Labral Tears of the Shoulder

The glenoid labrum is a densely fibrous tissue that is located along the periphery of the glenoid portion of the scapula. It functions to provide increased stability, while still allowing great range of motion. In addition, it serves as an attachment point for tendons and ligaments. Tears can occur in all regions of the labrum. The two most common sites include the superior labral anterior-posterior (SLAP) tear, occurring with forced traction of the shoulder and/or direct compression, and the Bankart lesion, created by episodes of anterior instability. Symptoms of deep-seated pain (SLAP tears) or anterior instability (Bankart lesions) are the most common presentations, but concomitant shoulder pathology makes diagnosis challenging and clouds many physical exam findings. Physical exam includes several clinical tests, with the O’Brien’s test being the most common for SLAP tears and the surprise test as the most accurate for Bankart lesions. As in any case of shoulder pain, the initial imaging of choice is plain radiography. With a high clinical likelihood of labral disease, this should be followed by either magnetic resonance imaging or magnetic resonance arthrography. Initial management of SLAP tears involves exhausting non-operative treatment, focusing on stretching and strengthening of the dynamic shoulder stabilizers. Initial management of Bankart lesions (after reduction) may be conservative or operative and depends on demographic and radiographic factors. Surgical management of SLAP tears are reserved for those who have failed conservative management. Operative treatment of Bankart tears are reserved for those with recurrent instability despite conservative treatment.