Home >Shoulder > Other Soft Tissue Conditions
Glenoid Labrum tear
This is a tear of the cartilage rim that provides stability in the shoulder joint. This injury commonly occurs with forward dislocation or subluxation of the shoulder, although it is possible to injure the Glenoid Labrum in children without instability of the shoulder. This injury is characterised by deep pain in the shoulder usually located towards the front of the shoulder, a clicking, popping or locking in the shoulder with movement, instability and/or a decrease of range of movement.
The SLAP lesion is a specific injury to the gleniod labrum. The shoulder joint is an extremely shallow, and thus inherently unstable, ’ball and socket’ joint. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called the glenoid labrum that forms a cup for the end of the upper arm bone (humerus) in which to move. This cuff of cartilage makes the shoulder joint much more stable, yet allows for a very wide range of movements (in fact, the range of movements your shoulder can make far exceeds any other joint in the body).
When the labrum of the shoulder joint is torn, the stability of the shoulder joint is compromised. A specific type of glenoid labrum tear is called a SLAP lesion; this stands for Superior Labral tear from Anterior to Posterior. The SLAP lesion occurs at the point where the tendon of the biceps muscle inserts on the glenoid labrum. The mechanism of this injury is usually a fall onto an outstretched arm.
Typical symptoms of a SLAP lesion include a catching sensation, pain with movement, and susceptibility to dislocation. Diagnosis can be quite difficult, as these injuries do not show up well on MRI scans. Usually, the diagnosis is made at the time of surgery. A typical course of action when there is suspicion for a SLAP lesion is to try physiotherapy, relative rest, anti- inflammatory medication, and steroid injections. If these do not help the problem, shoulder arthroscopy can be performed, and the injury can be diagnosed and treated.
Another specific type of labral tear is called a Bankhart lesion, and is due to dislocation of the shoulder (glenohumeral) joint causing the tear. The Bankhart lesion is located in a specific area of the labrum (anterio-inferior), and makes the shoulder unstable and prone to recurrent dislocation.
Typical symptoms of a Bankhart lesion include a catching, constant aching, feeling of instability and susceptibility to dislocation. Diagnosis can be difficult as these injuries do not always show up well on MRI scans. Usually, the diagnosis is made at the time of surgery. When there is suspicion for a Bankhart lesion, attempts at physiotherapy to strengthen the shoulder may help. If strengthening does not help the problem, shoulder arthroscopy can be performed, and the injury can be diagnosed and treated. Treatment is either a repair of a labral tear, or a tightening of a loose labrum.
Inflammation of the fluid filled sac(supraspinatus bursa) below the supraspinatus tendon is subacromial bursitis. This can be caused by a fall on the shoulder, a blow to the top or front of the shoulder, injury to the supraspinatus tendon or repetitive use of the shoulder such as with reaching. It is characterised by pain in the front and/or upper part of the shoulder aggravated by lifting the arm outwards and rotating the arm.
Adhesive Capsulitis (Frozen Shoulder)
Frozen shoulder, or adhesive capsulitis, is a condition characterized by a loss of motion in the shoulder joint caused by a thickening and shrinking of the ligamentous structures surrounding the shoulder joint. The diagnosis is often used for any painful shoulder condition associated with a loss of motion, but it is important to understand what caused the symptoms in order for treatment to proceed effectively. Often people experience trauma to the shoulder prior to the onset of the frozen shoulder, and sometimes there is no known cause for the symptoms.
The condition of frozen shoulder is characterized by a decrease in motion, primarily lifting the arm and turning it inwards. The condition is most common in the 40-60 year old age group and it is twice as common in women as men. People usually experience pain as the first symptom, followed by the loss of motion and a decrease in pain. Normally a gradual return of motion will follow; however, the length of time for recovery can be prolonged, with an average duration of 18 months.
The treatment primarily consists of pain relief and physiotherapy. Exercise serves to increase range of movement and to minimize the loss of muscle mass on the affected arm due to decreased activity. Physiotherapists may also incorporate ultrasound, ice, heat, and other modalities into the rehabilitation program. Cortisone injections are also commonly used to decrease the inflammation in the joint. Usually up to three injections can be given, spanning several weeks. After three injections, if improvement is not seen it is unlikely that more injections will alter the course of this condition.
If the above treatments do not resolve the problem, occasionally a patient will need to go to the operating room. If this is the case, the doctor may perform a manipulation under anaesthesia. The surgeon will move the arm to break up adhesions while the patient is asleep; there is no actual surgery involved. Alternatively, an arthroscope can be inserted into the joint to cut through adhesions. Surgical release is rarely a necessary technique.