If you have suffered an injury to your shoulder that happens to involve your labrum, you have come to the right place. Labrum injuries of the shoulder may occur due to several different reasons, some of which are repetitive throwing, compression injuries, or following a shoulder dislocation. Depending on the extent of the injury, surgery may or may not be indicated in order to return to optimal function. In this article, we will discuss how shoulder labrum injuries occur, as well as the current evidence related to shoulder labrum rehab!

 

What Is The Shoulder Labrum?

The labrum is a type of cartilage that lines the inside of the shoulder joint, giving it further compression, protection, and reinforcement. There is also a labrum present at the hip joint as well. Both the labrum of the shoulder and hip may be compromised with the potential for injury; however, the shoulder tends to be a bit more unlucky than the hip. The reason being is that the hip has what we like to call a “nice bony fit”, one in which the head of the hip joint fits congruently into the socket (acetabulum). On the contrary, the shoulder joint is like a golf ball on a tee, with a much larger head of the shoulder (humeral head), trying to fit its way into a more shallow, smaller shoulder socket (glenoid). That fit is not so great, certainly not as congruent as the hip joint. As a result, repetitive overuse of the shoulder falls, or episodes of instability can cause damage to the labrum of the shoulder more easily than the hip.

 

How Do Shoulder Labrum Injuries Occur?

Labrum injuries of the shoulder are usually broken down into 2 separate categories: compressive/shearing or tensile.

Compressive or shearing labral injuries often occur following an episode of shoulder subluxation, or dislocation. What happens in these situations is that the head of the shoulder moves abnormally outside of the shoulder cavity it sits in, resulting in a tear, or even detachment of the labrum from the socket. These types of shoulder labrum injuries are more common in individuals who have ‘loose shoulders’, also known as shoulder hypermobility. Some individuals innately have an anatomical make-up in which their connective tissues are “more lax”, meaning they can move within further ranges of motion compared to others. Think of that person you know who can put their palms all the way on the floor with their legs straight, bend their pinky all the way back to their hand, or even hyperextend their elbows.

 

Do You Need Guidance With Shoulder Labrum Injury Rehab?

If you are having questions about your shoulder labrum injury, have not been able to gain access for treatments, and are waiting to start your path to recovery, this is the program for you. Our comprehensive Shoulder Program has helped many individuals recover from many ailments of the shoulder, including shoulder labrum injuries! Click HERE to learn more about our shoulder program.

 

Shoulder Hypermobility Versus Instability

Shoulder labrum injuries become even more problematic if an individual’s hypermobility transitions to shoulder instability. It is important to differentiate these two terms: hypermobility versus instability. One can innately have hypermobility throughout the body, but if he or she still has the proper strength, control, and stability, issues will not arise. It is when one does not have control of their own stability in a particular body region that the term instability is appropriate. If you happen to notice that your shoulder repeatedly will ‘slip out of place’, and you can put it back in on your own, that is one of the signs you may have shoulder instability. Maybe you have noticed when you reach your arm back very far and quickly, you feel your shoulder is going to ‘pop out’. This is also another warning sign.

READ: SHOULDER INSTABILITY AND REHAB

 

Bankart Lesions of The Shoulder

The compressive/shearing type of shoulder injuries is further classified into 2 main types of lesions, the first of which is a Bankart Lesion. This type of lesion occurs during a shoulder anterior dislocation, which is by far the most common type. The head of the shoulder will forcefully move forward within the socket and will push against the front, lower portion of the labrum, resulting in a lesion of the cartilage tissue. If part of the bony socket is also fractured during this event, it is known as a bony Bankart Lesion. What happens if one does not have a Bankart Lesion treated is that the shoulder becomes even more susceptible to instability, and repeated dislocations, potentially worsening already existing injuries to the joint.

 

Exercises For Shoulder Labrum Injuries

 

Hill Sachs Lesions Of The Shoulder

The other common compressive/shearing type of shoulder injury is a Hill Sachs Lesion. Rather than the socket or labrum being the brunt of the force in this situation, it is the head of the shoulder, particularly the back, outside portion of it (posterolateral). It also occurs following anterior shoulder dislocations, but what is different in this scenario is that the head of the shoulder comes into contact with the front portion of the shoulder socket (glenoid), which results in a fracture of the humeral head.

HILL SACHS AND BANKART LESIONS

 

Tensile Shoulder Labrum Injuries

Tensile labrum injuries occur due to what is known as the ‘peel back mechanism’. It is helpful if you understand a bit more about the anatomy of the shoulder, and what other tissues are associated with the labrum. The biceps muscle has 2 tendons: a long head of the biceps tendon, and short head of the biceps tendon. The long head of the biceps tendon travels up in the front of the shoulder and actually attaches to the top portion of the labrum, while the short head of the biceps tendon has an attachment to a bony prominence on the shoulder blade known as the coracoid process. The peel-back mechanism occurs most often in throwing athletes. What happens is if you think about when a quarterback or baseball pitcher is about to release a ball from their hand, and their arm is all the way cocked back. This is known as the ‘late cocking phase of throwing’, just before the acceleration phase.

This combined position anatomically of the shoulder is termed: shoulder abduction, extension, and external rotation, which is one of the most vulnerable positions of the shoulder joint. That vunerable position in combination with high, tensile forces of repetitive throwing is thought to create a peeling mechanism in which the biceps tendon pulls on the labrum, eventually leading to a potential tear of the labrum and even the biceps tendon as well. This type of injury is known as a Superior Labrum Anterior to Posterior (SLAP) Tear.

 

What Does It Feel Like If I Have A Torn Labrum?

In some situations, you will know right away if something is wrong with your shoulder, but in other circumstances, it may not be that easy to know what is going on. If you have had an acute episode of a shoulder dislocation, for example, that is a very traumatic event that does not need an explanation to know something considerable happened. However, overuse shoulder labrum injuries are also very common, and many can go undetected for a period of time. Some of the signs and symptoms you may experience if you have an injured labrum of the shoulder includes:

• Audible clicking, popping sensations that are accompanied by pain – Let’s get this straight. Clicking, cracking, all those other noises your body makes are completely normal! However, it is when these sounds are accompanied by significant pain and loss of function that they can become abnormal. Listen more about the rice Krispy sounds your body makes in this pod episode.

LISTEN: THE REALITY OF CRACKING SOUNDS YOUR BODY MAKES

 

• Feelings of shoulder giving out or feeling ‘heavy’: This is often a complaint in throwers and athletes who are doing a lot of activity.

 

• Weakness accompanied by pain: You will start to notice that in addition to the feelings of giving way, clicking, and other symptoms, your arm also may become weaker than it usually is

 

How Do I Heal From A Shoulder Labrum Injury?

The first question that needs to be answered after you have a shoulder labrum injury is: Do I need surgery or not? This really depends on the extent of the injury, as well as your daily activity and hobby demands. The difficult part of shoulder labrum injuries is that if you happen to injure your labrum, you are losing even more stability of the shoulder than it already has. The shoulder is already fighting an uphill battle, as it was mentioned earlier in regards to it’s incongruent bony fit of the joint, leading to a whole heck of mobility and not a lot of stability. Adding an injured, important connective tissue that helps protect the shoulder joint makes you even more susceptible to further injuries in the future. This is why in many situations, especially if you are going to be returning to higher-level activities that require significant demands of your shoulder that surgery is an appropriate option.

However, if you, your healthcare team, and your family all decide that surgery is not the best option for you, or that you want to utilize the conservative treatment route first, individuals have had successful outcomes with partial labral tears with this approach! A dedicated focus on your rehab, with minor activity modifications, can put you back to your previous level of function, and have your shoulder feeling better than ever.

 

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How Does Rehab Differ Between Shoulder Labrum Post Surgically Versus Conservatively?

As we know, surgery will prolong the rehab process and outcomes. You will start in a sling following a labral repair in order to protect the tissue. This is especially important for healing in tissues like the labrum, which is made up of fibrocartilage. Tissues like tendons, ligaments, and cartilage are less abundant in the blood supply, which prolongs the healing process. Rehab will feel slow and tedious the first month or two, mainly focusing on regaining your range of motion, and you won’t even really be moving the shoulder purely on your own until 6-8 weeks depending on the surgical protocol you are following. Once you get to the 2-3 month point, active range of motion will continue to return, and you will eventually progress to strengthening, stability, and return to function/sport exercises. This course of care can last anywhere from 4-6 months.

With conservative treatment, you get to skip the beginning process that you would have surgically of being in a sling and confined to very limited movements. That isn’t to say that you will not need to modify your activity and be conscientious of your movements of the shoulder. Avoiding extreme ranges of motion that place the shoulder in vulnerable positions, carrying and lifting heavy items, and so forth will need to take precedence in addition to your focused rehab program. You may even need to be sidelined from sport for a period of time if you are going through rehab in order to further protect the tissue and give you the best chance of a 100% recovery.

 

Don’t Make These Mistakes With Your Shoulder Rehab

 

Exercises For Shoulder Labrum Rehab

Now that you have some background on what shoulder labrum injuries are, as well as treatment options, here are some examples of exercises for shoulder labrum rehab.

Shoulder Active Assist Range of Motion

Sample Phase 1 of Shoulder Rehab Program

External rotation of the shoulder is one of the most limited motions following a shoulder labrum injury, especially post surgically. The key is to tread lightly and slowly move into more abduction and external rotation of the shoulder. Remember, that is the most vulnerable position of the shoulder that leads to many labral tears in the first place. We can’t go right back there after surgery! Eventually, we will get there, but progressing from 0 degrees (arm at the side) to 45 degrees (which is shown here), and eventually, 90 degrees of abduction is the proper progression for range of motion restoration.

 

Shoulder Labrum Stability and Core Exercise

In addition to closed chain exercises, integrating core stability is very important for shoulder health.

 

Shoulder Labrum Dynamic Overhead Stability Exercise

Holding a kettlebell upside creates a more unstable environment that the shoulder has to work in!

 

Shoulder Labrum Plyometric Exercise

During the late phase of recovery as one is returning to activity and sport, we need to put the shoulder in the positions of highest vulnerability and train in those positions!

 

Closing Thoughts

Shoulder labrum injuries may occur due to a variety of scenarios, and are broken down into different categories. Regardless of the type of shoulder labrum injury you have sustained, with the right team in your corner of healthcare practitioners, friends, and family, you can get back to the activities you love! Outcomes post surgically as well as conservatively are both great, but it is important to have an intentional, thoughtful decision before proceeding with your direction of care. As always, drop comments, and reach out to us at info@theprehabguys.com for any questions you may have, especially if you are looking for more guidance with your shoulder labrum injury!

 

Take Control of Your Shoulder Health

Movement from the shoulder girdle is what allows you to start to have access to feeding, grooming, and moving things around in your environment. Not that we like to play favorites or place one joints’ importance over another one but I think it’s safe to say, the shoulder is pretty dang important! It’s gifted with movement in all planes of motion which then burdens the joint to have stability and strength to control the mobility that it has. You will learn to use isometrics as a natural painkiller and utilize safe and effective strategies to restore function to the shoulder!

 

References

1. Knesek M, Skendzel JG, Dines JS, Altchek DW, Allen AA, Bedi A. Diagnosis and management of superior labral anterior posterior tears in throwing athletes. AM J Sports Med. 2013;41(2):44-460. doi: 10.1177/0363546512466067. Epub 2012 Nov 20.
2. Terry GC, Friedman SJ, Uhl TL. Arthroscopically treated tears of the glenoid labrum. Factors influencing outcome. Am J Sports Med. 1994;22(4):504-512
3. Escamilla RF, Barrentine SW, Flisig GS, et al. Pitching Biomechanics as a pitcher approaches muscular fatigue during a simulated baseball game. Am J Sports Med. 2007;35:23-33
4. Ma R, Brimmo OA, Li X, Colbert L. Current concepts in rehabilitation for traumatic anterior shoulder instability. Current Reviews in Musculoskeletal Medicine. 2017;10(4):499-506. doi:10.1007/s12178-017-9449-9

 

About The Author

Sherif Elnaggar, PT, DPT, OCS, SCS

[P]Rehab Head of Content

Sherif graduated from Temple University with a Bachelor’s of Science Degree and a concentration in Kinesiology. He then received his Doctorate of Physical Therapy Degree from DeSales University, graduating with honors of the professional excellence award and research excellence award. After his graduate studies, he served as Chief Resident of the St. Luke’s Orthopedic Physical Therapy Residency Program. Sherif is a Board Certified Orthopedic Clinical Specialist. Sherif focuses on understanding how movement impairments are affecting function while also promoting lifestyle changes in order to prevent recurrences of injury. His early treatment interests include running related injuries, adolescent sports rehab, and ACL rehab in lower extremity athletes. He also has been involved in performance training for youth soccer players. Outside of working as a physical therapist, he enjoys traveling, running and cycling, following Philadelphia sports teams, and spending time with his family.

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.