Overview
The labrum is a ring of cartilage that surrounds the shoulder socket. I think of the shoulder as a bowling ball sitting on a relatively flat plate. The humeral head is the bowling ball, and the glenoid is the plate. The labrum acts like a rubber bumper around the edge of the plate, making the socket deeper and helping keep the ball centered. The labrum also serves as the attachment site for both the major stabilizing ligaments of the shoulder and the long head of the biceps tendon.
There are three basic types of labral tears: degenerative (most common), traumatic Bankart lesions (most common traumatic tear), and SLAP tears.
Degenerative Labral Tears
Degenerative labral tears are the most common type of labral tear and occur as part of the normal aging process. Just as arthritis causes wear of the joint surfaces, the labrum may also become frayed over time. These tears rarely require treatment by themselves. When I perform arthroscopy for impingement or rotator cuff disease, I routinely inspect the joint. If labral fraying is present, I simply smooth the tissue (debridement). This does not change the postoperative rehabilitation or recovery.
Traumatic Labral Tears
A traumatic labral tear usually occurs following a shoulder dislocation. During the injury, the stabilizing ligaments tear away from the bone. Because those ligaments attach to the socket through the labrum, the ligament-labrum complex is commonly pulled off the bone together. This injury is called a Bankart lesion. Treatment follows the same principles as shoulder instability.
Superior Labral Tears
A SLAP tear (Superior Labrum Anterior to Posterior) usually occurs when the arm is forcefully jammed upward. As the humeral head is driven upward against the socket, it can peel the upper portion of the labrum away from the bone. This upper portion of the labrum is where the long head of the biceps tendon attaches to the glenoid through the labrum. Because of this, a SLAP tear often also involves the attachment of the biceps tendon.
Treatment
Younger patients, overhead athletes, and overhead laborers may be considered for surgical reattachment of the superior labrum if they remain symptomatic after an unsuccessful trial of conservative treatment. The rehabilitation protocol following a SLAP repair is very similar to that of a Bankart repair.
For the vast majority of other patients, if surgery is required, treatment is directed toward the biceps tendon with an arthroscopic biceps tenodesis. This procedure has a quicker, less complicated, and more predictable recovery while providing excellent outcomes.