Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Glenoid Labrum Tears

Glenoid labrum tears
The glenoid labrum is a fibrocartilage rim surrounding the articular surface of the glenoid cavity (the socket of the shoulder joint). The labrum contributes to stability by increasing the depth of the glenoid socket. The loss of the glenoid labrum decreases the depth of the socket by 50% in either direction. A glenoid labral tear is commonly associated with anterior dislocation or subluxation of the shoulder or with a degenerative lesion. An isolated glenoid labral tear, without instability, can occur in younger throwing athletes, in wrestlers and boxers, and in racket players.

Symptoms and diagnosis

– Pain in the shoulder occurs during activity, especially during overhead movements such as throwing. The pain is often deep and located anteriorly. If an athlete localizes the pain to the anterior aspect of the shoulder joint, labral tears should be suspected.
– There is a popping, catching or locking sensation.
– Sometimes there can be a feeling of instability and a slight limitation of motion.
– During examination the doctor can detect a clicking or locking. This is felt during overhead abduction and rotation.
– There is tenderness to palpation over the joint line.
– The anterior slide test (Kibler test), where the arm is pressed upwards from behind, may cause pain.
– The diagnosis is confirmed by an MRI (with accuracy of around 76–90%) or an MR arthrogram (accuracy: 90–93%) or shoulder arthroscopy.

Treatment

The athlete should:
– rest from painful activities;
– carry out open and closed kinetic chain exercises for strength training.

The doctor may perform arthroscopic surgery to reattach the labrum using sutures or absorbable tacks. The healing time is about 3–4 months and return to throwing takes 3–6 months.

SLAP lesions

Labral injuries are usually located at the anterior aspect of the glenoid. However, some glenoid labral lesions are located in the superior labrum, from anterior to posterior, at the biceps tendon insertion. These
are known as Superior Labrum from Anterior to Posterior (SLAP) lesions. They are treated with the help of arthroscopy if they cause symptoms. There are four types:
– Type I is characterized by fraying in the superior labrum, but the labrum remains firmly attached to the glenoid. Treatment is by arthroscopic debridement if the injury is causing problems.
– Type II includes an injury where the superior labrum and biceps tendon are stripped off the underlying glenoid. The frayed labral tissue may be debrided or reattached, after which the arm should be
immobilized to allow the biceps labral complex to heal. The optimal treatment of this injury is controversial.
– Type III includes fragmentation of the superior labrum with an intact biceps tendon. The treatment is by excision of the labral fragments.
– Type IV is a labral tear across the superior labrum into the biceps tendon. Treatment usually consists of excision of the labral and biceps fragments.

Comments are closed.