Hany Elrashidy, MD
Sports Medicine
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Hany Elrashidy, MD
Dr. Elrashidy is an Orthopedic Surgeon with subspecialty training in Sports Medicine, Arthroscopy and Shoulder Surgery.
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Why Does My Shoulder Hurt?

Why Does My Shoulder Hurt?

Source: Stop Sports Injuries

The labrum is a rim of cartilage that lines the socket of the shoulder and adds stability to the shoulder joint. The shoulder joint itself is made up of the glenoid (the socket) and the humeral head (the ball), from the top of the upper arm bone (the humerus). The labrum deepens this fairly shallow socket by up to 50%, increasing shoulder stability. It also serves as an attachment site for ligaments and tendons in the shoulder. Along with the rotator cuff and muscles around the shoulder blade, the labrum adds stability to a very mobile shoulder joint.

Labral injuries are a common cause of shoulder pain in athletes of all ages and levels of competition. These injuries typically occur from either:

  1. Shoulder trauma: From falls or during sports, when an athlete sustains a direct blow to the shoulder, a sudden forceful pull or when trying to stop a fall.
  2. Repetitive shoulder motion: These injuries occur commonly in throwing athletes such as baseball players or quarterbacks.

When the labrum is injured, depending on the location and extent of injury (inflammation, partial tear, complete tear), symptoms an athlete may note include pain (with motion, overhead activity or at night), loss of motion and instability. Additional common complaints include:

  • Mechanical symptoms: Catching, locking or popping
  • Sensation of shoulder instability
  • Loss of motion and decreased strength

The two most common types of labral injuries are SLAP (Superior Labrum Anterior to Posterior) and Bankart tears.

  • SLAP tears occur at the top of the labrum, where the biceps tendon inserts into the shoulder. Patients typically note pain at the top/front of the shoulder. This injury can be due to trauma or from repetitive use of the arm and shoulder. SLAP injuries are common in overhead throwing athlete who place tremendous stress across the shoulder. Traumatic causes include falling on an outstretched arm or directly onto the shoulder or when suddenly lifting a heavy object
  • Bankart tears typically occur after a shoulder dislocation. When the ball dislocates out the front of the shoulder, this causes a tear of the front, lower part of the labrum. Depending on age and activity level, the injury can lead to pain and feelings of instability or apprehension with the arm in certain positions. A Reverse Bankart tear occurs when the ball is forced the opposite way, causing a tear of the back portion of the labrum. This may lead to pain in the back of the shoulder as well as posterior instability. These tears commonly occur in athletes who block or tackle, such as football linemen and safeties.

Most labral tears are successfully treated without surgery. Non-operative treatments include:

  • Anti-inflammatory medication: Prescription strength Advil or Aleve
  • Physical Therapy: The goal is to strengthen muscle groups which help with shoulder stability (i.e. rotator cuff and shoulder blade muscles)
  • Activity modification: Avoid positions or activities which stress the shoulder

Shoulder Arthroscopy/Labral Repair

After an initial dislocation, younger athletes, especially those involved in contact sports, are at a high risk of recurrent dislocation. In this group or in those who have tried non-surgical treatment but continue to experience pain or recurrent instability, arthroscopic labral repair has proven to be a successful and reliable treatment option. Athletes who undergo labral repair with appropriate rehab, report significantly improved pain and a decrease in recurrent shoulder instability.

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