What is it?
A labral tear is an injury to the fibrous cartilage portion of the shoulder joint that helps hold the long bone of the arm within the socket of the shoulder. A labral tear can occur if the shoulder is dislocated or if there is a sudden force to the shoulder with the arm fully extended, like what happens in an automobile accident. Labral tears may also occur with overuse in weight lifting, in throwing sports, and in overhead sports. While these injuries do occur in younger athletes, they most commonly occur in the older population.

Causes
The head of the long bone of the arm (humerus) lies in a shallow socket (the glenoid fossa) of the shoulder blade. The head is much larger than the shallow socket and relies on a fibrous ring of tissue (the labrum) to hold it in place. A labral tear occurs when an injury to the shoulder causes a tear in this fibrous ring, leading to pain and, possibly, a feeling of instability.

Risk Factors
• Falling on an outstretched hand • A direct blow to the shoulder • Sudden pull while lifting an object • Weight lifters or throwing athletes can also develop this problem

Symptoms
• The most common symptom is pain with overhead movements. • Catching, locking, or popping can all be symptoms of a labral tear. • There can also be pain at night, especially while lying on the affected shoulder.

Sports Medicine Evaluation
After a careful history and physical examination, a sports medicine physician may obtain additional imaging. Often, the first imaging obtained will be an x-ray, but will likely be normal. Usually, the only way to diagnose a torn labrum is to order magnetic resonance imaging (MRI) with contrast dye that is injected into the joint.

Treatment
Until the diagnosis is confirmed, anti-inflammatory medications and ice to help alleviate pain will often be useful. • Rehabilitation may help strengthen the rotator cuff muscles and improve flexibility to alleviate stress on the shoulder joint. Pitchers, in particular, should be evaluated for GIRD (glenohumeral internal rotation deficit). • If conservative therapy fails to alleviate symptoms, surgical intervention may be needed.

Prevention
• Take precautions to avoid falling • Avoid repetitive overhead activity if possible • Use proper technique when lifting, throwing or moving objects

Return to Play
After a period of rest and non-painful rehabilitation, the athlete may begin a graduated interval throwing program leading to full sports participation. However, many of these injuries require surgical intervention, and return-to-play may take an extended period of time.

AMSSM Member Authors
Dustin W. Lash, DO and Tracy Ray, MD

References
Edmonds EW, Dengerink DD. Common conditions in the overhead athlete. Am Fam Physician. 2014 Apr 1;89(7):537-41.

Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014 May;42(5):1155-60.