A torn labrum is an injury to the ring of cartilage that provides stability and cushioning to the shoulder or hip joint. The labrum functions like a gasket, deepening the joint socket to help keep the ball of the joint securely in place. While a tear compromises this function and causes symptoms, surgery is not a necessity for every person or every type of tear. The appropriate course of action depends heavily on the injury’s severity and location, the patient’s symptoms, and their lifestyle.
Confirming the Injury
A torn labrum typically causes deep joint pain, often aggravated by specific movements, or a feeling of instability. Patients may experience mechanical symptoms such as catching, clicking, or locking, or a sensation that the joint is going to “give out.” These symptoms prompt a visit to a healthcare provider, who begins the diagnostic process with a physical examination.
During the exam, the provider moves the hip or shoulder into various positions to test the joint’s range of motion and provoke symptoms. Imaging scans are then used to confirm the diagnosis and assess the extent of the tear. An X-ray can rule out bone issues, but a definitive diagnosis often requires magnetic resonance imaging (MRI). A magnetic resonance arthrogram (MRA), which involves injecting a contrast dye into the joint before the scan, provides the clearest view of the labrum.
The Non-Surgical Approach
For many individuals, conservative treatment is the initial and often successful strategy for managing a labral tear. This approach focuses on reducing pain and inflammation while improving the function of surrounding muscles. Rest and modifications to activity are the first recommendations to avoid movements that irritate the injury and allow inflammation to subside.
Physical therapy (PT) is a central component of non-surgical management designed to strengthen the muscles that stabilize the joint. Strengthening the rotator cuff (shoulder) or the gluteal and core muscles (hip) helps reduce stress on the damaged labrum. A typical PT program progresses over several weeks, starting with gentle range-of-motion exercises and gradually introducing controlled resistance training.
Pain management typically involves nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which help decrease both pain and swelling within the joint. If oral medications are insufficient, a corticosteroid injection may be used to deliver a potent anti-inflammatory medication directly into the joint space. This conservative course of treatment is usually trialed for a defined period, often six to twelve weeks, before more invasive options are considered.
Determining the Need for Surgery
Surgical intervention is typically reserved for cases where non-surgical treatments have failed to provide sufficient relief after several months. Persistent and unacceptable symptoms, such as constant pain or significant limitations in activity, are major factors in the decision-making process. Tears that cause severe mechanical symptoms, like locking or persistent instability, may also necessitate surgery because the torn tissue is physically impeding the joint’s smooth function.
The characteristics of the tear itself also play a large role, especially if the labrum has fully detached from the bone or if the tear is associated with joint instability. Tears that are large, displaced, or involve the attachment of the biceps tendon, such as a SLAP tear in the shoulder, may be less likely to heal without surgical repair. The procedure is most often performed arthroscopically, a minimally invasive technique using small incisions to insert a camera and specialized instruments.
The primary goals of arthroscopy are either repair or debridement. Labral repair involves reattaching the torn labrum to the bone of the socket using small surgical anchors and sutures. If the tissue is too frayed or damaged to be reattached, the surgeon may perform a debridement, which trims the unstable edges. A severely damaged labrum may require reconstruction using a tissue graft.
Recovery and Long-Term Outlook
The recovery timeline varies significantly based on the chosen treatment path. For those who manage the injury non-surgically, improvement is typically noticeable within weeks, and a return to full activity may occur within a few months. However, the continued commitment to physical therapy is what allows the surrounding muscles to provide the necessary stability to compensate for the damaged labrum.
Surgical recovery is a longer, more structured process, requiring immobilization, often four to six weeks in a sling, to allow the repaired tissue to heal to the bone. Post-operative physical therapy is structured into phases, progressing from passive motion to active motion and strengthening. Full recovery and clearance to return to strenuous activities or sports typically takes four to six months or longer, but the prognosis for pain relief and functional improvement is high following successful surgery.