Anatomy

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.

Image showing the glenoid labrum firmly attached to the glenoid.

Image showing a tear in the glenoid labrum. At the base, the tear has separated the tissue of the labrum from the bony glenoid.

Imaging

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. 

Image of X-Ray showing a normal shoulder and a dislocated shoulder. This dislocated shoulder is usually put back in place in the Emergency Department or in the Office.

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.

In this image, the if the humeral head moves forward and pops out, it can tear the labrum (white) and lead to a tear (red).

Shoulder Dislocation

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.

A Bankart Lesion, also known as a labral tear, is when the soft labrum is detached from the bone. This occurs when the humerus dislocates.

Treatment Plans

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

Image showing drill holes that are created to place anchors.

Image showing how anchors are placed into the bone with sutures coming from them. These will be later tied around the soft torn labrum to repair it.

Image showing a final repair of the torn labrum. The stitches are sinched down and the bumper is repaired to prevent re-dislocation.

Rehabilitation

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%!

A patient being rehabilitated after shoulder surgery. The rehabilitation is a long process but success rates are excellent!