Physical Therapy Guide to Shoulder Labral Tear
What Is a Shoulder Labral Tear?
The ring of cartilage called the glenoid labrum provides extra support for the shoulder joint, helping to keep it in place. A shoulder labral tear occurs when part of this ring is disrupted, frayed, or torn. Tears may lead to shoulder pain, an unstable shoulder joint, and, in severe cases, shoulder dislocation. Likewise, a shoulder dislocation can result in labral tears.
When you think of the shoulder joint, picture a golf ball resting on a tee. The top of the humerus (upper arm bone) is like the ball, and the glenoid (shallow socket on the shoulder blade) is like the tee. The labrum provides a rim for the socket (golf tee) so that the humerus (golf ball) does not easily fall off. If the labrum is torn, it is harder for the humerus to move correctly in the joint. The end result could be pain, weakness, or further injury to the shoulder joint.
Because the biceps tendon attaches to the shoulder blade through the labrum, labral tears can occur when you put extra strain on the biceps muscle, such as when you throw a ball. Tears also can result from pinching or compressing the shoulder joint when raising the arm overhead.
There are two types of labral tears:
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Traumatic tears. These usually occur because of a single incident. Examples include a shoulder dislocation or a heavy lifting injury. Weightlifters, gymnasts, and construction workers who use their arms overhead are more likely to experience traumatic labral tears. Activities like striking a hammer or swinging a racquet, where impact occurs at a distance from the shoulder and falling on an outstretched arm, also can cause a traumatic tear.
- Nontraumatic tears. This type most often occurs due to muscle weakness or repetitiveness. When the muscles that stabilize the shoulder joint are weak, more stress is put on the labrum, leading to tears. Some people with nontraumatic tears tend to have more "looseness" or hypermobility throughout all their joints. This looseness might be a factor in the development of a tear.
How Does It Feel?
A shoulder labral tear may cause you to feel the following:
- Pain over the top of your shoulder, and possibly pain in the back of the shoulder or down into the biceps area.
- "Popping," "clunking," or "catching" with shoulder movement. A torn labrum has "loose ends" that get flipped or rolled within the shoulder joint during arm movement. These loose ends can also become trapped.
- Shoulder weakness, often on one side.
- The feeling that your shoulder joint will pop out of place.
How Can a Physical Therapist Help?
Physical therapy is the usual treatment for shoulder labral tears with minor symptoms. Your physical therapist will educate you about positions and activities to avoid. They will tailor a treatment plan for your recovery based on your needs. Your treatment may include:
Manual therapy. Your physical therapist may provide gentle manual (hands-on) therapy to decrease your pain and begin to restore your shoulder movement.
Strengthening exercises. Improving the strength of the shoulder muscles will help you decrease stress on the torn labrum and allow for better healing. Your physical therapist may guide you through shoulder rotation exercises that target the shoulder-joint muscles, as well as shoulder-blade (scapular) exercises to provide stability to the shoulder joint itself.
Stretching exercises. A muscle imbalance or decreased flexibility can result in poor posture or too much stress on the shoulder joint. Your physical therapist may prescribe stretching exercises to improve the function of the muscles surrounding the shoulder. These may include gentle stretches of the chest muscles. They also may introduce middle-back (thoracic) stretches. These allow your body to rotate or twist to the side, so the shoulder joint doesn't have to stretch further to perform tasks like swinging a racquet or golf club.
Postural exercises. Your physical therapist will assess your posture and teach you specific exercises to ensure that your shoulders are properly positioned for daily tasks. A forward-head and rounded shoulder posture puts the shoulders at risk for injury.
Education. Education is an integral part of any physical therapy treatment plan. Your physical therapist will help you understand your injury, the reasons for modifying your activities, and the importance of doing your exercises to decrease your risk of future injury.
Home exercise program. A home exercise program is an important companion to treatment in the physical therapy clinic. Your physical therapist will identify the stretching and strengthening exercises that will help you steadily improve your shoulder function and meet your work, home, and activity goals.
If Surgery Is Needed
In more severe cases, when conservative treatments are unable to fully relieve symptoms, you may need surgery to reattach the torn labrum. After surgery, your physical therapist will design a treatment program based on your needs and goals. They will work with you to help you safely return to your daily activities.
A surgically repaired labrum may take nine to 12 months to completely heal. Immediately after surgery, your physical therapist will teach you ways to avoid putting excessive stress or strain on the repaired labrum.
As the labrum heals, your physical therapist will introduce resistance and strengthening exercises, such as those listed above, to your treatment plan. They will work with you to address your specific needs and help you slowly and safely return to your daily activities and any tasks that require force or lifting. Your physical therapist will gradually introduce movements to your program to help you safely return to your usual activities and avoid reinjury.
**Article from choosept.com
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