The shoulder joint relies on the labrum, a ring of specialized, rubbery fibrocartilage that lines the glenoid (the shoulder’s socket), to maintain stability. The labrum deepens the socket by up to 50%, helping the head of the upper arm bone (humerus) fit securely. A labral tear occurs when this tissue rim is damaged, compromising the joint’s stability.
Tears are commonly caused by acute trauma, such as falling onto an outstretched arm or a direct blow. Repetitive overhead motion, often seen in athletes, or natural degeneration can also lead to a tear. Depending on the location and type of tear, symptoms can include deep shoulder pain, a feeling of instability, and a catching or locking sensation during movement.
Initial Non-Surgical Treatment Pathways
For many individuals, the initial approach to recovery does not involve surgery. This conservative pathway begins with activity modification and rest to allow the injured tissue to settle and prevent further damage. Avoiding forceful movements, heavy lifting, or activities requiring the arm to be raised overhead is recommended during this phase.
Pain and inflammation are managed with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. If pain persists, a corticosteroid injection may be administered directly into the shoulder joint. This delivers a strong anti-inflammatory medication to the affected area, providing temporary relief.
Targeted physical therapy is the cornerstone of non-surgical treatment, aiming to compensate for the instability caused by the torn labrum. The program focuses heavily on strengthening the muscles surrounding the shoulder, specifically the rotator cuff and the periscapular muscles. Improving the strength and endurance of these muscles helps stabilize the joint externally and reduces stress on the damaged labrum, often allowing patients to regain function.
Surgical Procedures for Labral Repair
When conservative measures fail to provide relief, or when the tear is severe and involves significant joint instability, surgery becomes the method to fix the torn labrum. The vast majority of labral repairs are performed arthroscopically, utilizing small incisions and specialized instruments to visualize and repair the joint. This minimally invasive technique is preferred as it generally results in less trauma to surrounding tissues.
The approach to repair is determined by the tear’s specific location. An anterior labral tear, typically resulting from a shoulder dislocation, is known as a Bankart lesion. A Bankart repair involves reattaching the torn labrum and often tightening the stretched capsule to restore stability and prevent future dislocations.
A tear located at the top of the labrum, where the biceps tendon attaches, is termed a SLAP (Superior Labrum Anterior to Posterior) tear. SLAP repair is commonly performed for symptomatic lesions. The procedure involves reattaching the superior labrum to the bone of the glenoid rim. For complex SLAP tears, a biceps tenodesis may be performed, which involves detaching the biceps tendon from the labrum and reattaching it to a different area on the humerus.
In both Bankart and SLAP repairs, the torn tissue is secured back to the glenoid bone using specialized surgical implants. The surgeon uses small suture anchors drilled into the bone. Strong sutures are then passed through the torn labrum and tied down to the anchors, firmly compressing the labral tissue against the bone to promote biological healing.
Post-Treatment Rehabilitation and Recovery Timeline
A structured rehabilitation program is necessary for a successful outcome, regardless of whether the tear was managed conservatively or repaired surgically. Following surgery, the initial phase focuses on protecting the repair site, which often involves wearing a sling for four to six weeks to immobilize the shoulder. During this period, movement is strictly limited to passive range of motion (PROM), meaning the arm is moved only by the therapist or the non-operated arm, to avoid stressing the healing tissue.
The second phase, typically beginning around four to six weeks post-surgery, introduces active-assisted range of motion (AAROM) and then active range of motion (AROM). The goal is to safely restore the full mobility of the shoulder without compromising the repair. Gentle isometric exercises may also be introduced to begin activating the rotator cuff and periscapular muscles.
Between eight and twelve weeks, the rehabilitation progresses into the strengthening phase, where the focus shifts to building muscle strength and endurance. The physical therapist guides the patient through progressive resistance exercises, beginning with low-weight, high-repetition movements. Full recovery is a gradual process, as the soft tissue needs time to biologically heal to the bone.
A full return to demanding activities, such as overhead sports, is generally not expected until four to six months post-surgery, and sometimes up to nine months. Rushing the recovery process before the repair has achieved sufficient strength increases the risk of re-injury or failure of the surgical fixation.