While 23% to 38% of competitive swimmers experience some form of shoulder injury every year, you don’t have to be a competitive swimmer to suffer from common shoulder overuse injuries.
In fact, baseball, softball and volleyball players, as well as anyone who performs repetitive movements with their shoulders (think painters, landscapers or movers), are at risk for “swimmer’s shoulder” and shoulder labral tears.
Normal Shoulder Function
The shoulder is the most mobile joint in the body, allowing for a range of motion that includes “adduction, abduction, flexion, extension, internal rotation, external rotation, and 360-degree circumduction…” as well as “scapular protraction, retraction, elevation, and depression.” One downside of this extensive range of motion is the shoulder’s inherent instability.
A ball-and-socket joint, the main part of the shoulder is formed where the head of the humerus (upper arm bone) fits into the socket of the scapula (shoulder blade). The shoulder joint, however, is very complex and includes connections between other bones (including the clavicle), ligaments, tendons and muscles in order to provide a full range of motion and stabilize the ball-and-socket.
Swimmer’s Shoulder vs Shoulder Labral Tears
The structure of the shoulder lends itself to impingement syndrome, also known as swimmer’s shoulder. The muscles and tendons in the shoulder joint are surrounded by bone, particularly the rotator cuff. The rotator cuff is a group of muscles and tendons that works together to keep the head of the humerus in the socket of the scapula and helps raise the arm overhead.
A classic overuse injury, swimmer’s shoulder occurs when repetitive overhead motions (like swimming, throwing, etc.) cause inflammation in the rotator cuff, compressed tendons and reduced blood flow.
Labral tears, on the other hand, can result from both the wear and tear of repetitive motion or from traumatic injury. The rest of this post will be dedicated to labral tears in the shoulder; for more information on swimmer’s shoulder, read about common symptoms, causes and treatments.
What is a shoulder labral tear?
Though the labrum in the shoulder works with the rotator cuff to keep the head of the humerus in the socket of the scapula, the labrum is a type of cartilage (vs a group of muscles and tendons).
The labrum is more rigid than the articular cartilage found on the end of bones within joints and exists only around the socket where it is attached to the shoulder joint. The labrum deepens the shoulder socket by up to 50% by forming a bumper around the socket that helps hold the ball in place. The labrum also acts as an anchor, attaching to other structures in the joint, including the ligaments and muscles of the rotator cuff.
Repetitive overhead motions from swimming, throwing or occupational requirements can weaken the cartilage of the labrum, eventually resulting in a shoulder labral tear. Tears in the labrum are also commonly caused by traumatic impact or injury.
Types of Shoulder Labral Tears
There are three types of labrum tears in the shoulder, classified mainly by location. The labrum itself is located in what is called the glenoid socket, and labral tears can happen anywhere within the glenoid.
Posterior Labral Tear
The least common type of labrum tears, posterior labral tears usually result from impacts to the back of the shoulder that may or may not dislocate the shoulder from back to front. Put simply, a posterior labral tear is when the labrum on the posterior (back) side of the shoulder is torn off of the bone.
Bankart Tear (or Lesion)
Common in people with dislocated shoulders and younger populations, Bankart lesions occur when the labrum is damaged in the lower half of the glenoid socket.
SLAP Tear (or Lesion)
The most common type of labral tear in the shoulder, SLAP tears stretch from “superior labrum, anterior to posterior,” or front-to-back. Swimmers, baseball and softball players, tennis players and people who use a lot of overhead motions are at risk for SLAP tears. Weightlifters, gymnasts and impact athletes are also at risk, as SLAP tears commonly occur alongside damage to the biceps tendon.
Labral Tear Symptoms, Diagnosis & Treatment
Labral tears are typically painful yet difficult to diagnose. If you’re experiencing symptoms of a labral tear, you should see an orthopedic shoulder specialist for proper diagnosis and care.
- Locking, popping, catching or grinding sensation
- Decreased range of motion
- Pain with overhead lifting
- Pain with shoulder movement
- Pain holding the shoulder in specific positions
- Decrease strength, throwing velocity or feeling of a “dead arm” after extensive overhead use
- Feeling like the shoulder is going to dislocate
Exam, Diagnosis & Treatment
Your shoulder specialist will first take a medical history that includes injuries and symptoms and then perform a physical examination. The exam will involve range of motion, stability and strength tests. Depending on the results, your doctor may order an X-ray and/or an MRI.
Most initial treatments for shoulder labral tears are non-surgical. If your orthopedic shoulder surgeon determines that nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy haven’t adequately healed your injury, he or she may recommend arthroscopic surgery.
If you’re experiencing the symptoms of a torn shoulder labrum or have questions about labral tears, please contact us or comment below.