Labral, Bankart and SLAP Tears
The labrum is the “suction cup” cartilage rim that deepens the socket and is the attachment point for the glenohumeral ligaments and the biceps tendon. When the shoulder has a trauma like a dislocation, the labrum can “peel off the rim”.
Dr. Nicholson will perform a physical evaluation to evaluate for instability and pain. An MRI or MRA may be needed to further examine the joint and determine the severity of the injury. Treatment is often conservative or surgical, depending on age, athletic activity, and severity of the injury.
SLAP tears: The superior labrum that tears anterior to posterior, is called a SLAP tear; sometimes described by severity in terms of distance. (Example, 11 O’clock to 2 O’clock tears) Overhead athletes commonly sustain SLAP tears because of the acute or repetitive trauma.
Symptoms associated with SLAP or labral tears include:
(1) Repetitive pain with certain activity
(2) A sensation of “popping” or “clicking”
(3) Decrease in strength or motion
(4) A deep ache within the shoulder
Bankart lesions: Commonly associated with a dislocation event. This disrupts the inferior (lower half) of the labrum and can cause damage to the connective tissue around the glenoid labrum. Bony-Bankart lesions show a fracture of the anteroinferior glenoid rim, which may result in an open procedure.
Symptoms associated with Bankart Lesions can include:
(1) Popping or grinding
(2) Deep pain or ache
(3) Weakness or loss of range of motion
(4) Instability or chronic dislocation events
Non-surgical treatment goal is to reduce pain, restore range of motion and create stability. Many patients with dislocation events benefit from conservative management.
Rest: Resting the injured joint is the first step to reduce swelling and pain. Keeping it immobilized for the first 2-5 days will help with pain. Be sure to use the arm gently within a week to avoid a frozen shoulder.
Ice: In the first 24 hours of an injury, ice it to reduce swelling and pain.
Heat: After 24 hours have passed, a heating pad or hot compress can help.
NSAIDS (non-steroidal anti-inflammatory drugs): Reduce pain and swelling through NSAIDS such as ibuprofen (Advil), naproxen (Aleve), or aspirin.
Physical therapy and exercise: Gentle exercises and stretches designed to strengthen the muscles surrounding the shoulder joint.
The type of surgery Dr. Nicholson will recommend will depend on; the severity of the tear and associated symptoms, age and level of activity. Surgical intervention for SLAP or labral tears is an arthroscopic procedure to debride or repair the labrum. Most procedures are performed arthroscopically using small tools to access the joint:
Debridement: Involves “smoothing” the torn labrum so movement is not disrupted by the “catching” sensation felt on exam. This is recommended when the SLAP lesion is stable.
SLAP repair: When SLAP lesions are commonly unstable or symptomatic, Dr. Nicholson will reattach the labrum to the socket with sutures. This is a common procedure for overhead athletes.
Bankart Repairs: This is commonly associated with instability of the shoulder and when repaired, restores stability. Labral repairs are common in the lower half of the socket and are repaired with sutures. If there is a bony-bankart lesion, Dr. Nicholson will restore the fracture to the attachment site.
Patients can expect to wear a sling for 4-6 weeks and attend formal physical therapy for 8-16 weeks. Athletes can expect to return to non-contact sport between 4-5 months and contact or collision sport between 5-6 months.