The shoulder is comprised of a bony socket called the glenoid. Around the glenoid is a rim of softer cartilage called the labrum. The labrum functions to increase the size of the joint so that the shoulder remains stable in the extremes of motion. This soft tissue is usually firmly attached to the glenoid bone. When the shoulder pops out of place, the soft tissue is peeled off the bone and a labral tear occurs.
The first imaging studies are usually X-Ray. Our doctors will look for bone loss, like the Hill-Sachs lesion, when looking at X-Rays.
An MRI will routinely be ordered to look for a torn labrum. The image sequence will show a gap in the labrum, indicated below with the red.
Shoulder injuries occur when the arm is in certain positions and "pops" out of the socket. Generally, patients are taken to the emergency room when this happens and will have their shoulder relocated. Unfortunately, even the shoulder is put back in place, something more likely than not had to tear in order for the shoulder to pop out. Most cases involve the glenoid labrum in the front- which is called the Bankart lesion.
Most shoulder dislocations do not have to be repaired for people who dislocate one time. However, data shows that patients under the age of 21 who dislocate their shoulder have an extremely high rate of re-dislocation and has lead sports physicians to fix first time dislocators if they are in the under 21 age group. If you are over the age of 40, shoulder dislocations are associated not only with a labral tear but also a rotator cuff tear. Diagnosis is made by injecting dye in the shoulder and looking at the joint in 3D with an MRI. Once a diagnosis is made, our doctors will discuss what plan is best for you after evaluating age, job, sports played and any other decisions that factor in repairing the tear.
Surgical Treatment: Arthroscopic Labral Repair
Depending on the repair and tissue quality, most people report being back to 100% around 4-6 months after surgery. The rehabilitation process is long, starting with simple motion and progressing to strengthening activities. Most patients start physical therapy around 4-6 weeks after surgery. Outcomes are extremely good, with success rates greater than 95%!