A
SPORTS PHYSIOTHERAPY OVERVIEW OF TREATMENT, PREVENTION & MANAGEMENT OF
LABRAL TEARS FACTORING SHOULDER INSTABILITY & NON-SURGICAL PAIN MANAGEMENT
The Shoulder Labrum Tear, as the name suggests, is a painful and limiting condition caused by a tear in the thick
piece of tissue attached to the edge of the shoulder.
Research
studies have been shown that Shoulder Labral Injuries have a prevalence rate of
0.12 per 1000 exposures; in this sense, elite athletes are highly susceptible
to sustain these types of shoulder disabilities resulting in instability due to
collision over the shoulder, and persistent traumatic events, is worth keeping
in mind that overhead and contact sports such as baseball, cricket, rugby,
volleyball, American Football, and other overhead arm motions activities
similar to throwing are tending to generate the Shoulder Labral Injury ,
reports (Sandeep Mannava MD et la, 2018).
The Shoulder labrum, as we have just mentioned, outlines and covers the entire surface of the
shoulder joint and also reinforces the socket and ball of said joint (Cooper De et al, 1992).
The shoulder joint is made up
of the glenoid, which is the shallow depression of the socket, and the head of
the upper forearm known as the humeral head, that is the ball which inserts
into the socket, explains (Stephen Fealy MD, 2020).
Johns Hopkins
says, there are three ways this piece of tissue can be torn, the 1st is
completely outside the bone, the 2nd way is where the tendon of the biceps
muscle is attached, and the 3rd can bring about both ways within and along the
edge of the labrum. Which is why a physical examination and assessment is
essential to diagnose alongside MRI Screening to accurately determine the
complexity of injury.
A
research article posted by Hospital for Special Surgery (HSS)
indicates the labrum is essential in the fixation of the shoulder because it
has many ligament attachment sites which provide support to the joint; the most
common are the rotator cuff and several muscles that enclose the shoulder which
prevent the shoulder from dislocating.
SO, WHAT DOES A TORN SHOULDER LABRUM ACTUALLY
FEEL LIKE?
Most commonly symptoms of a torn shoulder
are intense sharp shoulder pain, achiness in the joint, instability and a
feeling of grating, grinding, locking, and catching while performing shoulder
movements.
Patients who usually suffer from this
condition usually report deep pain in the shoulder joint accompanied by a
popping sensation and instability to hold the arm in specific positions.
According to Rebound,
the most common Shoulder Labrum Tear Symptoms
are:
- Instability
in the shoulder
- Deep
pain in the joint
- Popping
and Clicking Sensation
- Discomfort
or pain when lifting objects or moving the arm
- Reduced
ROM
Weakness
in the Shoulder joint, on numerous occasions on one side
These symptoms vary depending on what type
of labrum tear the patient has suffered, they’re described below.
WHAT ARE THE DIFFERENT TYPES OF SHOULDER LABRAL TEARS?
The two most common types of
labral injuries are the SLAP tear and Bankart tear. Both types of tears are usually accompanied by
aching pain and difficulty performing normal shoulder movements.
What are SLAP tears?
SLAP
acronym means "Superior Labrum
Anterior to Posterior”. The part affected in this type of tear is the front
area of the upper arm where the biceps tendon connects with the shoulder.
Baseball
pitchers and volleyball players who perform high-energy, quick-snap actions
across the top of the musculoskeletal area of the shoulder are the most
vulnerable to this injury.
Patients with SLAP tears may present pain close to the biceps tendon in
the front of the shoulder. The
anterosuperior labrum usually appears to have a poor blood supply, whereas the
inferior labrum has a significant blood flow (Cooper DE et al, 1992).
How incident is the SLAP in the population?
Even today the incidence of
this condition is a matter of debate; it is known that Snyder has stated on
different occasions that the percentage has been growing exponentially hard in
the last decades. Proof of this are the studies carried out in 2002 where the
incidence in the population was 4 out of every 100,000 people and in 2010 where
the incidence increased to 22.3 out of every 100,000 people. Another
characteristic of this condition is that the highest incidence usually occurs
in young patients between 20 and 29 years of age and between the ranges from 40
to 50 years, lays out (Scott D. Mair et la, 2021).
What are Bankart tears?
Bankart tears are most common
in younger subjects who have had their shoulder dislocated. The joint capsule (fibrous
tissues that surround, support, and keep safe the joint) can pull on the lower
portion of the labrum and tear it if the ball of the shoulder joint falls out
of the socket. As a result of the labrum rupture, the shoulder is more likely
to re-dislocate, causing instability.
Anterior instability is
caused by a dislocation in which the head of the humerus slips toward the front
of the body, and its lifetime reoccurrence is nearly from 1% up to 2%, claims (Matthew Varacallo et al, 2021).
Posterior instability occurs
when the ball slips toward the back of the body, it should be noted that this
particular one is an odd condition as it represents 10% incidence of all
existing shoulder injuries, apprises (Alaina Brelin et al, 2017). The affected individuals
with Bankart tears may be concerned that the shoulder will dislocate or slip
out of place.
ARE ATHLETES THE MOST PRONE TO SHOULDER
LABRAL INJURY AND CAN SHOULDER LABRUM TEAR BE PREVENTED?
Normally this condition is
quite difficult to prevent, unfortunately high performance athletes are predisposed
to have it as this condition is sensitive to overhead movements.
However, people who have
suffered from a traumatic event such as a fall are also prone to experience it.
Older adults are also at risk for this injury as these tissues become more
fragile with aging, as well as tissue degeneration caused by recurring overhead
manual labourer occupations, points out (David
C et la, 2021).
Although SLAP is difficult to
prevent there are certain methods that can help prevent it. As we mentioned
earlier, athletes are more likely to develop this affection, especially
baseball and softball pitchers due to overuse of movement in the shoulder.
Monitoring and limiting the pitch count especially in a young pitcher can be a
good precaution method against this condition, affirms (John Henry Wilckens, MD).
CAN A SHOULDER LABRAL TEAR HEAL WITHOUT
SURGERY?
Initial treatment for shoulder labrum tear & for SLAP usually does not
require surgical intervention; initially Physical
Therapy Manchester is used depending on the severity of the tear. "Surgeons
should try to be as conservative as possible when treating a torn shoulder
labrum," says Dr. Fealy.
Surgeons will usually conduct a physical clinical
assessment and order MRI or X-ray to determine
which the appropriate treatment for the patient is.
Sports Physiotherapy Manchester is usually accompanied by
anti-inflammatories, and, in specific cases, cortisone injections for Shoulder Labral Injury can also be used. Gradual shoulder extensions performed by a
physical therapy Manchester practitioner over a period of one to two months
should also be added.
For this reason is essential to seek
out and turn up to your Physiotherapy
Manchester practitioner in order to assess your condition with the shoulder labrum tear test, feel free to
contact us
www.mysportsinjury.co.uk
HOW LONG DOES THE SHOULDER LABRUM TEAR INJURY TAKE TO BE SOLVED UNDER MY
SPORTS INJURY CLINIC PHYSIOTHERAPY MANCHESTER MANAGEMENT PROGRAM?
The required recovery time
frame to rehab a torn labrum could approximately take from 2 months up to 3
months, in this case scenario is paramount the physiotherapy guidance of your Sports Massage Manchester clinicians,
explains MorePhysicalTherapy.
WHEN DO YOU NEED SURGERY FOR A TORN
SHOULDER LABRUM?
Surgical treatment should be
considered when all non-conservative methods have been tried without efficacy.
The type of intervention that will be performed on the patient will depend on
the severity of the tear. "If physical therapy fails and the athlete still
can’t complete overhead motions, or the shoulder continues to dislocate,
surgical treatment might be required to reattach the torn ligaments and labrum
to the bone," says Dr. Fealy.
Russel Warren, MD, for Arthroscopic procedures
sets out that one of the most used
methods to treat SLAP is arthroscopy, since when carried out through a small
incision it is much less invasive than an open operation.
Doctors usually recommend
more conservative methods for older people who do not perform physical activity
on a regular basis; otherwise young athletes are usually managed through
arthroscopic surgery to achieve greater efficiency. Find the best Sports physiotherapist in Manchester to treat
your Labral Tear Condition.
WHAT IS THE RECOVERY TIME FRAME FOR
SHOULDER LABRUM TEAR SURGERY?
Recovery from surgery depends
on different factors such as the specific location of the tear and how good the
surgical intervention was. Regularly, the recovery period after undergoing
surgery varies from 4 up to 5 weeks when the labrum begins to adhere to the
edge of the bone again and it could take twice time period time for it to fully
strengthen. In athletes the period is much longer because they will need from 6
months to a year to fully recover.
Patients are usually
recommended to wear a sling for four weeks after the operation, regardless of
the surgery performed. This helps protect the shoulder while it heals during
the post-operative period. In parallel, the
recovery process must be accompanied by a Sports Physical Therapist including custom
counselling in order to return a full function and live pain-free.
The average time of returning to sports and getting back on
daily basis activities after arthroscopic SLAP repair surgery ranges from 8 up
to 9 months and the success rate accounts for 69.9% of screened individuals who
got back their optimal level and proficiency, says (Aarabi Thayaparan et al, 2019).
SHOULDER LABRAL TEAR EXERCISES RECOMMENDED BY YOUR SPORTS MASSAGE
MANCHESTER CHIROPRACTORS
If
arthroscopic surgery is indicated in a SLAP injury, the Physical Manual
Therapist must design a program for shoulder
rehabilitation including shoulder
labral tear exercises, starting with a functional assessment, subsequently;
pain treatment, passive / active mobilisations, is important avoid Adhesive
Capsulitis of the Shoulder (prolonged immobilization), adjacent trigger point
treatments, and Neurodynamic exercises.
1. Toning
or strengthening exercise for recovery from shoulder injuries
These are exercises to
strengthen or tone the rotator muscles of the shoulder, supraspinatus,
infraspinatous, and rotator cuff. In addition, the posterior muscles of the arm
as well.
Use a rubber
band, dumbbell, perform a short contraction, take a break between contractions
of at least 3-4 seconds, it can be done several times a day.
2. Stabilisation
exercises for shoulder injuries and rehabilitation
We show you a
series of exercises indicated to stabilise the shoulder joint, recommended in
cases of shoulder rehabilitation in injuries where stability is affected.
Kneel on and put
your hands on the floor like a cat-cow position and start making circles in
that position in order to give a little loads to the injured shoulder so the
musculoskeletal area actives and stabilise itself.
You
can also add an unsteady object to the routine like a ball; this exercise can
be performed several times a day as well.
3. Exercises
to improve shoulder mobility
We give you
various recommended exercises to improve and regain mobility of the shoulder
joint complex.
Kneeling, we
place our hands and head resting on the floor with our arms extended above our
heads. We should feel a stretch in the shoulder or upper or lower back.
We
stand in a narrow squat rack or under a door frame and place the hand and
forearm on each side of the structure. Keeping the arms in that position, we
advance the torso until we feel a stretch in the pectoral or shoulder area.
We
lie on the floor on our back with a mobility roller under the centre of the
back longitudinally, or some other structure that raises our back without
hindering movement. We place the arms extended to the sides of the body with
the palms facing the ceiling. From that position we slide the backs of the
hands up to the top of the head and return to the starting point. We should
feel a stretch in the chest area and / or in the anterior shoulder area.
KEY POINTS ABOUT SHOULDER LABRUM TEAR
The shoulder is
one of the most important regions of our body and at the same time, one of the
most affected parts since it suffers a lot of wear and tear on a day-to-day
basis. You might think that this deterioration occurs mainly in athletes, but
contrary to what people believe, anyone can have shoulder problems due to a
fall or a repetitive activity in which the arm has to be raised overhead. These
two factors can lead to a tear in the labrum, that is, a partial tear in the
cartilaginous ring that surrounds the base of the shoulder joint and provides
it with stability.
There
are two types of tears. Traumatic tear of the labrum; athletes are very prone
to suffering from it. It occurs mainly for these reasons due to a shoulder
dislocation and also for an injury as a result of lifting heavy objects or high
impact activities. The other one is non-traumatic tear of the labrum; it occurs
in people with great laxity, since they have greater mobility in the shoulder
joint. It is precisely this joint instability of the shoulder or muscle
weakness that causes tears.
Many times this
condition is asymptomatic, especially when it is a small tear, so it does not
cause pain.
To find out if a
labrum tear is suffered, the sports physiotherapy Manchester practitioner will
perform the shoulder labrum tear test that assess the labrum and the stability
of the shoulder joint, and an MRI may be also prescribed.
Depending on the
type of tear, it can be treated with physical therapy that will plan a
rehabilitation and prevention treatment for certain movements and positions, perform
manual therapy to reduce pain and correct movement, do exercises to strengthen
the shoulder, balance the muscles, reduce pressure on the labrum and do
stretching. Likewise, the
physiotherapist will help those who have undergone surgery through progressive
rehabilitation exercises to prevent the tissues from tearing again.
Published
by Rafael Peña
for www.mysportsinjury.co.uk
References
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Murphy CP, et al. Prevalence of Shoulder Labral Injury in Collegiate Football
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2. Thayaparan A, Yu J, Horner
NS, Leroux T, Alolabi B, Khan M. Return to Sport After Arthroscopic Superior
Labral Anterior-Posterior Repair: A Systematic Review. Sports Health. 2019
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31584340; PMCID: PMC6822213.
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A, Dickens JF. Posterior Shoulder Instability. Sports Med Arthrosc Rev. 2017
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