A labral tear can be a significant injury. If you have been diagnosed with a tear of the labrum, arming yourself with information will be your next step. Learn more about anatomy, symptoms, diagnosis, and most important the best treatment options before making a decision on what you would do next.
There are two places that the labrum is found in the body: the shoulder and the hip. IN the hip, the labrum is attached to the socket of the pelvis called the acetabulum. In the shoulder, the labrum is attached to the socket of the scapula, called the glenoid. The labrum is a piece of cartilage that functions to deepen the socket in both of these ball and socket joints. As with all cartilage, the labrum does not have a good blood supply and thus when torn, cannot heal.
In the shoulder the most common area of the labrum is the superior or upper portion of the labrum. The specific term for a labral tear of the shoulder is called a SLAP tear. SLAP stands for Superior Labrum Anterior to Posterior and specifies the location of the tear.
Hip tears can also be termed acetabular labral tears. In the hip, the labrum is attached to the socket of the hip, called the acetabulum.
The most common signs and symptoms associated with a torn labrum are pain, limited range of motion, and limited function.
Pain related to hip labral tears is often describe as “deep” and is generally located in the groin. Patients with a torn labrum of the hip will display the “C” sign. Simply put, the patient forms the letter “C” with their hand and places it on the outside of the hip to indicate the location of their pain.
SLAP tears of the shoulder can also produce pain described as “deep”. In addition, SLAP tears can also create anterior or front of the shoulder pain. This is generally caused by the long head of the biceps tendon. This biceps tendon attaches to the top of the glenoid labrum and thus if the labrum becomes injured, the biceps tendon can become irritated.
Limited range of motion can occur in both hip and shoulder SLAP tears. The ability to bring the knee to the chest (hip flexion) as well as rotate the thigh inward (hip internal rotation) and the two motions generally most limited with acetabular tears. In the shoulder, the ability to raise the arm overhead is generally most limited.
Finally, the pain and limited range of motion from these injuries can often lead to limited function. For a torn labrum of the hip, extended sitting, standing and walking can be limited. For shoulder SLAP tears overhead activities including reaching and throwing can be limited.
A torn labrum can be somewhat difficult to diagnose. A physical exam is the starting point your physician will use to narrow the field of potential causes of pain. Typically x-rays will be utilized, however, because the labrum is cartilage and thus is soft tissue, it does not show up on x-ray. Thus, the only way to definitively make the diagnosis of a torn labrum is through MRI. Specifically with the shoulder, the use of a contrast material may be recommended with the MRI in order to give a clearer picture.
Even if an MRI indicates a labral tear, the size and location of the tear will affect whether surgery is necessary. Conservative treatment is most often recommended prior to choosing a surgical option.
Typical conservative treatment for labral tears of the shoulder and hip include rest, ice, physical therapy, anti-inflammatory medication and injections. Anti-inflammatory medication and cortisone injections can be greatly helpful in reducing irritation and inflammation caused by the torn labrum. Physical therapy is a key component to restoring joint range of motion and strength. If however, after these conservative treatments are utilized, pain and limited function persists, surgery may be necessary.
Surgery for repairing labral tears of the hip and shoulder is done arthroscopically. Repair of the labrum of the shoulder is more common than the hip thus it is important if considering hip labral repair that your surgeon be an expert in this procedure. Following both shoulder and hip labral repairs, physical therapy will be an important component to returning to function. Generally each surgeon will have their own protocol or timeline for returning to functional activities with returning to sports occurring generally within 6 months after surgery.