Labrum Tear

What is Labrum Tear?

Labrum tear of the shoulder usually occur as a result of an injury or as an effect of the aging process. The symptoms that may be experienced and the treatment that is required will depend on the type and degree of damage to the labrum [1].

Location Of Labrum

There are 3 bones that comprises the shoulder: the shoulder blade (scapula), the upper arm bone (humerus) and the collarbone (clavicle). The labrum is a fibrocartilage that lines the shoulder socket that molds to accommodate the head of the humerus.

The labrum contributes to the stability of the shoulder and a tear in it may lead to a partial or complete dislocation of the shoulder. Figure 1 shows the location of labrum [1, 2, 3, 4].

Figure 1- The location of the Labrum

Classification

There are 3 types of tears to the labrum fibrocartilage:

Superior Labrum, Anterior to Posterior (SLAP) Tear

In a SLAP tear, the damage occurs at the top of the shoulder socket. This area is where the biceps tendon attaches to the shoulder. This type of tear most usually occurs to athletes who do overhead throws such as baseball and tennis players [4, 5].

Bankart Tear

A Bankart tear occurs after an individual sustains a shoulder dislocation. The tear happens as the shoulder pops out of the socket. This is the type that mostly occurs in younger patients. In a Bankart tear, it is the inferior glenohumeral ligament that is torn. This type of tear increases the risk of more dislocations in the future [5].

Posterior Labral Tears

A posterior labral tear may be uncommon but it may happen to athletes in a condition that is called internal infringement. In this condition, the labrum and the rotator cuff are pressed together in the back of the shoulder [5].

Causes

The primary cause of a labrum tear is trauma. Some of the activities that may cause the injury include [3, 4]:

• A sudden pull that occurs when trying to lift something heavy
• A violent overhead reach
• Falling on an outstretched arm
• Direct blow to the shoulder area

Symptoms

The symptoms of a labrum tear is usually a pop or catching sensation that can be felt during particular movements of the shoulder. Aching pain will be felt and this may endure for a long period of time. Other symptoms that may be felt include [2, 3, 4]:

• Weakness or instability in the shoulder
• Pain associated with daily activities
• Loss of strength in the shoulder area
• Limited range of motion

Diagnosis

Health History and Physical Examination

The focus of the health history is to get more information about the pain that is felt by the patient. It is important to identify the event that may have produced the injury or intensified the pain that is felt.

The pain will also be characterized, including the origin and intensity of this pain. During the physical examination, the physician will make the patient do some arm movements to test the range of motion, shoulder stability and pain [2, 3].

Imaging Tests

Further tests such as imaging diagnostic tests may be requested to visualize the tear in the labrum. A Magnetic Resonance Imaging (MRI) may show soft tissues around the area but it will be difficult for it to show the actual tear.

It would be more possible to see the tear through a Computed Tomography scan (CT scan) and a special dye. The dye that will be injected into the affected shoulder will be able to show the outline of the labrum. The said dye will be able to leak into the damaged labrum and this will show up on the CT scan [2, 3].

Arthroscopy

The gold standard diagnostic test to confirm the diagnosis of a labrum tear is the arthroscopy. In this test, the arthroscope will be inserted in the shoulder joint through a small incision. Pictures of the labrum will be projected into a TV screen and any tear on it will be identified [2, 3].

Treatment

Nonsurgical Treatment

Conservative treatment modalities will be advised to the patient first to see if this will resolve the problem. Anti-inflammatory medications may be prescribed to reduce the pain and the swelling on the labrum.

Cortisone injections may be given if the previously prescribed medication is ineffective in reducing the pain. Exercises done with a physical therapist will be able to reduce the pain and strengthen the rotator cuff muscles [2, 3, 4].

Surgical Treatment

If the conservative methods are unsuccessful, the patient may have to undergo an arthroscopic surgery. In this procedure, the surgeon will do some repair depending on the tear to the labrum.

If the tear is minimal, the torn flap will be removed and any other problems will be resolved. If the tendon is detached to the labrum, it may have to be reattached using absorbable wires or sutures [2, 3].

Rehabilitation

After a surgery to repair the damage to the labrum, the shoulder should be placed in a sling for 3-4 weeks. Exercises to improve the motion and flexibility of the shoulder may be required after the shoulder is removed from the sling. It may take 3-4 weeks before the shoulder will fully healed [2, 3, 4].

ICD 10

The 2016 ICD-10-CM diagnosis code used for the labrum tear is S43.43. It is further specified as S43.431, S43.432, or S43.439 depending on the shoulder that is affected (right, left, unspecified). The code A, D, S is also used if it is initial encounter, subsequent encounter or sequela [6].
References

1. Johns Hopkins. (2015, August 23). Labral Tear of the Shoulder. Retrieved from Hopkins Medicine: http://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/sports-medicine/conditions-we-treat/labral-tear-shoulder.html
2. Orthopod. (2003). A Patient’s Guide to Labral Tears. Retrieved from Houston Methodist: http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/shoulder/labral-tears/
3. Orthoinfo. (2001, January). Shoulder Joint Tear. Retrieved from Orthoinfo: http://orthoinfo.aaos.org/topic.cfm?topic=a00426
4. WebMD. (2014, November 14). Shoulder SLAP Tear. Retrieved from WebMD: http://www.webmd.com/pain-management/tc/shoulder-slap-tear-topic-overview
5. Cluett, J. (2016, March 6). Bankart Tear. Retrieved from About.com: http://orthopedics.about.com/cs/generalshoulder/a/bankart.htm
6. ICD10Data. (2015). Dislocation and sprain of joints and ligaments of shoulder girdle. Retrieved from ICD10Data: http://www.icd10data.com/ICD10CM/Codes/S00-T88/S40-S49/S43-/#S43.431