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Shoulder Labral Tear and Shoulder Dislocation the Shoulder Joint Is a “Ball and Socket” Joint with Tremendous Flexibility and Range of Motion

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Shoulder Labral Tear and Shoulder Dislocation the Shoulder Joint Is a “Ball and Socket” Joint with Tremendous Flexibility and Range of Motion Shoulder Labral Tear and Shoulder Dislocation The shoulder joint is a “ball and socket” joint with tremendous flexibility and range of motion. The “ball” is the humeral head while the “socket” is the glenoid. The labrum is a ring of cartilage that is attached to the glenoid. Labral tears often occur in younger active patients, particularly those involved in contact, overhead, or throwing sports and activities. What does it do? The labrum provides stability to the shoulder in several ways. The labrum increases the size of the socket, which helps keep the humeral head in place. The labrum also is attached to key stabilizing ligaments and to the biceps tendon. How do injuries occur? There are 2 common labral tears. The Bankart tear is a tear in the front lower portion of the labrum. This typically occurs after a shoulder dislocation. When the humeral head comes out of place, it puts tremendous pressure on the front of the labrum and often causes it to tear. This leads to loss of shoulder joint stability. In patients who dislocate their shoulder from a significant force or after multiple recurrent dislocations, the labral tear can extend towards the back of the glenoid as well. The other common labral tear is the SLAP tear. The SLAP tear is a tear in the upper portion of the labrum. This can happen after a fall or shoulder dislocation. This can also occur with repetitive overhead sports and throwing as an overuse type injury. Signs and Symptoms Patients with shoulder dislocations and acute labral tears often have immediate pain and describe hearing or feeling a “pop” in their shoulder. Patients will oftentimes need help from a medical professional to reduce the shoulder, or put it back in place. There can be lasting aching and pain in the shoulder and limited motion due to the pain. Some patients may even have numbness or tingling in their arm from nerves being stretched by the injury. Patients with chronic labral tears usually have deep shoulder pain, especially after sports and activities which involve overhead motions or throwing. Some patients can feel like the shoulder is “loose”, unstable, and going to pop out of place. In patients with SLAP tears, the biceps tendon can be tender to touch and cause pain during activities and shoulder motion. Treatment For patients with Bankart tears or tears after shoulder dislocation, surgery is typically recommended, especially in younger athletic and active patients who wish to return to sports and activities. Non-surgical treatment can lead to chronic shoulder instability and multiple shoulder dislocations, which can worsen the labral tear and may lead to cartilage damage as well. The goals of shoulder labral surgery are to restore shoulder stability, prevent further damage, and allow for effective rehabilitation. The labrum is repaired and the stabilizing ligaments are tightened usually with an arthroscopic, minimally invasive technique. In some patients, especially those who are at high risk for repeat dislocation, an open repair may be necessary. Dr. Kumar will discuss surgical options with you prior to surgery and describe the expected recovery course. After surgery, a rehabilitation program specific for each patient is created with a physical therapy team in order to reduce post-surgical pain, restore motion, and regain strength. Sport- specific training is a critical aspect of recovery in order to return patients to sports and activities as quickly and safely as possible. For patients with SLAP tears, non-surgical treatment is the initial treatment step. Treatment is focused on reducing pain, restoring motion, and regaining strength with a specific physical therapy program. Once the pain is improved with rest, a rehabilitation program focused on strengthening the upper back and shoulder muscles is implemented to recondition the shoulder. Once the shoulder has improved in strength and flexibility, sport-specific training is performed. For patients involved in overhead and throwing sports, a focus on improving mechanics and strengthening the core, hip, and legs are also included to prevent re-injury. For many patients, non-surgical treatment can provide the relief necessary to return to sports and activities. However, some patients may not improve as expected and surgery may be recommended in these cases. There are many surgical options in such cases and Dr. Kumar will discuss these with you prior to surgery. Age, sports, work, physical exam, and radiology findings all play a role in determining which procedure may best work for each patient. After surgery, a rehabilitation program specific for each patient is created with a physical therapy team in order to reduce post- surgical pain, restore motion, and regain strength. Sport-specific training is a critical aspect of recovery in order to return patients to sports and activities as quickly and safely as possible. Shoulder Impingement The shoulder joint is a “ball and socket” joint with tremendous flexibility and range of motion. The “ball” is the humeral head while the “socket” is the glenoid. The rotator cuff attaches to the top of the humerus and sits below a part of the shoulder blade called the acromion. Shoulder impingement can occur in patients of all ages, especially those involved in sports and activities with repetitive overhead motion. How do injuries occur? During certain shoulder motions, the space for the rotator cuff becomes very narrow. The rotator cuff tendon can begin to scuff on the outside against the acromion or underneath against the glenoid and labrum. Impingement is commonly seen in patients of all ages with weak upper back, shoulder blade, and shoulder muscles. This imbalance leads to poor shoulder mechanics and reduces the space for the rotator cuff. Poor flexibility and range of motion can also cause this imbalance. Patients involved in sports and activities with repetitive overhead or throwing motions place significant stress on the shoulder and are at risk for developing impingement. Signs and Symptoms Patients with impingement have deep aching shoulder pain which can be worse after sports and activities. Pain can also be worse at night and result in difficulty sleeping. Activities that involve overhead or throwing motions are also difficult to perform due to pain. Sometimes, attempting to elevate the arm above shoulder height can cause a sharp pain. Shoulder motion can also be limited because of the pain. Treatment Surgery is not usually necessary for patients with shoulder impingement. Treatment is focused on reducing pain, restoring motion, and regaining strength with a specific physical therapy program. Once the pain is improved with rest, a rehabilitation program focused on strengthening the upper back and shoulder muscles is implemented to recondition the shoulder and improve joint mechanics. Shoulder flexibility is also a focus, particularly with stretching of the internal rotators and pectoralis muscles. Once the shoulder has improved in strength and flexibility, sport-specific training is performed. For patients involved in overhead and throwing sports, a focus on strengthening the core, hip, and legs is included to prevent re-injury. For many patients, non-surgical treatment can provide the relief necessary to return to sports and activities. However, some patients may not improve as expected and further investigation may be warranted. Dr. Kumar will discuss all of your options with you with the goal of returning patients to sports and activities as quickly and safely as possible. Rotator Cuff Tear The rotator cuff tendon attaches at the top of the humerus (arm bone) and is a major contributor to shoulder motion, function, and strength. Rotator cuff tears can occur in patients of all ages, especially those involved in sports and activities with repetitive overhead motion and heavy lifting. What does it do? The rotator cuff is actually made up of 4 different muscles and tendons. The subscapularis is located at the front of the shoulder. The supraspinatus, infraspinatus, and teres minor are located on the back of the scapula (shoulder blade). The rotator cuff has many functions. It is critical for forward elevation of the arm and for abduction, or bringing the arm out to the side. It also helps with internal and external rotation. The rotator cuff is especially important for motion above shoulder height. How do injuries occur? Rotator cuff tears can happen in multiple ways. Acute (sudden) tears can occur after shoulder trauma, such as a fall or dislocation. Sometimes, an already weak rotator cuff can tear after a mild injury. Trauma involving significant force on the shoulder can tear a normal healthy rotator cuff tendon. Usually, the rotator cuff tendon tears due to a chronic, degenerative process. Over time, repetitive stress on the tendon combined with poor shoulder mechanics and weak upper back muscles cause small tears to develop. This leads to irritation, inflammation, and pain, all of which can make the shoulder weaker and lead to greater stress on the rotator cuff. Eventually, these small tears can become bigger and more problematic. Signs and Symptoms Patients with rotator cuff tears oftentimes have deep aching in the shoulder, which can be aggravated after sports and activities. Pain can be worse at night and result in difficulty sleeping. Activities that involve overhead or throwing motions are often difficult to perform due to pain. Carrying heavy objects away from your body and attempting to elevate the arm above shoulder height can cause a sharp pain. Shoulder motion, particularly raising the arm above shoulder height or reaching behind your back, can become more and more difficult over time. Treatment Treatment for rotator cuff tears is based on many factors, including age, severity of tear, shoulder motion and function, and other shoulder conditions. Non-surgical treatment is usually the initial step in treatment. A physical therapy program focused on reducing pain, restoring motion, and regaining strength is developed.
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