Shoulder Instability and Labral Tears

As the most movable joint in your body, the shoulder has many functions. The shoulder can rotate, lift, and turn in many directions. However, this greater range-of-motion can sometimes cause instability and labral tears.

Shoulder Instability and Labral Tears: What are they?

Shoulder instability occurs when the top of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse. Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability.

Labral tears can occur from repetitive shoulder motion or when the tissue rim surrounding the socket experiences an injury. Often, throwing athletes or weightlifters experience glenoid labrum tears from repetitive shoulder motion. The labrum wears down over time, which can also cause tears.

Woman in pain from shoulder instability or a labral tear

Woman getting examined for shoulder instability or a labral tear

Symptoms: What does Shoulder Instability or a Labral Tear feel like?

The shoulder may feel loose or slip in and out of the joint
Shoulder instability may follow repeated shoulder dislocations
Shoulder pain is a common occurrence, especially when engaging in overhead activities
The shoulder catches, locks, pops, or grinds
Everyday activities cause pain

Causes

Shoulder Dislocation: Severe injury or trauma is often the cause of an initial shoulder dislocation. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability.

Repetitive Strain: Some people with shoulder instability have never had a dislocation. Most of these patients have loose ligaments in their shoulders. Sometimes the loose ligaments are part of a normal person’s anatomy, though it can also be the result of repetitive overhead motion. Sports such as swimming, tennis, and volleyball require repetitive overhead motion that can stretch out the shoulder ligaments. Many jobs also require repetitive overhead work. Looser ligaments can make it hard to maintain shoulder stability. Repetitive or stressful activities can challenge a weakened shoulder. This can result in a painful, unstable shoulder or a labral tear.

Multidirectional Instability: A small number of patients experience shoulder instability without a history of injury or repetitive strain. In such patients, the shoulder may feel loose or dislocate in multiple directions, meaning the ball may dislocate out the front, out the back, or out the bottom of the shoulder. This is called multidirectional instability. These patients have naturally loose ligaments throughout the body and may be double-jointed.

Acute Trauma: Labral tears can result from a sudden or forceful movement of the arm when it is above the level of the shoulder. Car accidents, falls, or forceful pulling on the arm are all examples of labral tear causes.

Evaluation: How are shoulder instability and labral tears diagnosed?

If you are experiencing shoulder pain, your doctor will take a history of your injury. You may be able to remember a specific incident or you may note that the pain gradually increased. The doctor will do several physical tests to check range-of-motion, stability, and pain. Your doctor may also test for general looseness in your ligaments. For example, you may be asked to try to touch your thumb to the underside of your forearm. Your doctor will also request X-rays to see if there are any other reasons for your symptoms.

Shoulder Instability: Your doctor may order imaging tests to help confirm your diagnosis and identify any other problems. X-rays will show any injuries to the bones that make up your shoulder joint. Magnetic resonance imaging (MRI) can provide detailed images of soft tissues. It may help your doctor identify injuries to the ligaments and tendons surrounding your shoulder joint.

Labral Tears: Because the rim of the shoulder socket is soft tissue, X-rays will not show labral tears or damage to the rim. The doctor may order a computed tomography (CT) scan or MRI scan. In both instances, a contrast medium may be injected to help detect tears. Ultimately, however, the diagnosis will be made with arthroscopic surgery.

Treatment

At first, both labral tears and shoulder instability will most likely be treated with non-surgical options. If these options do not relieve the symptoms, surgery may be needed.

Man receiving physical therapy for shoulder instability or a labral tear

Non-operative treatment

Your doctor will develop a treatment plan to relieve your symptoms. It often takes several months of non-surgical treatment to tell if the treatment is working. Non-surgical treatment typically includes a combination of rest, anti-inflammatory medication, and rehabilitation exercises to strengthen the rotator cuff muscles.

Surgery

Surgery can repair torn or stretched ligaments so that they are better able to hold the shoulder joint in place. Depending on the injury, your doctor may perform a traditional, open procedure, or an arthroscopic procedure in which small incisions and miniature instruments are used.

Arthroscopy is a minimally invasive surgery. A doctor will look inside the shoulder with a tiny camera and perform the surgery with special pencil-thin instruments.

Some patients may require an open surgical procedure. An open procedure involves a larger shoulder incision and direct visualization to perform the repair.

Recovery: What Can Be Expected?

After surgery, patients will need to wear a sling for several weeks, depending on the doctor’s recommendation. Your doctor will also prescribe gentle, passive, pain-free range-of-motion exercises. When the sling is removed, you will need to begin exercises to rehabilitate the ligaments. These will improve the range of motion in your shoulder and prevent scarring as the ligaments heal. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.

Be sure to follow your doctor’s treatment plan. Although it is a slow process, your commitment to physical therapy is the most important factor in returning to all the activities you enjoy.

Woman swimming after receiving treatment for shoulder instability

Physicians

The following physicians specialize in the treatment of Shoulder Instability and Labral Tears:

R. Blake Curd, MD

Evan N. Hermanson, MD

Erik D. Peterson, MD

Peter A. Looby, MD

Matthew J. McKenzie, MD

Keith M. Baumgarten, MD

Jason L. Hurd, MD

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Testimonials

I have had a knee and two shoulder replacements plus a diagnosis on an injury to my leg that probably saved muscle loss. I feel that Dr. Zoellner is the best orthopedic doctor that I could possibly have.

Love OI and Dr. Curd. He’s helped me with a couple of issues and I couldn’t be more pleased. The PA Chad is wonderful as well. The surgery went well, treatment(s) for another issue are as easy as they can be and easily scheduled. Definitely recommend Dr. Curd to anyone with hand or shoulder issues!

What a great doctor. Dr. Looby has seen me through knee and shoulder surgeries, with great skill and care. He always makes sure I am doing ok and answers all my questions and listens to my concerns. It has been an awesome journey to being pain-free and able to function normally. I will be able to dance at my daughter’s wedding. I am so grateful. What a blessing!

Dr. Baumgartner’s kind and pleasant personality set me at ease for the complex shoulder replacement surgery. He’s an outstanding and highly skilled surgeon; I highly recommend him.

From my first consult, I liked Dr. Hermanson and felt very confident in his abilities to fix my shoulder. My surgery and hospital stay were so positive! I recommended him to a friend and he did her surgery as well. He and his staff are professional, kind and a pleasure to work with! I highly recommend him!

Liz Hansen

Shoulder Instability and Labral Tears