The labrum is a fibrocartilaginous ring that wraps around the glenoid, or the “socket” of our shoulder. It deepens the socket about 50% in order to improve congruency of the humeral head, or the “ball” into the glenoid (socket). It also serves as an attachment site for our shoulder ligaments and some tendons, making this structure a vital component of shoulder stability. For people with excessive motion at the shoulder or generalized hypermobility, it can cause increased amount of shear forces to the labrum making this structure prone to injury. Labral injury can occur as tearing or as a detachment from the glenoid; and can happen traumatically or over time. The two most common labrum detachment injuries are termed SLAP lesions and Bankart lesions based on the location of the detachment.
For those with a known or possible labrum pathology, surgery may be a viable option in order to stabilize the shoulder and repair a labral tear. However, it may be better for initial treatment of any shoulder instability to be in a non-operative manner. Non-op rehab for labral tears will focus on decreasing pain and modifying provocative activities. Exercises will focus on improving the strength and endurance of the rotator cuff and scapular musculature. The goal is to improve the neuromuscular control of the shoulder complex in order to stabilize the shoulder using the muscles around it.
The following is one study that discusses non-operative outcomes of SLAP labral tears. In this study, 39 individuals who met the criteria were followed. Out of all the individuals, 51% of subjects opted for surgery while the others remained in non-op management. The non-op management group received non-steroidal anti inflammatory drugs (NSAIDs) and a physical therapy program focused on scapular stabilization exercises along with posterior capsule stretching. This study utilized patient reported questionnaires that measured functional abilities, pain scales, and quality of life to determine the effectiveness of non-operative vs operative management to treat a SLAP labral tear.
After a three year follow-up, those that stayed with non-operative management had significant improvements in pain, functional activities, and quality of life. They also had comparable outcomes to the surgery group in returning to sport, however returning to overhead sports was more difficult. This study shows that some patients can have successful outcomes of a SLAP tear even without surgical interventions and the fact that it is a 3 year follow up indicates long term results are positive which may arguably be more meaningful for patients. However, non-operative management is not appropriate for everyone. In this study, those that opted for surgical intervention was due to failure to improve and still showed positive outcomes as well. Based on results from this study, it is best for those with SLAP labral tears to trial a course of non-conservative management first before considering surgical intervention. This also stresses the importance of a healthcare team of surgeons and physical therapists working together to make the best recommendations for each patient. Each patient is different and each patient’s current clinical presentation, functional deficiencies, and goals need to be taken into account when making this decision.
At Physical Therapy First, we look at all parts of the patient and take into account all of their needs. We are able to spend one hour of direct 1 on 1 time with each of our patients. This is unique and rare in outpatient orthopedic physical therapy. It allows us to perform more thorough evaluations, look into different parts of the body, and be able to work toward individualized goals in a more specific manner. If you have a known diagnosis of a labral tear, it is recommended to give physical therapy a try before looking into surgical options. Or, if you have been experiencing shoulder pain and not sure why, we can perform an examination and determine what the best care moving forward is. We will make sure to work with you and monitor your progress to make the most appropriate recommendations.
Ellenbecker, T., Manske, R., Kelley, M., 2016. Current Concepts in Orthopaedic Physical Therapy The Shoulder: Physical Therapy Patient Management Using Current Evidence. Orthopaedic Section APTA
Edwards, S., Lee, J., Bell, J., Packer, J., Ahmad, C., Levine, W., Bigliani, L. and Blaine, T., 2010. Nonoperative Treatment of Superior Labrum Anterior Posterior Tears. The American Journal of Sports Medicine, 38(7), pp.1456-1461.)