Shoulder Joint Tear

The shoulder joint involves three bones:

the shoulder blade (scapula)
the collarbone (clavicle)
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. The head of the humerus is much larger than the socket and is surrounded by a soft fibrous tissue rim called the labrum. This helps to stabilize the joint. The rim deepens the socket by up to 50 percent so that the head of the humerus fits better. It also serves as an attachment site for several ligaments.

Injuries

Injuries to the tissue rim (labrum) surrounding the shoulder socket can occur from acute trauma or repetitive shoulder motion.

Examples of traumatic injury include:

Falling on an outstretched arm
Direct blow to the shoulder
Sudden pull, such as when trying to lift a heavy object
Violent overhead reach, such as when trying to stop a fall or slide

Injury due to repetitive shoulder motion are more often see in athletes and weighlifters. 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 of a tear

It is difficult to diagnose a tear in the shoulder socket rim because the symptoms are very similar to other shoulder injuries. Symptoms may include:

Pain, usually with overhead activities
Catching, locking, popping or grinding
Occasional night pain or pain with daily activities
A sense of instability in the shoulder
Decreased range of motion
Loss of shoulder strength

Diagnosis

A thorough physical examination by your doctor to gather medical history and history of shoulder pain. Also try to see if there was a specific incident or injury to the shoulder.
Physical tests done by your doctor to check range of motion, stability and pain
X-rays will be ordered to see if there are any other reasons for your shoulder pain. X-rays will not show damage to the rim of the shoulder because it is a soft tissue.
CT –Scan (computed tomography) or MRI may be ordered. In both cases, a contrast dye may be injected into the shoulder to help detect shoulder tears
Usually, the diagnosis will be confirmed with arthroscopic shoulder surgery

Treatment: Non-Surgical

Rest to relieve symptoms
Anti-inflammatory medications are prescribed to relieve pain and inflammation: e.g. Ibuprofen, Naprosyn
Rehabilitations and home exercises are given to strengthen the rotator cuff muscles

If these conservative measures are insufficient, your physician may recommend arthroscopic surgery.

Treatment: Surgical

If the injury is confined to the rim itself, without involving the tendon, the shoulder is still stable. The surgeon will remove the torn flap and correct any other associated problems. If the tear extends into the biceps tendon or if the tendon is detached, the result is an unstable joint. The surgeon will need to repair and reattach the tendon using absorbable tacks, wires or sutures.

Tears below the middle of the socket are also associated with shoulder instability. The surgeon will reattach the ligament and tighten the shoulder socket by folding over and "pleating" the tissues.

Rehabilitation after shoulder surgery

After surgery, you will need to keep your shoulder in a sling for three to four weeks. Your physician will also recommend that you begin gentle, passive, pain-free range-of-motion exercises.

Once 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.