SCINQ Guide to Baseball Injuries: Torn Labrum

Condition: Labrum tears are common among pitchers but can be a bit of an enigma. Depending on the size of the tear, a player can play through it, sometimes not even knowing that there’s been any damage.

The labrum is a ring of fibrous cartilage around the shoulder socket, technically called the glenoid. Its main function is to deepen the socket increase the stability of the joint. It also plays a role in shock absorption within the socket. In addition, the biceps tendon is attached to the labrum and can be affected by trauma. Injuries tend to occur either through repetitive motions, shoulder dislocation, or as a result of age.

Labral injuries can occur in different ways. They can come completely off the bone or along the edge of the labrum or where the bicep tendon attaches. They are classified by their location, namely superior/inferior/anterior/posterior. The most common types of labral injuries are SLAP lesions and Bankart tears. SLAP (superior labrum anterior posterior) lesions occur toward the top of the glenoid. This particular injury can also cause bicep problems since the muscle’s tendons are attached in the vicinity. Like muscle injuries, labral tears are classified according to grades, in this case there are 4 different categories.

Bankart lesions occur on the bottom end of the socket and toward the front. The most common causes for this type of tear is shoulder dislocation. Bankart tears often result in increased shoulder instability.

Symptoms: The most common symptom of labral tears is pain while performing overhead activities like pitching, throwing, or hitting a serve in tennis. A pop or click is often felt and the shoulder feels like it’s locking up.

Diagnosis: Because the cartilage involved is deep in the shoulder, physical exams are not enough to make a proper diagnosis. The best available tests for labral tears are magnetic resonance imaging (MRI) scans or CT-arthrogram (CAT) scan (80-85% accuracy). Unfortunately, when it comes to SLAP tears, neither test is very good due to the complexity of the area. MRIs may miss smaller tears.

The best way to make a diagnosis is with arthroscopy. However, since it is a surgical procedure, Major League Baseball players may not be enthusiastic about the option.

Treatment: For less severe tears, a period of rest followed by conservative rehabilitation is an option. Rehab tends to be lengthy. However, if the tear is sever enough that it does not respond to rest and rehab, surgery is unavoidable.

Players: Miguel Andujar

IMAGE SOURCE: Creative Commons

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