Disease Description (Causes and Symptoms)
- Definition summary: The labrum is fibrocartilage that surrounds the rim of the glenoid cavity of the scapula and helps with joint stability and contact between the articular surfaces. When the superior glenoid labrum is damaged at the area continuous with the long head tendon of the biceps, it may be diagnosed as a superior labral tear from anterior to posterior (SLAP) lesion, among other conditions.
- Causes and pathophysiology:
- Acute trauma: Anterior dislocation of the shoulder joint or impact injuries caused by hitting the shoulder or falling onto an outstretched arm.
- Repetitive overuse: Degenerative damage caused by repeated traction and compression of the shoulder joint during overhead sports (baseball, tennis, volleyball, etc.), glenohumeral internal rotation deficit (GIRD), and other factors.
- Mechanism: Compression or traction of the shoulder joint can separate the labrum from the bone or damage the area connected to the long head tendon of the biceps, causing pain, instability, and catching/clicking sounds.
- Main symptoms:
- Shoulder pain, especially when raising the arm overhead or extending it backward; a heavy or unstable feeling; and a “pop” or other noise from the shoulder.
- Limited movement, weakness, and worsening symptoms during certain movements, such as throwing or placing objects overhead.
- Age-related characteristics: Younger people often have accompanying dislocation and instability, while people in their 50s or older may also have rotator cuff tears or arthritis.
Treatment Methods and Precautions
- Diagnostic tests:
- Clinical examination: Specific tests such as the O’Brien test, crank test, and biceps load test may be used as aids.
- Imaging tests: Intra-articular contrast-enhanced MRI (MR arthrogram), which is more sensitive than conventional MRI, is recommended. If the diagnosis is unclear, arthroscopy (diagnostic arthroscopy) is the standard method for definitive confirmation.
- Conservative treatment (initial treatment is prioritized):
- Activity modification and acute-phase pain control, such as cold compresses and NSAIDs.
- Physical therapy: Initial stretching, including the posterior joint capsule → gradual strengthening of the rotator cuff and muscles around the scapula → proprioceptive training and functional retraining.
- Exercise program: Restoring shoulder flexibility, correcting GIRD, scapular stabilization exercises, and correcting throwing posture and technique.
- Injection treatment: Steroid injections and similar treatments for symptom relief may provide temporary benefit but are not definitive treatment.
- Surgical treatment (when conservative treatment fails or the injury is severe):
- Indications: Persistent pain or functional impairment, detached tears causing instability, and recurrent symptoms in high-level athletes, among others.
- Procedures: Arthroscopic labral repair (or debridement of the detached area), and, when necessary, repair or tenodesis of lesions of the long head tendon of the biceps. Arthroscopic surgery is primarily performed and involves less incision and bleeding.
- Postoperative care: Wearing a sling or other brace, gradual ROM and strength rehabilitation over several weeks to months, and a progressive return plan. For athletes, it may take 6–12 months or longer to fully regain performance.
- Precautions and complications:
- If left untreated, persistent pain, instability, and functional impairment may develop, particularly in sports or occupational activities.
- Surgical complications: Infection, nerve injury, joint stiffness (adhesions), re-tear, and persistent postoperative pain.
- Prognosis: Most people improve with conservative or surgical treatment, but high-level athletes may not fully return to their preoperative performance level.
- Points to note for self-management:
- Do not self-diagnose or resume strenuous exercise prematurely. If pain is severe or functional impairment persists, evaluation by a specialist is necessary.
- Perform stretching and strengthening exercises consistently, avoid overuse, and maintain proper technique and posture.
Checklist Before an Outpatient Visit (Items to Bring and Example Questions)
- Items to bring:
- A list of current medications, including prescription drugs, OTC medications, and supplements.
- Past medical and surgical history, particularly shoulder-related surgeries and any history of dislocation.
- Previous imaging tests and reports, such as MRI or X-ray results, or CDs/USB drives if available.
- A record of the time symptoms began, aggravating factors (specific movements or sports), and symptom patterns, including pain intensity and frequency and effects on daily life and exercise.
- Information about occupation, type of exercise or sport, and level of participation (recreational, amateur, or professional).
- Questions to record beforehand for yourself (useful when explaining your condition to the doctor):
- When did the symptoms first begin, and was there a specific trigger, such as an injury or repetitive movement?
- What is the location and nature of the pain (sharp, dull, or radiating), and what factors worsen or relieve it?
- What activities have you been unable to do because of the pain, such as throwing or putting a towel over your head, and how much does it limit your daily life?
- What treatments have you tried previously, such as the duration and frequency of physical therapy, medications, or injections, and how did you respond?
Examples of General Questions to Ask the Doctor
- Is this diagnosis certain? What additional tests are needed?
- How likely is improvement with conservative treatment? Is there a time limit for assessing its effectiveness?
- How should the recommended rehabilitation (exercise) program be structured? How often should I do it?
- If surgery is necessary, what are the expected procedure, recovery period, and complications?
- What are the advantages and disadvantages of medications or injection treatment for pain control?
- When can I be expected to return to sports or work?
Examples of Condition-Specific Questions
- How are SLAP lesions classified, such as types I–IV, and which type do I have? Please explain the recommended treatment for my type.
- I am an overhead throwing athlete (or an athlete in a specific sport). How do the surgical treatment options—labral repair versus biceps tenodesis—differ in their effects on recovery of athletic performance? Please tell me about the risk of recurrence and the expected time of return.