By Laurie Melrose-Doering, Osteopath & Applied Kinesiologist
The labrum is a fibrous cartilaginous ring that attaches to the socket of the glenohumeral joint of the shoulder. In a labral tear, the labrum is torn as a result of trauma to the shoulder or overuse. Often, there is also a detachment of the long head of biceps, which attaches to the labrum.
As well as shoulder pain, a labral tear is likely to cause shoulder instability.
Pathologies of the labrum can occur in isolation or in combination with rotator cuff tears, impingement, shoulder instability, or dislocation.
There are three different types of glenoid labrum pathology. The different types have different causes:
Many of the symptoms overlap with other shoulder conditions, such as rotator cuff tears or shoulder instability. Labral tear is, hence, difficult to diagnose. If shoulder pain is resistant to osteopathic treatment, your osteopath should refer you for an MRI.
It is estimated that 10 to 20% of patients with shoulder pain have a labral tear. The incidence is higher in:
In the case of a mild labral tear, conservative management is usually effective. If, however, the labral tear is severe, surgery may be required.
Firstly, inflammation around the shoulder be reduced. This means avoiding actions and positions that exacerbate the pain, as well as applying ice to the shoulder.
Then, special attention must be given to the biceps tendon, as it is a key player in shoulder stability.
Conservative management can include massage, acupuncture, or osteopathy.
Surgery focuses on open or arthroscopic debridement and reattachment of the labrum. The success rate is ca. 60-90%.
An osteopath will improve the function of the shoulder which will help speed up recovery.
Osteopathy – combined with AK diagnosis – is perfectly placed to treat the position of the biceps tendon within its groove. This is a very subtle technique but highly effective.
If the labral tear is severe, osteopathy alone may be insufficient – surgery may be required. I would, however, trial osteopathy first, as it is less invasive and it may be possible to avoid surgery.
By Laurie Melrose-Doering, Osteopath & Applied Kinesiologist
