Shoulder Instability and Labral Tears

Conditions That Can Cause Recurrent Dislocations and Pain

Your shoulder is an incredibly mobile joint, allowing for a wide range of motion in everyday activities and sports. This mobility also makes your shoulder more vulnerable to injury, especially when it becomes unstable or when the labrum, the cartilage that stabilises the joint, is torn.

Shoulder instability occurs when the head of your upper arm bone (humerus) is forced out of your shoulder socket (glenoid). This can happen due to an injury, repetitive overuse, or a natural looseness in your shoulder joint so, if your shoulder frequently dislocates or subluxes, it’s considered unstable.

CAUSES OF SHOULDER INSTABILITY AND LABRAL TEARS

Your shoulder joint is one of the most mobile joints in your body, allowing for a wide range of movement. This mobility, though, can make your shoulder more prone to instability.

Common causes of shoulder instability include:

Trauma: A fall or direct blow can push your shoulder out of its socket.
Repetitive Motion: Sports with overhead movements like swimming, tennis, or baseball can lead to instability over time.
Congenital Looseness: Some people are born with looser shoulder ligaments, making them more susceptible to instability.

TYPES OF LABRAL TEARS

The labrum is a thick ring of cartilage that lines your shoulder socket, helping to stabilise the joint by deepening the socket and providing attachment points for ligaments. When the labrum is torn, your shoulder can become unstable, causing pain and difficulty with movement.

Common types of labral tears include:

SLAP Tear (Superior Labrum Anterior and Posterior): This tear occurs at the top of the labrum where the biceps tendon attaches.
Bankart Tear: Often associated with shoulder dislocations, this tear affects the lower part of the labrum.
Posterior Labral Tear: This less common tear occurs due to a posterior shoulder dislocation.

SYMPTOMS OF SHOULDER INSTABILITY AND LABRAL TEARS

Recurring Dislocations or Subluxations: The shoulder may feel like it slips out of place or fully dislocates, often during sports or overhead movement.
Deep or Aching Shoulder Pain: Pain is commonly felt deep within the shoulder joint, especially with activity or after a dislocation.
Clicking, Catching or Locking Sensation: These may occur with arm rotation or lifting, and can be a sign of a torn labrum.
Weakness or Fatigue: You may notice reduced strength or endurance in the affected shoulder, especially during repetitive tasks.
Loss of Range of Motion: The shoulder may feel stiff or restricted, particularly when reaching overhead or behind your back.
Apprehension with Movement: A sensation of instability or fear that the shoulder may dislocate again during certain movements or positions.

DIAGNOSIS OF SHOULDER INSTABILITY AND LABRAL TEARS

Accurately diagnosing shoulder instability or a labral tear is essential for developing an effective treatment plan. When you meet with Dr Liddell, he will take a comprehensive approach to assessing your shoulder, combining a detailed discussion of your symptoms, a hands-on physical examination, and advanced imaging techniques if required. This thorough evaluation helps determine the underlying cause of your symptoms and guides the next steps in your care.

DETAILED HISTORY AND INITIAL ASSESSMENT

Dr Liddell will begin by discussing your symptoms, medical history, and any previous shoulder injuries. Understanding the nature of your pain, when it occurs, and whether specific movements trigger discomfort can help identify potential causes of instability or labral damage. Details about your physical activity, occupation, and past treatments will also provide important context for the examination.

PHYSICAL EXAMINATION

A thorough physical examination allows Dr Liddell to assess your shoulder’s stability, mobility, and strength. This may include:

Apprehension Test: Dr Liddell will gently move your arm into certain positions to determine if you experience discomfort or a sensation of the shoulder ‘slipping out’ of place.
Relocation Test: Pressure is applied to stabilise the shoulder, and the response is observed to assess instability.
Range of Motion and Strength Tests: These evaluate how well your shoulder moves and how strong the surrounding muscles are, helping to identify any limitations or weaknesses contributing to instability.

DIAGNOSTIC IMAGING

If further evaluation is needed, imaging tests can provide detailed insights into the structures within your shoulder:

X-rays: These help rule out fractures, bone abnormalities, or alignment issues that may contribute to instability.
Magnetic Resonance Imaging (MRI): An MRI provides high-resolution images of soft tissues, including the labrum, tendons, and ligaments. In many cases, an MRI with contrast (arthrogram) is recommended to highlight labral tears more clearly.
Ultrasound: This dynamic imaging technique may be used to assess real-time movement of the shoulder or detect tendon injuries.

SPECIALISED TESTS

In certain cases, additional tests may be needed to clarify the diagnosis:

CT Scan: Provides a more detailed view of bone structures, particularly if there are concerns about bone loss or fractures.
Electromyography (EMG): If nerve involvement is suspected, an EMG assesses the function of nerves and muscles around the shoulder.

PERSONALISED DIAGNOSTIC PLAN

Each patient’s condition is unique, and Dr Liddell will tailor the diagnostic approach based on your symptoms and medical history. By combining a detailed assessment, hands-on examination, and targeted imaging, he can provide an accurate diagnosis and develop a treatment plan designed to restore your shoulder’s function and stability.

SHOULDER INSTABILITY & LABRAL TEARS TREATMENT OPTIONS

Labral tears don’t typically heal on their own, but symptoms can sometimes be managed through physiotherapy and strengthening exercises. For some patients, non-surgical options can effectively manage shoulder instability and labral tears. These include:

Activity Modification: Avoiding overhead movements, contact sports, or other activities that provoke symptoms may help prevent further injury and reduce pain.
Physiotherapy and Rehabilitation: A structured physiotherapy program focuses on strengthening the muscles that support the shoulder, improving control, and enhancing joint stability.
Anti-Inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce inflammation, particularly during flare-ups or after activity.
Corticosteroid Injections: In selected cases, an injection into the shoulder joint may be used to reduce inflammation and provide temporary relief of pain.

If symptoms continue or shoulder dislocations recur despite conservative care, surgical treatment may be recommended. These options include:

Arthroscopic Labral Repair: This minimally invasive procedure reattaches the torn labrum and tightens the surrounding joint capsule to improve stability.
Capsular Shift or Stabilisation Surgery: For patients with generalised instability or repeated dislocations, tightening the shoulder capsule can help restore control and reduce the risk of further injury.
Post-Surgical Rehabilitation: Physiotherapy after surgery is essential for protecting the repair, restoring range of motion, and gradually building strength and function.