Shoulder Labral Tear
The shoulder joint is a “ball and socket” joint that enables the smooth gliding and thereby the movements of arms. However it is inherently unstable because of the shallow socket. A soft rim of cartilage, the labrum lines the socket and deepens it so that it accommodates the head of the upper arm bone better.
Traumatic injury to the shoulder or overuse of shoulder (throwing, weightlifting) may cause labral tear. In addition ageing may weaken the labrum leading to injury.
Shoulder labral tear injury may cause symptoms such as pain, catching or locking sensation, decreased range of motion and joint instability.
Shoulder labral tear is often diagnosed with symptoms, history, physical examination and radiological techniques. Magnetic resonance arthroscopy may be more appropriate for diagnosing shoulder labral tear.
Conservative Treatment Options
Your doctor may start with conservative approaches such as prescribing anti-inflammatory medications and advice rest to relieve symptoms until diagnostic scans are done. Rehabilitation exercises may be recommended to strengthen rotator cuff muscles.
If the symptoms do not resolve with these conservative measures, your doctor may recommend arthroscopic surgery. During arthroscopic surgery, your surgeon examines the labrum and the biceps tendon. If the damage is confined to the labrum without involving the tendon, then the torn flap of the labrum will be removed. In cases where the tendon is also involved or if there is detachment of the tendon, absorbable wires or sutures will be used to repair and reattach the tendon. After the surgery, you will be given a shoulder sling to wear for 3-4 weeks. You will be advised motion and flexibility exercises after the sling is removed. These exercises increase the range of motion and flexibility of shoulder joint.
Acromioclavicular joint (AC joint) dislocation or shoulder separation is one of the most common injuries of the upper arm. It involves separation of the AC joint and injury to the ligaments that support the joint. The AC joint forms where the clavicle (collarbone) meets the shoulder blade (acromion).
It commonly occurs in athletic young patients and results from a fall directly onto the point of the shoulder. A mild shoulder separation is said to have occurred when there is AC ligament sprain that does not displace the collarbone. In more serious injury, the AC ligament tears and the coracoclavicular (CC) ligament sprains or tears slightly causing misalignment in the collarbone. In the most severe shoulder separation injury, both the AC and CC ligaments get torn and the AC joint is completely out of its position.
Symptoms of a separated shoulder may include shoulder pain, bruising or swelling, and limited shoulder movement.
The diagnosis of shoulder separation is made through a medical history, a physical exam, and an X-ray.
Conservative treatment options
Conservative treatment options include rest, cold packs, medications, and physical therapy.
Surgery may be an option if pain persists or if you have a severe separation.
Of late, research has been focused on improving surgical techniques used to reconstruct the severely separated AC joint. The novel reconstruction technique that has been designed to reconstruct the AC joint in an anatomic manner is known as anatomic reconstruction. Anatomic reconstruction of the AC joint ensures static and safe fixation and stable joint functions. Nevertheless, a functional reconstruction is attempted through reconstruction of the ligaments. This technique is done through an arthroscopically assisted procedure. A small open incision will be made to place the graft.
This surgery involves replacement of the torn CC ligaments by utilizing allograft tissue. The graft tissue is placed at the precise location where the ligaments have torn and fixed using bio-compatible screws. The new ligaments gradually heal and help restore the normal anatomy of the shoulder.
Postoperative rehabilitation includes use of shoulder sling for 6 weeks followed by which physical therapy exercises should be done for 3 months. This helps restore movements and improve strength. You may return to sports only after 5-6 months after surgery.
- Patient Resources