Shoulder Labrum Tear: Understanding Pain Locations, Symptoms, and Management

What part of shoulder hurts with labrum tear?

A labral tear in the shoulder typically causes a deep, aching pain felt within the joint itself, often localized to the front, top, or back depending on the specific location of the tear, and can be exacerbated by movement, especially overhead activities.

Understanding the Shoulder Labrum

The shoulder joint, anatomically known as the glenohumeral joint, is a ball-and-socket joint that offers an impressive range of motion. This mobility, however, comes at the cost of stability. Central to its stability is the labrum.

• What is the Labrum? The labrum is a ring of tough, fibrous cartilage that surrounds the glenoid (shoulder socket). It acts like a bumper, deepening the socket by about 50% and providing a crucial attachment point for ligaments and the long head of the biceps tendon.
• Role in Shoulder Stability: By increasing the surface area of the socket and serving as an anchor for key stabilizing structures, the labrum helps keep the head of the humerus (upper arm bone) centered within the glenoid, preventing dislocations and subluxations.

Common Locations of Labral Tears

The location of pain often correlates directly with the specific area of the labrum that is torn. While pain can be diffuse, certain tear types have more characteristic pain patterns.

• SLAP Tears (Superior Labrum Anterior to Posterior): These tears occur in the upper part of the labrum, where the biceps tendon attaches. Pain from a SLAP tear is typically felt deep inside the shoulder, often at the front or top of the shoulder. It can be aggravated by overhead movements, throwing activities, or lifting heavy objects.
• Bankart Lesions (Anterior-Inferior Labrum): A Bankart lesion is a tear of the labrum in the lower-front part of the shoulder socket. These tears are common after anterior shoulder dislocations. The pain is usually localized to the front and lower part of the shoulder and is often accompanied by a feeling of instability or apprehension, especially when the arm is moved into an abducted (away from the body) and externally rotated position.
• Posterior Labral Tears: Less common than anterior tears, posterior labral tears occur at the back of the shoulder socket. Pain is felt deep in the back of the shoulder and can be exacerbated by activities involving pushing, pressing, or reaching across the body.

Characteristics of Pain with a Labral Tear

Beyond location, the quality and presentation of pain can provide clues to a labral tear.

• Deep, Aching Pain: Many individuals describe a persistent, dull ache deep within the shoulder joint. This pain may be present even at rest.
• Sharp, Catching Pain: Sudden, sharp pain can occur with specific movements, especially those that involve rotating the arm or moving it overhead. This is often described as a "catching" sensation, indicating mechanical impingement of the torn labrum.
• Pain with Specific Movements: Activities that load the biceps tendon (e.g., lifting, carrying, throwing) or place the shoulder in unstable positions (e.g., reaching behind the head, external rotation) often elicit or worsen pain.
• Night Pain: Lying on the affected shoulder or certain sleeping positions can aggravate the pain, disrupting sleep.

Accompanying Symptoms

Pain is rarely the sole symptom of a labral tear. Other mechanical symptoms often accompany the pain, providing further indicators.

• Clicking, Popping, or Grinding Sensations: These audible or palpable sensations within the shoulder joint are very common. They occur as the torn piece of labrum gets pinched or moves abnormally during joint motion.
• Instability and Apprehension: A feeling that the shoulder is "loose" or might "pop out" is particularly common with Bankart lesions. Patients may experience apprehension when moving their arm into certain positions associated with previous dislocations.
• Weakness and Decreased Range of Motion: Over time, pain and mechanical issues can lead to a reduction in the shoulder's strength and an inability to move the arm through its full range of motion, particularly with overhead activities.
• Loss of Function: The combination of pain, instability, and weakness can significantly impair daily activities, athletic performance, and occupational tasks.

Causes of Labral Tears

Labral tears can result from a variety of mechanisms.

• Acute Trauma: A direct blow to the shoulder, a fall onto an outstretched arm, or a sudden forceful pull on the arm can cause an acute tear. Shoulder dislocations are a common cause of Bankart lesions.
• Repetitive Overhead Activities: Athletes involved in sports like baseball, tennis, swimming, or weightlifting (especially overhead pressing) are at higher risk due to chronic stress and microtrauma to the labrum and biceps anchor.
• Degeneration: As we age, the labrum can naturally weaken and fray, making it more susceptible to tears from less significant trauma or even normal daily activities.

Diagnosis of a Labral Tear

Accurate diagnosis requires a thorough clinical evaluation.

• Clinical Examination: A healthcare professional will take a detailed history of the injury and symptoms, followed by a physical examination. This includes assessing range of motion, strength, and performing specific provocative tests designed to reproduce the pain or mechanical symptoms associated with a labral tear.
• Imaging (MRI with Arthrography): While standard X-rays can rule out bone fractures, they do not show soft tissue injuries. Magnetic Resonance Imaging (MRI) is the preferred imaging modality. Often, an MRI with arthrography (where a contrast dye is injected into the joint before the MRI) is used to enhance the visibility of the labrum and detect subtle tears.

Management and Prognosis

Treatment for a labral tear depends on the type and severity of the tear, the patient's symptoms, activity level, and overall health.

• Conservative Management: Many labral tears, especially smaller or degenerative ones, can be managed non-surgically. This typically involves:
  • Rest and activity modification to avoid aggravating movements.
  • Pain management with NSAIDs (non-steroidal anti-inflammatory drugs).
  • Physical therapy focusing on restoring range of motion, strengthening the rotator cuff and scapular stabilizers, and improving neuromuscular control.
• Surgical Intervention: For larger tears, tears causing significant instability, or those that fail to respond to conservative treatment, surgical repair may be necessary. This is typically performed arthroscopically, using small incisions and a camera.
• Rehabilitation: Post-surgical rehabilitation is crucial for a successful outcome, involving a structured program of progressive exercises to regain strength, flexibility, and function over several months.

When to Seek Professional Medical Advice

If you experience persistent shoulder pain, especially accompanied by clicking, popping, instability, or a significant loss of function, it is imperative to consult with a healthcare professional. An accurate diagnosis by a physician, orthopedist, or sports medicine specialist is essential to determine the cause of your pain and guide appropriate treatment, ensuring the best possible outcome for your shoulder health.