- There are basically two very common types of labral tears.
But the causes are very different.
The first type of labral tear
that's probably the most common
is what we call a Bankart tear
or an anterior labral tear,
which occurs in the very front of the shoulder.
And the most common cause of that
is a shoulder dislocation,
when the ball pops out of the socket,
very common in football, a linebacker or a free safety
that gets caught in a position
with the arm in the abduction and external rotation
and they get hit and their shoulder pops out the front,
The ball pops out of the front of the socket.
And when the ball pops out of that socket,
it catches the labrum and tears the labrum
off the bone as it comes out.
The second most common type of tear
is what's called a SLAP lesion or a superior labral tear
which is a labrum on the top of the socket.
That occurs more from kind of chronic repetitive overuse,
such as an overhead athlete,
like a pitcher or a tennis player, a javelin thrower.
People with repetitive motion
can have a superior labral tear.
They all complain of a loss of velocity in their fastball
or they just can't get the football down the field
like they wanted to before.
And they complain of pain kind of anterior and superiorly,
whereas the anterior labral tear or a Bankart type tear,
they're having typically some instability episodes.
When they bring their arm up into certain positions,
particularly abduction and external rotation,
when they get caught in this position,
sometimes even in their sleep,
they'll feel the shoulder kind of
give out on them or sublux.
A lot of times athletes will try
and get through a whole season
without even telling us.
Particularly linebackers, free safeties
tend to be very tough individuals.
And they won't even bring it up until after the season.
And they'll come in and they'll say, "You know, doc,
"my shoulder's been popping out on me all season.
"What can you do for me?"
Diagnose a labral tear,
it involves basically three components.
First component is history,
which is, you know, when and where they're having pain
or are they having instability.
The second component is physical examination.
We literally place our hands on the patient
and kind of get a sense of how unstable their shoulder is.
Sometimes we can even pop a shoulder out in the office
if you're not careful, if a patient is really unstable.
Specifically with a SLAP tear or a superior labral tear,
a patient commonly will have pain
with elevation, with the thumb down like this
and slight adduction now.
Do you have pain?
Hold your arm up and resist me right there.
Hold it, hold it.
Does that cause any pain?
- No.
- And now with the palm up,
typically they'll have pain in this position
with a superior labral tear.
But when you bring their palm up like this,
they will have no pain.
Hold it up right there.
Typically we want to know, you know,
what positions does their shoulder feel unstable
and is it abduction, external rotation,
which is classically leads to the anterior labral tear.
Basically when they have pain,
how much force it takes,
do they have pain in the weight room,
a lot of times with lifting,
bench pressing, things like that,
do they have a painful catching in the weight room?
This is where the shoulder typically comes out the front.
And we call this an apprehension test.
And we bring them back as far as we can.
And if they have an unstable shoulder,
they will commonly stop me.
They'll say, "Doctor, stop, I feel like
"it's going to pop out."
But Jason obviously has a negative apprehension sign.
He has no sign of instability out at the front.
The second test we do is what's called
an inferior sulcus test.
You literally, to assess if the ball is unstable
in this plane inferiorly,
we just lie them flat and apply a force distally.
And if some people are so unstable inferiorly
that they will notice a big sulcus or dent in the skin here.
But he's fine.
And then for anterior stability,
we literally again abduction, external rotation.
And we actually apply a force and see
how much we can ride that ball out of the socket.
But he's very stable right there.
Does it feel at all like you have any instability there?
- [Jason] No.
- [Dr. Luchetti] So he's stable
inferiorly and anteriorly,
and he has a negative apprehension test right there.
The third component, diagnosis,
would be an MRI with contrast,
which is a special type of MRI
where dye is injected into the shoulder
and the dye leaks up underneath the labral tear.
And an MRI really is the definitive diagnosis.
This is an MRI of a shoulder
that illustrates a Bankart lesion,
that is, a tear of the labrum
in the front and below.
What do I mean by that?
Well, this is the ball of the sockets.
Since we're looking at a cross section
looking down on a cross section of the shoulder.
This is the ball, and this is the shoulder blade.
And on the end of the shoulder blade is the labrum.
And the labrum here is indicated in a darker black.
It's this area right here.
The white that we see has been injected into the joint.
This is a dye.
And the dye is used to outline
a tear in the labrum.
The yellow arrow is pointing to this tear in the labrum.
And I'm going to outline it just like this.
So this is a torn labrum.
This is a normal labrum.