Physical Therapy for Shoulder Labral Tear
What is shoulder labral tear?
A shoulder labral tear refers to a tear in the labrum, which is the cartilage that forms a cup-shaped structure around the shoulder socket (glenoid) to help stabilize the shoulder joint. The labrum provides a secure attachment for the shoulder's ball (humeral head) and prevents excessive movement.
There are two main types of shoulder labral tears:
1. SLAP tear (Superior Labrum Anterior to Posterior): This type of tear occurs at the top (superior) part of the labrum where the biceps tendon attaches. It is often caused by overhead motions, like those in throwing sports.
2. Bankart lesion: This type occurs in the lower part of the labrum and is commonly associated with shoulder dislocations or instability. It can make the shoulder prone to further dislocations.
Photo from LEXMEDICUS
What causes a shoulder labral tear?
A shoulder labral tear can be caused by a variety of factors, including:
Trauma or Injury: Sudden injuries, such as a fall onto an outstretched arm, a car accident, or a sports-related injury can put excessive strain on the shoulder joint, leading to a labral tear.
Overuse or Repetitive Motion: Activities that involve repetitive overhead motions, such as swimming, baseball, or weightlifting, can gradually wear down the labrum and increase the risk of a tear over time.
Aging: As people age, the labrum may naturally degenerate or weaken, making it more susceptible to tears. This is often seen in older adults.
Dislocation or Instability: If the shoulder joint is dislocated or experiences frequent instability, the labrum can become damaged. This is particularly common in athletes involved in contact sports.
Genetic Factors: Some individuals may have a naturally weaker or more flexible shoulder joint, which increases their risk of developing a labral tear.
Acute Events: In some cases, an acute event, like lifting a heavy object improperly, can cause a tear in the labrum
Shoulder labral tear symptoms
Symptoms of a shoulder labral tear can vary depending on the severity of the tear and the specific area affected. Common symptoms include:
Pain
A. Constant or intermittent pain in the shoulder, which may worsen with overhead activities, lifting, or certain movements.
B. Pain may be more noticeable with throwing motions or any repetitive movement of the arm.
Weakness
A. A feeling of weakness in the shoulder, especially when trying to lift or carry heavy objects.
B. The shoulder may feel unstable or "loose," and movements may become difficult.
Clicking, Popping, or Grinding Sensations
A. A sensation of clicking, popping, or grinding in the shoulder joint, especially when moving the arm.
B. This can happen when the labrum interferes with the normal movement of the shoulder.
Limited Range of Motion
A. Difficulty in moving the shoulder through its full range of motion, especially when raising the arm overhead or reaching behind the back.
Shoulder Instability
A. A sensation that the shoulder is slipping or may dislocate.
B. This can be more common in cases of Bankart tears, where the labrum is torn in the lower part of the shoulder socket.
Sleep Disturbances
A. Pain and discomfort may interfere with sleeping, especially when lying on the affected shoulder or during certain arm positions.
Tingling or Numbness (in some cases)
A. In rare cases, nerve irritation can occur, leading to tingling or numbness in the arm.
Instability in Specific Positions
A. The shoulder may feel unstable or like it could pop out of place when performing activities such as throwing, swimming, or weightlifting.
If you experience these symptoms, it’s a good idea to consult a healthcare provider for an evaluation, as they can confirm the diagnosis and recommend appropriate treatment.
How to diagnose a shoulder labral tear?
The gold standard in diagnosing shoulder labral tears is Magnetic Resonance Arthrography (MRA) due to its ability to visualize the labrum clearly and accurately. MRA is a specialized form of magnetic resonance imaging (MRI) where a contrast agent (usually gadolinium-based) is injected directly into the shoulder joint. This helps to better visualize the labrum and other soft tissues, making it more effective in detecting labral tears compared to standard MRI.
However, a physical therapist can usually diagnose a shoulder labral tear or SLAP tear without an MRI or other advanced imaging.
In the clinic, our physical therapists perform a thorough examination that includes a subjective history, range of motion testing, strength testing, joint mobility testing, flexibility testing, and special tests for the shoulder to rule in a shoulder labral tear or SLAP tear.
Can physical therapy help a torn shoulder labrum?
Yes, physical therapy can help with a torn shoulder labrum, although it depends on the severity of the tear and the individual's specific condition. In many cases, especially for partial tears or mild to moderate symptoms, physical therapy can be highly beneficial.
According to this article, shoulder labral tears can be treated successfully and conservatively with physical therapy to improve pain, function, and quality of life.
According to this systematic review, nonoperative physical therapy for SLAP tears in athletes can be successful, especially when athletes complete their rehabilitation program before attempting a return to play.
A physical therapist will typically design a program to strengthen the muscles around the shoulder joint, improve stability, and restore mobility. Physical therapy often includes:
Range-of-motion exercises: These help improve flexibility and reduce stiffness.
Strengthening exercises: Targeting the rotator cuff and shoulder muscles to improve stability and reduce stress on the labrum.
Proprioceptive exercises: These exercises improve the sense of joint position and help the body control movements to prevent further injury.
Postural correction: Improving posture to reduce stress on the shoulder.
Joint Mobilization: Manual therapy techniques from a physical therapist can help improve joint movement if stiffness is contributing to pain.
However, for more severe tears, or if physical therapy does not provide relief, surgery might be required to repair the labrum.
It's essential to get an evaluation from a healthcare provider to determine the best course of treatment based on the specifics of your injury.
Best treatment for shoulder labral tear
The best treatment for a shoulder labral tear should address the impairments found on clinical examination. These are the most common impairments for a shoulder labral tear:
Decreased strength and endurance of the rotator cuff and scapular muscles
a. Especially in overhead and extended positions
Tightness in the posterior capsule of the shoulder (behind the shoulder)
Tissue stiffness in the infraspinatus muscle (posterior rotator cuff muscle)
Decrease joint mobility of the acromioclavicular joint (top of the shoulder)
Shortened pectoralis minor muscle length
Decreased mobility of the thoracic spine (especially into extension)
In the initial phase of treatment, manual therapy and activity modification is helpful to enhance short-term improvements in pain and function. Manual therapy techniques are beneficial to modulate pain and to complement exercise to improve mobility, muscle activity, and strength. Our therapists utilize manual therapy techniques that target the AC joint (acromioclavicular joint), the shoulder joint (glenohumeral joint), the shoulder blade (scapulothoracic joint), and the thoracic spine.
When symptoms are less irritable, our therapists will transition from exercises with a symptom modulation focus to interventions that target muscle performance and other impairments related to the patient’s movement dysfunction. Exercises to strengthen the shoulder blade muscles and load the shoulder into elevated and extended positions are essential components of rehabbing a shoulder labral tear.
Shoulder labral tear recovery time: how long does rehab take for a shoulder labral tear?
The recovery time for a shoulder labral tear can vary significantly depending on the severity of the tear, the treatment approach, and the individual’s overall health and rehabilitation progress. Here's a general breakdown of the rehab timeline:
Non-Surgical Recovery:
Mild to Moderate Tears: If surgery isn't required, recovery typically involves physical therapy and rest. For mild to moderate labral tears, it can take around 3 to 6 months to regain full function. During this period, the goal is to strengthen the surrounding muscles, restore range of motion, and reduce pain.
Rehabilitation Phases:
Phase 1 (Weeks 1-4): Focus on pain management, reducing inflammation, and gentle range-of-motion exercises.
Phase 2 (Weeks 4-8): Strengthening exercises are introduced, focusing on stabilizing the shoulder.
Phase 3 (Weeks 8-12): Progressing to more advanced strength and mobility exercises.
Best sleeping position for shoulder labral tear
The best sleeping positions for a shoulder labral tear will be on your back or the non-painful side. Try to avoid sleeping on your stomach or the painful side especially with the arm elevated during the more irritable stages. You can place a pillow under your involved shoulder as you sleep on your uninvolved shoulder. Our therapists find that this can be relieving for some clients.
Best exercises for shoulder labral tear
Shoulder External Rotation Progression
Kettlebell Arm Bar
Bottoms Up Kettlebell Press
Shoulder Tap Progression
Row with Dumbbell
Shoulder labral tear stretches/mobility exercises
Foam Roll Thoracic Spine
Child’s Pose with Side Bending
Pec Dooway Stretch (both sides)
Wall Slides with Towel (flexion, scaption, abduction)
Exercises to avoid with a shoulder labral tear
In the more irritable stages of a shoulder labral tear, you’ll want to temporarily avoid activities and movements that involve end-range overhead movements, reaching across your body, and reaching away from your body. Examples of these activities include rock climbing, olympic weightlifting, and lifting overhead, etc.
Exercises to avoid and their modifications include:
Bench Press
Temporary Modification: Floor Press
Overhead Press
Temporary Modification: Incline Press
Lat Pull Down
Temporary Modification: Row with Band
Conclusion
If you are experiencing a shoulder labral tear or SLAP tear, click the button below to speak with one of our Doctors of Physical Therapy.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.
Dr. Vincent Liu, PT, DPT
Doctor of Physical Therapy
The Game Plan Physical Therapy