoulder pain with diminished strength.[symptoma.com]
  • On this page: Symptoms Causes & anatomy Treatment Symptoms Symptoms include shoulder pain which cannot be localized to a specific point. Pain is made worse by overhead activities or when the arm is held behind the back.[sportsinjuryclinic.net]
  • A labral tear is a cause of shoulder pain. The glenoid labrum provides extra support for the shoulder joint, helping to keep it in place. The labrum is a cartilage ring that surrounds the shoulder socket.[stmarysmaine.com]
  • Symptoms of a glenoid fracture include shoulder pain while lifting your arm, at night or with everyday activities, swelling, catching or popping of the arm, instability and inability to move the arm.[carrellclinic.com]
Shoulder Pain
  • Patients present clinically with shoulder pain while raising the arm above the head, a sensation of shoulder joint instability, locking or popping or grinding of the joint, nocturnal shoulder pain with diminished strength.[symptoma.com]
  • On this page: Symptoms Causes & anatomy Treatment Symptoms Symptoms include shoulder pain which cannot be localized to a specific point. Pain is made worse by overhead activities or when the arm is held behind the back.[sportsinjuryclinic.net]
  • A labral tear is a cause of shoulder pain. The glenoid labrum provides extra support for the shoulder joint, helping to keep it in place. The labrum is a cartilage ring that surrounds the shoulder socket.[stmarysmaine.com]
  • Symptoms of a glenoid fracture include shoulder pain while lifting your arm, at night or with everyday activities, swelling, catching or popping of the arm, instability and inability to move the arm.[carrellclinic.com]
Stiffness of the Shoulder
  • The visible symptoms are: A numbing and diffused pain in the posterior portion of the shoulder Varied shoulder movements cause some popping or clicking sounds Stiffness of the shoulder joints Shoulder strength weakening Feelings of a shoulder dislocation[injuredshoulder.com]
  • Glenoid Labrum Tear Signs and Symptoms Symptoms of glenoid labrum tear can include: Pain with overhead movement Catching, locking, popping or grinding sensation Decreased range of motion Shoulder stiffness Shoulder instability Shoulder weakness, often[baptisthealth.com]
Stiffness of the Shoulder
  • The visible symptoms are: A numbing and diffused pain in the posterior portion of the shoulder Varied shoulder movements cause some popping or clicking sounds Stiffness of the shoulder joints Shoulder strength weakening Feelings of a shoulder dislocation[injuredshoulder.com]
  • Glenoid Labrum Tear Signs and Symptoms Symptoms of glenoid labrum tear can include: Pain with overhead movement Catching, locking, popping or grinding sensation Decreased range of motion Shoulder stiffness Shoulder instability Shoulder weakness, often[baptisthealth.com]
Frozen Shoulder
  • Rupture Distal Humerus Fractures of the Elbow Dislocated Shoulder Elbow Dislocation Elbow Injuries in the Throwing Athlete Elbow (Olecranon) Bursitis Elbow Fractures in Children Forearm Fractures in Children Fracture of the Shoulder Blade (Scapula) Frozen[venturaorthopedicsurgeon.com]
Seizure
  • Posterior dislocations are associated with epileptic seizures, high energy trauma, electrocution and electroconvulsive therapy. On the images a posterior dislocation is seen with a fracture.[radiologyassistant.nl]

Workup

A glenoid labrum tear can be diagnosed after obtaining a detailed patient history, performing a clinical examination of the shoulder joint and neck followed by imaging studies. Specific inquiry about the activities should be made as the patient may be using the shoulder for repeated overhead shoulder movements such as pitching or weightlifting.

Imaging studies such as plain X-rays of the shoulder, ultrasonography, computed tomography (CT) scan, magnetic resonance imaging (MRI) and CT arthrography can help in the diagnosis [11] [12], although contrast- enhanced MRI is the gold standard test used for confirmation. Plain X-rays of the shoulder may reveal associated fractures while ultrasonography is very sensitive in detecting labral tears and is useful for the preoperative evaluation of patients with an anterior instability of the shoulder joint.

Based on findings of arthrotomography, labral tears have been classified as [13]:

Grade I: simple tears within the labrum or at the labrum-glenoid cartilage junction
Grade II: complete segmental tear
Grade III: labral tear associated with a fracture of the bony rim of the glenoid.

Other imaging findings in glenoid labral tears include paralabral cysts (in SLAP tears), and fluid in the suprascapular notch with nerve compression.

Treatment

  • Some of the types of treatments are: Non-surgical treatments: One of the most important non-surgical treatments that are suggested are physical therapy and exercises.[injuredshoulder.com]
  • Conservative treatment of labral tears involves: Pain management Activity modification Physiotherapy to restore range of motion, strength and endurance.[shouldersurgery.com.au]
  • […] of Glenoid Labral Tear Treatment depends on the severity of the tear.[rebalancetoronto.com]
  • Conservative treatment methods may prove to be effective if the condition is not severe. These treatments include physical therapy, rest, and medication to reduce inflammation.[parkviewortho.com]
  • What are the treatment options for Labral tears? The treatment primarily depends on a patient’s activity level and symptoms. Most times, treatment will begin with a conservative approach.[stmarysmaine.com]

Prognosis

  • Prognosis The prognosis for people with a glenoid labrum tear depends upon where the tear is located and how severe it is.[baptisthealth.com]
  • The recovery time for a labral tear will depend greatly on the severity of the tear and its prognosis. If your injury is one that responds well to conservative treatment in the form of Physiotherapy or Chiropractic Care then estimate 6-12 weeks.[rebalancetoronto.com]
  • […] linear high T2/PD intensity through the non-displaced anteroinferior labrum, indicating tear abnormally small or absent anterior labrum 3 double axillary pouch sign (coronal MR arthrogram) - specific sign for an anteroinferior labral tear Treatment and prognosis[radiopaedia.org]
  • […] lesions were classified by Snyder et al, based on arthroscopic evaluation. 13 Additional categories of SLAP tears were described by Maffet et al, Morgan et al, Resnick and Beltran. 14,15,16 Although the classification of SLAP tears is useful in terms of prognosis[radsource.us]

Epidemiology

  • Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty[mdedge.com]
Sex distribution
Age distribution

Pathophysiology

  • Gulotta Chapter 2 Pathophysiology and Biomechanics of Glenohumeral Instability Xinning Li, Paul Yannopoulos, Jon J. P. Warner Chapter 3 Workup of the Patient Presenting with Instability Ryan T. Cassilly, Jon-Michael E. Caldwell, William N.[euro-libris.ro]

Prevention

  • Prevention While many risk factors cannot be controlled, you can help prevent a glenoid labrum tear in these ways: Avoid certain athletics: Sports that involve repetitive overhead motion or heavy overhead lifting are a primary cause of glenoid labrum[baptisthealth.com]
  • Demonstrates which exercises your patients should perform in order to decrease their chance of injury or increase strength following an injury through illustrated exercises for rehabilitation and injury prevention.[books.google.de]
  • Seite 32 - GUSTILO, RB, and ANDERSON, JT: Prevention of Infection in the Treatment of One Thousand and Twenty-five Open Fractures of Long Bones. Retrospective and Prospective Analyses. J. Bone and Joint Surg., 58-A: 453-458, June 1976. ‎[books.google.de]
  • The only real prevention of this kind of injury is to strengthen the muscles around the shoulder, and to avoid any kind of activity that would put strain on the shoulder labrum.[g2orthopedics.com]
  • Unfortunately, shoulder labral tears are hard to prevent, especially in athletes, because the force of the overhead motion contributes to the injury.[hss.edu]

References

Article

  1. Mihata T, McGarry MH, Tibone JE, Fitzpatrick MJ, Kinoshita M, Lee TQ. Biomechanical assessment of Type II superior labral anterior-posterior (SLAP) lesions associated with anterior shoulder capsular laxity as seen in throwers: a cadaveric study. Am J Sports Med. 2008 Aug; 36(8):1604-10.
  2. O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998 Sep-Oct; 26(5):610-3.
  3. Green RA, Taylor NF, Mirkovic M, Perrott M. An evaluation of the anatomic basis of the O'Brien active compression test for superior labral anterior and posterior (SLAP) lesions. J Shoulder Elbow Surg. 2008 Jan-Feb; 17(1):165-71.
  4. Stetson WB, Templin K. The crank test, the O'Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. Am J Sports Med. 2002 Nov-Dec; 30(6):806-9.
  5. Kibler WB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy. 1995 Jun; 11(3):296-300.
  6. Kim SH, Ha KI, Han KY. Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. Am J Sports Med. 1999 May-Jun; 27(3):300-3.
  7. Burkhart SS, Morgan C. SLAP lesions in the overhead athlete. Orthop Clin North Am. 2001 Jul; 32(3):431-41, viii.
  8. Jobe CM. Posterior superior glenoid impingement: expanded spectrum. Arthroscopy. 1995 Oct; 11(5):530-6.
  9. Dessaur WA, Magarey ME. Diagnostic accuracy of clinical tests for superior labral anterior posterior lesions: a systematic review. J Orthop Sports Phys Ther. 2008 Jun; 38(6):341-52.
  10. Tibone JE, Jobe FW, Kerlan RK, et al. Shoulder impingement syndrome in athletes treated by an anterior acromioplasty. Clin Orthop Relat Res. 1985 Sep; 134-40.
  11. Zlatkin MB, Sanders TG. Magnetic resonance imaging of the glenoid labrum. Radiol Clin North Am. 2013 Mar; 51 (2):279-97.
  12. Fallahi F, Green N, Gadde S, Jeavons L, Armstrong P, Jonker L. Indirect magnetic resonance arthrography of the shoulder; a reliable diagnostic tool for investigation of suspected labral pathology. Skeletal Radiol. 2013 Sep; 42 (9):1225-33.
  13. el-Khoury GY, Kathol MH, Chandler JB, Albright JP. Shoulder instability: impact of glenohumeral arthrotomography on treatment. Radiology. 1986 Sep; 160(3):669-73.

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Last updated: 2018-06-22 04:27