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Physical Therapy after a Shoulder Labrum Tear

Rehabiliation of an unstable shoulder

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Updated June 05, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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A torn labrum is a problem in the shoulder that may cause shoulder pain, frequent dislocations of your shoulder, or problems with properly using your arm. Physical therapy may be necessary to help you decrease pain, improve mobility, and regain normal use of your arm after a labrum tear.

What Exactly is Your Labrum?

Your shoulder is a ball and socket joint. The ball is at the end of your humerus, the arm bone, and it sits in the socket located at the end of your scapula, or shoulder blade. The ball is much bigger than the socket which allows a lot of mobility to occur at your shoulder joint. This allows you to move your arms in many directions.

Since the ball is so much bigger than the socket, the shoulder is considered a very unstable joint. The ball can easily slip out of the socket, causing shoulder pain and dysfunction.

The labrum is a band of cartilage that courses around the edge of the socket in your shoulder. It serves to add depth to the socket of your shoulder joint.

Imagine your shoulder as a golf ball on a tee. The ball is much bigger than the tee and can easily roll off. If the edge of the tee where ball sits has a small band of tissue around it, the tee would be deeper, and the ball would be less likely to roll off. Thus, the labrum makes your shoulder socket deeper to help keep the ball in the joint.

The labrum also serves as an attachment point for other structures in your shoulder. Some of the ligaments that support your shoulder attach to the labrum. One of the two biceps tendons attach to the top portion of the labrum in your shoulder.

Injury to the Labrum

Your labrum in your shoulder can be injured in a number of different ways. These include, but are not limited to:

  • Sports injuries
  • Repetitive overhead motions like throwing
  • Falling onto an outstretched hand or onto the side of your shoulder
  • Motor vehicle accidents
  • Repetitive lifting of heavy items
  • Forceful blow to your shoulder

Symptoms of a Torn Labrum

Since there are many muscles and ligaments in the shoulder, a torn labrum may be difficult to diagnose. Some of the signs and symptoms of a labrum tear include:

  • Shoulder pain
  • A catching sensation in your shoulder
  • Difficulty lifting your shoulder
  • A feeling that your shoulder is coming out of joint

If you suspect that you have a torn labrum in your shoulder, you should consult with your doctor. He or she can confirm the diagnosis, and the proper treatment can be started right away.

Diagnosis of a Labrum Tear

The diagnosis of a labrum tear can be difficult because your shoulder has many small ligaments and muscles that attach around the joint. Initially, your doctor or physical therapist may perform shoulder special tests to determine if your shoulder labrum is torn. The apprehension test and relocation test are common tests to determine if your shoulder is unstable and a labrum tear may be present.

Your doctor may also take an x-ray if you have had a recent traumatic event that caused your shoulder problem. An MRI of your shoulder may be taken to visualize the inside of your shoulder to determine if you have a labrum tear.

If you have had an MRI of the shoulder and it shows a labrum tear, it is helpful to know which type of labrum tear you have. The three most common types of labrum tears are:

  • Bankart Tear. The Bankart tear occurs near the front and bottom portion of your labrum, and frequently occurs when your shoulder dislocates.
  • SLAP Tear. SLAP is an acronym for Superior Labrum, Anterior to Posterior. This is a tear in the upper portion of your labrum where your long biceps tendon attaches.
  • Posterior labrum tear. This rare labrum tear occurs at the back of your shoulder labrum and may cause your shoulder to dislocate towards the back of your body.

Physical Therapy for a Labrum Tear

If you have suffered a labrum tear, your doctor may refer you to physical therapy. There, your physical therapist will evaluate and assess your current condition to help formulate a plan of care to treat your torn labrum

Acute labrum tears may be quite painful, and your physical therapist may provide you with treatments to control your pain. Heat or ice may be used, or electrical stimulation like TENS may be used to help decrease your pain. Caution should be used with passive modalities; many studies indicate that active involvement in your care is the best form of treatment.

Sometimes your shoulder becomes tight after an acute labrum tear. Your physical therapist may help you work on restoring normal range of motion (ROM) in your shoulder. Care should be taken not to be too aggressive here. A torn labrum usually causes your shoulder joint to be unstable, and aggressive ROM may cause your shoulder to come out of joint.

Since a torn labrum may cause your shoulder to be unstable, exercises to improve strength and stability around your shoulder are an essential part of your rehabilitation.

Exercises to increase shoulder strength should focus on the muscles called the rotator cuff. These four muscles surround your shoulder and help to keep your shoulder in place when you move your arm. Strengthening the muscles around your shoulder blade and in your arm may also help to provide stability to your shoulder after a labrum tear.

Proprioception is your body's ability to recognize where it is in space. Exercises to improve the proprioception around your shoulder may be included in your treatment. Plyometric exercises may also be included in your rehabilitation program, especially if you are planning on returning to high level sports and recreation.

After a labrum tear in your shoulder, you should expect to return to normal activity in about six to eight weeks. If you are not making progress with physical therapy, you may need more aggressive treatments like shoulder surgery to help correct your problem. Be sure to speak with your doctor about your condition to understand what to expect.

A shoulder labrum tear can be a painful injury that limits your ability to use your arm normally. It may cause your arm to feel weak and unstable. Physical therapy can help to increase the strength and mobility in your shoulder to help you return to normal activity quickly and safely.

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