Before we dive into the shoulder labrum, take a second and observe the shoulder. We covered this issue with shoulder anatomy in the Intro to Shoulder Pain Rehab, but we'll reemphasize it here again...
The ball is 3x the size of the socket. It’s more like a ball on a tee than an actual “ball and socket” like the hip.
It’s not the most stable build, but it makes up for it with a ton of mobility.
Sandwiched between the arm bone and shoulder socket is a key structure called the labrum.
The labrum is a rubbery ring that surrounds the shoulder socket, and does things like:
Deepen the socket to support stability,
Provide an attachment to anchor ligaments and tendons,
Create a negative pressure to further stability—think of it as a suction cup.
In summary, the labrum provides stability, for a joint that very much needs the help. It also finds itself in the conversation around shoulder pain very often.
In this article, we’ll explore the labrum further, especially related to pain and injury, and shine some light on the best way to fix issues related to a torn labrum.
But spoiler alert…the labrum doesn’t fix itself.
Labrum Injury 101
Labrum tears generally occur when stability fails.
Sometimes that failure is due to an accident—like taking a fall on an outstretched arm or a lift that went wrong. This forces the arm bone into the labrum ring causing it to tear. Sometimes the forces are so great that the shoulder dislocates. In these cases a labrum tear is almost guaranteed, resulting in what’s called a Bankart lesion.
The labrum can also be injured by pulling on it. Notice in the picture how the bicep tendon attaches to the upper ring of the labrum. Stress that pulls on this attachment can peel away the upper part of the labrum ring, causing what’s called a SLAP tear.
The SLAP tear is extremely common in baseball players due to the extreme layback that occurs as part of the throwing motion. Or it can also occur from dropping down hard while hanging onto something (see: kipping pull-ups.) Or a SLAP tear can occur due to a blow to the shoulder as well.
Either way, when the labrum tears, it leaves behind an issue of both pain and lost stability that must be dealt with. This type of injury doesn’t have the ability to regrow either, so just taking some time off will not "repair" the issue.
Next, we’ll cover the follow-up to a labrum injury.
Diagnose a Labrum Tear
If you dislocated your arm while hucking off jumps at the terrain park—or maybe something slightly less awesome—bet on a labrum issue. This may follow up with a feeling that the shoulder will dislocate again and deserves a medical evaluation.
But sometimes it’s not so obvious, especially in the case of SLAP tears. Here are the signs and symptoms that you may have damaged your labrum:
Pain. Often deep and hard to pinpoint, with the feeling that it’s too deep to touch.
Pain with overhead activity
Decreased force production on that side
Sometimes a loss in shoulder range of motion, especially with internal rotation (turning the arm inwards)
In the clinic, a PT or sports med doc has lots of special tests to diagnose a labrum issue. You could search for them, but there is no one test that will check yes or no. It’s a system of ruling out other pathology, manual assessment, paired with patient information to create a full impression.
Basically, if you need assurance, you should get an evaluation with a specialist to feel more confident moving forward. Although, it’s not ridiculous nor harmful to initially work on a home fix for a suspected torn labrum with a program like Crossover Symmetry.
Next, we’ll show you how…
The Labrum Fix
As we mentioned earlier, the labrum doesn’t repair itself. So what kind of hocus pocus might we recommend?
The answer is a conservative plan of strengthening and some rest.
Which isn’t actually a cure, because the labrum remains torn, yet have no fear! You can still be healed.
First of all, labrum tears rarely happen in isolation. Due to instability caused by the torn labrum, or potentially the underlying issue that caused the labrum tear to happen, things such as bicep tendinosis, rotator cuff impingement, and bursitis can pop up as well. These are pain generators that will usually go away if you stop poking them.
Secondly, strengthening the muscles can make up for the loss in stability, restoring function as before. To support this, a 2016 study showed that 72% of people over the age of 40 had a SLAP tear that was pain-free.
If you’re unconvinced, it’s been estimated thatclose to 80% of major league baseball players have some degree of labrum tearing. Showing that it’s possible to buffer a labrum issue well enough to sustain the forces required to play a pro sport.
Labrum Fix Using Crossover Symmetry
There is a good chance you can too, with a simple prescription:
Avoid things that are painful for at least 30 days. If you keep provoking your pain, it’s not going to get better.
The “protocol” for a labrum tear would follow the same principles for approaching other shoulder issues. Work on restoring range of motion and improving the function of the scapula and rotator cuff muscles in all planes of motion.
Even if you don’t have a labrum tear, you’re still taking the steps in the right direction for fixing whatever shoulder ailment that pains you. Most important to the process is that the program needs to be consistent with daily compliance.
It doesn't have to be extensive, but it does need to be done regularly.
More Advanced Treatments
Give it 30 days and if the pain is still limiting your progress, high dose NSAIDs or corticosteroid injections are an appropriate option.
You’ll feel good after an injection, but don’t sit around and assume everything is fixed. Instead, it’s important to use the relief to address strength deficits.
As an athlete progresses past the basic rehab template, more advanced movements may be necessary to take on the specific stressors that will show up as part of their sport. In the end, nearly 70% of athletes have good outcomes with pain relief and return to sport through conservative management (ref).
If after 4 to 6 months, there has been no improvement despite a consistent effort with a conservative approach, it’s time to consider more advanced medical procedures.
Imaging may be ordered, but an MRI is not great at picking up all SLAP tears, so an MRA may be ordered for a more accurate assessment.
The final approach is arthroscopic surgery, which follows up with a 6 to 9-month recovery. The bicep tendon is often relocated from the superior labrum to lower on the arm during the procedure as well. This is called a bicep tenodesis and tends to have less pain and reduced risk of the repair failing.
Whether you are a weekend warrior, throwing a baseball in the Majors or working to get to the CrossFit Games, a torn labrum is not a career-ending injury. It may disrupt training and competition for a few months, but the majority of labral tears can be addressed successfully with non-operative care.
Take this as a reminder to continue your active participation in your shoulder health. This includes a plan for warming up the shoulder, accessory work, and sport-specific training.
Click Here to learn more about the Crossover Symmetry rehab approach and how you can maximize your shoulder health despite a labrum tear.