Glenoid Labral Injuries
This week’s blog topic is something that I have some personal experience with after an inopportune broomball incident while in PT school. Needless to say, ice is slippery and if you shift your weight unevenly, you can fall. A few days after the fall, my left shoulder dislocated anteriorly and afterwards I did the “pain dance” and used some very creative language. I subsequently had three inferior dislocations and sadly conservative care didn’t have the desired results, and I had a Bankart Repair followed by physical therapy.
The glenohumeral joint is a ball-and-socket joint which is comprised of the humeral head and the shallow glenoid fossa like a golf ball sitting on tee. The joint is surrounded by a rim of cartilage called the labrum. The labrum deepens the socket by up to 50% and increases the stability of the shoulder joint. The labrum serves as an attachment site for numerous ligaments and tendons including the long head biceps tendon which attaches at 12 o’clock if the joint was a clock. Labral injuries are usually caused by trauma including a fall or direct blow and repetitive strain such as with overhead activities. The two most common types are a SLAP lesion and a Bankart lesion.
Common symptoms associated with labral tears include:
- Sense of instability
- Recurrent shoulder dislocations
- Deep, nagging pain in shoulder joint
- Pain especially with overhead motions
- Catching, locking, popping, or grinding sensation
- Pain with daily activities
- Decreased shoulder ROM & strength
A SLAP lesion is short for Superior Labrum Anterior and Posterior. SLAP lesions can occur as the result of acute trauma, but a lot of them are the result of repetitive overhead motions or the normal aging process with the tearing of the labrum occurring in patients over 30-40 years of age.
A Bankart lesion is an injury to the anterior aspect of the labrum and are the result of repeated anterior dislocations. There are two types of Bankart lesion: a soft tissue lesion and a bony lesion. A soft tissue Bankart lesion is a tear of the anteroinferior labrum away from the glenoid rim. It may also result in stretching of the posterior capsule and tear of the inferior glenohumeral ligament. With a bony Bankart lesion, there is a fracture of anteroinferior glenoid rim in addition to the soft tissue injury. It’s also of note that a Reverse Bankart lesion can occur with posterior shoulder dislocations resulting in injury and detachment of the posteroinferior labrum. In most cases, conservative care can be very effective, but with Bankart lesions, research has shown that’s not the case. Patients who did not undergo a Bankart repair, had worse outcomes with recurrent instability rates from 17-96% for those under the age of 30 as reported in a 2012 article by Netto et al.
An interesting injury that can occur in conjunction with a labral tear is a Hill-Sachs lesion. A Hill-Sachs Lesion is a compression fracture of the posterosuperolateral humeral head which can occur with anterior instability or dislocation. The posterolateral humeral head impacts the anterior glenoid when dislocated and causes a “dent” or depression on the bone. A 2007 study by Yiannakopoulos found that Hill-Sachs lesions occur in 65% of acute dislocations and 93% in patients with recurrent instability.
If you are interested in learning more or about treatment options, don’t hesitate to call/text 701-318-4731 or email connectptnd@gmail.com to learn how we can help. Don’t forget to follow on Facebook and Instagram to stay up to date on the happenings at Connect Physical Therapy.
-Alison Fuhrman, PT, DPT, CMPT, OCS