Understanding the Recovery Timeline: Can a Shoulder Labral Tear Heal on Its Own?

An unstable shoulder joint can be the result or the cause of a labral tear. "Labral" refers to the glenoid labrum—a cartilage ring that surrounds the shoulder joint's base. Labrum injuries are frequent, can lead to significant pain, and may make it difficult to move your arm. A labral tear can happen from a fall, repetitive activities, or sports requiring you to raise your arms above your head. You may be wondering, "Can a shoulder labral tear heal on its own?" Some labral tears might be managed with physical therapy; in more serious cases, surgery might be needed to fix the torn labrum.

What is a Shoulder Labral Tear?

The glenoid labrum supports the shoulder joint, keeping it in place. A labral tear happens when a part of this ring is disrupted, frayed, or torn. These tears can cause shoulder pain, an unstable shoulder joint, and, in severe cases, shoulder dislocation. Similarly, a shoulder dislocation can lead to labral tears.

When you imagine the shoulder joint, envision a golf ball (the top part of the upper arm bone or humerus) sitting on a golf tee (the glenoid fossa, a shallow socket or cavity on the shoulder blade, or scapula). The labrum forms a rim around the socket (golf tee) so the humerus (golf ball) doesn't easily fall out. When the labrum is torn, it's tougher for the humerus to remain in the socket. This makes the shoulder joint unstable and more likely to get injured.

Since the biceps tendon connects to the shoulder blade via the labrum, labral tears might happen if you put too much pressure on the biceps muscle, like when you throw a ball. Tears can also be caused by pinching or squeezing the shoulder joint when you lift your arm above your head. There are two types of tears:

Traumatic labral tears often occur due to one specific event, like a shoulder dislocation or a heavy lifting injury. Individuals who frequently lift their arms above their heads—like weightlifters, lifters, and construction workers—are more prone to traumatic labral tears. Actions that involve force away from the shoulder, like hitting a hammer or using a racquet, can also lead to shoulder joint issues.

Nontraumatic labral tears usually happen due to muscle weakness or instability in the shoulder joint. When the muscles supporting your shoulder joint weaken, extra stress is placed on the labrum, causing a tear. Individuals with nontraumatic tears often have increased "looseness" or more mobility in all their joints, which may contribute to developing a tear.

What Are The Signs And Indications Of A Labral Tear?

The main sign of a labral tear not linked to instability is discomfort around the injury. People frequently mention:

The pain is found at the back above the shoulder or the front on top of the shoulder. The pain sensation is deep within. Pressing on the shoulder does not replicate their pain.

Labral tears involving the biceps tendon, known as SLAP tears, can cause pain when using the biceps tendon. Activities like pitching or serving a tennis ball, where the shoulder rotates inward during overhead movements, can be painful. Similarly, tasks requiring a screwdriver can also lead to discomfort since the biceps are crucial for this type of motion.

Patients who have labral tears due to internal impingement (where soft tissues get pinched) often say they feel pain when they throw. Typically, the pain is most intense when the arm shifts direction from late cocking to moving forward quickly. This pain is felt behind and above the shoulder. If a partial thickness tear in the rotator cuff is related, there might also be pain on the side of the shoulder.

How Is It Diagnosed?

Not all shoulder labral tears cause symptoms. When tears are small, most people can go about their day without feeling much pain. Sometimes, the labrum might even heal if you're careful not to strain the injured tissues. But because the labrum doesn't have much blood supply, it can be hard to heal completely. A shoulder with a labral tear might make popping or clicking sounds without causing much pain at first. However, as the tear gets worse, it often leads to weakness and discomfort or pain.

If the physical therapist suspects that you may have a labral tear, they will review your medical history and conduct a check to assess the state of the glenoid labrum (the cartilage ring at the shoulder's base). The tests will involve moving your shoulder in ways that might cause symptoms like "popping," "clicking," or slight pain. Through this evaluation, your physical therapist will decide if your shoulder joint is unstable. Magnetic resonance imaging (MRI) scans are also sometimes used. Labral tears can be hard to diagnose without arthroscopy. During this procedure, a tube-like tool called an arthroscope is put into the joint through a small cut to see or fix an injury.

How Is The Labrum Injured?

Tears of the labrum can be due to:

A direct impact or injury to the arm causes abnormal movement of the humerus.

Continuous stress on the greater tuberosity and rotator cuff at the back of the labrum. This condition is called internal impingement, where soft tissues get pinched. It is often observed in baseball and tennis players who frequently raise their arms overhead.

A common labral injury is a tear on the top of the labrum, extending from the front to the back of the cartilage. This type of injury is called a SLAP tear, which stands for superior labral anterior to posterior tear. When this happens, it affects how the biceps tendon attaches to the glenoid. It's very painful and can lead to the biceps tendon tearing.

At least five different types of SLAP tears have been identified. The treatment will depend on how stable the biceps anchor is and the specific type of tear that has happened. These injuries often occur due to:

• A fall on an outstretched arm.
• A forceful lifting maneuver.
• Repetitive throwing.

The orthopedic surgeon must determine whether the labral tear makes the shoulder unstable. If it isn't causing instability, surgery can fix it. However, if the tear is in an unstable shoulder, surgery can only work if the shoulder is stabilized simultaneously.

Can a Physical Therapist Help?

Shoulder labral tears that result in mild symptoms without causing shoulder instability are typically managed through physical therapy. Your physical therapist will:

• Explain to you which positions or activities you should avoid.
• Create a personalized plan for your healing process.
• Develop shoulder strengthening exercises, like external and internal rotations, to support the joint and reduce stress on the glenoid labrum.
• Stretching exercises like cross-body or doorway stretching can enhance the function of shoulder muscles. A specific method known as manual therapy can also reduce pain and enhance mobility.

Is Surgery Required?

For labral tears that are chronic, severe, or unresponsive to conservative treatments, arthroscopic shoulder surgery is usually recommended. During arthroscopic shoulder surgery, your surgeon may debride (trim) or reattach the torn labrum depending on the size and location of the damage. Tears that involve instability (subluxation or dislocation) typically require reattachment during surgery.

The length of recovery from labrum surgery depends on the type and severity of the tear. You will likely be in a sling for several (usually 4-6) weeks, followed by several more weeks of physical therapy.

What to Expect from Surgery

Tears needing medical care often appear in the later stages when natural healing hasn't happened yet. Tears in the biceps tendon's anchor are unlikely to get better without treatment because the biceps keep pulling on the labrum. Surgery might be needed for long-standing tears if patients can't or won't change their activities enough for healing and comfort. Surgery should be thought about if:

• Pain is unresponsive to anti-inflammatory medications like ibuprofen, rest, and activity modification.
• The labrum hasn't healed after an acute injury.

The arthroscope enables direct visualization and evaluation of the entire shoulder joint. Using this small instrument, the orthopedic surgeon first examines the labrum and all attachment areas for instability requiring repair. The labral injury is addressed once other disorders are treated or ruled out.

Arthroscopic surgery is commonly used to treat most labral injuries not linked to instability. These injuries can be managed by removing abnormal, damaged, or excess tissue. This surgical procedure aims to remove flaps that could restrict the movement of the humerus against the glenoid and eliminate any unstable parts of the labrum.

In some cases, certain painful, unstable SLAP tears, where the biceps tendon is detached, require specific care. If the anchor of the biceps tendon is no longer firmly connected to the glenoid, it needs to be attached back to the bone. Surgeons use suture anchors and arthroscopic techniques to mend the torn labrum in younger patients.

It's often safer for older people to have a biceps tenodesis and a debridement of the labrum. Tenodesis is when the biceps tendon is fixed to the bone away from the shoulder joint to reduce pain and maintain some strength and function. This surgery may be ideal for elderly patients as blood flow to the labrum decreases, hindering healing.

If you are experiencing shoulder pain and would like an evaluation by the orthopedic team at Sunnyvale Sports Medicine and Orthopedic Center, don't hesitate to contact our office for an appointment.