| (courtesy of
www.aaos.org)
Description
Advances in medical technology are enabling us to
identify and treat injuries that went unnoticed 20 years
ago. For example, physicians can now use miniaturized
television cameras to see inside a joint. With this tool,
they have been able to identify and treat a shoulder injury
called a glenoid labrum tear.
Anatomy
The shoulder joint involves three bones: the shoulder
blade (scapula), the collarbone (clavicle) and the upper
arm bone (humerus). The head of the upper arm bone (humeral
head) rests in a shallow socket in the shoulder blade
called the glenoid. Because the head of the upper
arm bone is usually much larger than the socket (much like
a golf ball on a tee), a soft fibrous tissue rim called the
labrum surrounds the socket to help stabilize the
joint. The rim deepens the socket by up to 50 percent so
that the head of the upper arm bone fits better. In
addition, it serves as an attachment site for several
ligaments.
Injuries
Injuries to the tissue rim surrounding the shoulder
socket can occur from acute trauma or repetitive shoulder
motion. Examples of traumatic injury include:
·1 Falling on an outstretched arm
·2 Direct blow to the shoulder
·3 Sudden pull, such as when trying to lift a
heavy object
·4 Violent overhead reach, such as when
trying to stop a fall or slide
Throwing athletes or weightlifters can experience tears
due to repetitive shoulder motion.
Tears can be located either above (superior) or below
(inferior) the middle of the glenoid socket. A SLAP
lesion (superior labrum, anterior [front] to posterior
[back]) is a tear of the rim above the middle of the socket
that may also involve the biceps tendon. A tear of the rim
below the middle of the glenoid socket that also involves
the inferior glenohumeral ligament is called a Bankart
lesion. Tears of the glenoid rim often occur with other
shoulder injuries, such as a dislocated shoulder (full or
partial dislocation).
Signs and symptoms
It is difficult to diagnose a tear in the shoulder
socket rim because the symptoms are very similar to other
shoulder injuries. Symptoms include
·1 Pain, usually with overhead activities
·2 Catching, locking, popping or grinding
·3 Occasional night pain or pain with daily
activities
·4 A sense of instability in the shoulder
·5 Decreased range of motion
·6 Loss of strength
Diagnosis
If you are experiencing shoulder pain, Dr. Brady will
take a history and examine your shoulder. He will also
obtain X-rays to see if there are any other reasons for
your problems. Because the rim of the shoulder socket is
soft tissue, X-rays will not show damage to it. Dr. Brady
may obtain an magnetic resonance image (MRI) scan of your
shoulder if indicated.
Treatment
Until the final diagnosis is made, Dr. Brady may
recommend an anti-inflammatory medication and rest to
relieve symptoms. Rehabilitation exercises to strengthen
the rotator cuff muscles may also be recommended. If these
conservative measures are insufficient, he may recommend
arthroscopic surgery.
Surgical repair of an isolated labral tear is 100%
arthroscopic. Basically, Dr. Brady will repair any labral
tear by placing absorbable anchors in the bone and tying
sutures (attached to the anchors) around the torn labrum.
He also takes care of any other problems in the shoulder
while he is in there (such as removing bone spurs).
Rehabilitation
After surgery, you will need to keep your shoulder in a
sling for three to four weeks. Your physician will also
prescribe gentle, passive, pain-free range-of-motion
exercises. When the sling is removed, you will need to do
motion and flexibility exercises and gradually start to
strengthen your biceps. Athletes can usually begin doing
sports-specific exercises after six weeks, although it will
be three to four months before the shoulder is fully
healed. |
