labrum

this is where the top of the labrum is pulled off the top of the Glenoid bone by the Biceps tendon during
repetitive throwing, pulling on the arm or falling on the outstretched arm. The tear occurs beneath the
Biceps origin and loosens it, causing pain with strenuous activity. This lesion is the cause of the infamous
“Dead-Arm” in throwers. The location of the tear (10 o'clock to 2 o'clock) has led to the eponym S.L.A.P.
(Superior Labral tear Anterior to Posterior.

B) Bankart Lesion

this “stretching” of the ligaments is most often a combination of genetics and overuse. The tissue making up the ligaments (Collagen) is more elastic in some patients and repetitive overhead activities can stress it enough to elongate it, causing capsular laxity. The result can be Multidirectional Instability (MDI). This disorder is characterized by a shoulder that easily dislocates and reduces in multiple directions. It is usually seen in teenage female athletes (Estrogen has an effect on Collagen which allows it to become lax).

these labrum and ligament injuries DO NOT HEAL and therefore require SURGERY

CLICK TO ENLARGE

ACROMION, SUPRASPINATUS TENDON, SUBDELTOID BURSA, INFRASPINATUS, GLENOID, LABRUM, SUBSCAPULARIS, GLENOHUMERAL, BICCEPS BRACHIL

A) SLAP REPAIR - this is an arthroscopic surgery of the shoulder that is performed on an outpatient basis. Three or four tiny
                                    portals (incisions ~ 1/3 inch long) are used and a general anesthetic is required. This takes about an hour to do. 3
                                    or 4 suture anchors are used to re-attach the Labrum to the Glenoid. Recovery involves a shoulder immobilizer for 6
                                   weeks and Physical Therapy for 2 months. Return to full activity takes 3 months for everything except throwing
                                   and contact…these require 6 months.

B) BANKART REPAIR - this procedure is the same as SLAP REPAIR except the part of the labrum that is repaired is at the bottom, and
                                              the the surgery includes tightening of the Inferior Glenohumeral Ligament. Three portals are needed and about
                                              an hour of general anesthesia. Suture anchors are used to re-attach the Labrum and a small portion of the
                                              Ligament to the Glenoid, thereby restoring Stability to the joint. Recovery is the same as for SLAP REPAIR.

C) CAPSULAR PLICATION - Capsular laxity is best treated with plication or pleating (as you do with curtains) of the ligaments. 10 mm
                                                       wide passes are made with sutures which are then tied together to plicate and tighten the capsule. This
                                                       procedure is done arthroscopically as an outpatient procedure. The recovery is the same as for SLAP and
                                                      BANKART REPAIR.

1. Anatomy and Function -

The LABRUM is a fibrocartilage ring around the bony cup (Glenoid) of the shoulder. This firm ring of soft tissue is attached to the rim of this shallow saucer-shaped bone, deepening the socket and assisting with joint stability. At the top of the labrum (12 o'clock position), the Long Head of the Biceps tendon finds its origin. The GLENOHUMERAL LIGAMENTS (capsule) which tether the Humeral Head to the Glenoid, are the keys to stability of the joint during shoulder motion. The main one is the Inferior Glenohumeral Ligament, which attaches the bottom of the Glenoid to the bottom of the Humeral Head…tightening with rotation of the arm and thereby The GLENOHUMERAL LIGAMENT (capsule) which tether the Humeral Head to the Glenoid, are the keys to stability of the joint during shoulder motion. The main one is the Inferior Glenohumeral Ligament, which attaches the bottom of the Glenoid to the bottom of the Humeral Head…tightening with rotation of the arm and thereby Stabilizing the shoulder during strenuous activity

2. Injury

A) Slap Tear

- the glenoid labrum can be torn in various locations and patterns:

this tear occurs during traumatic shoulder (glenohumeral) Dislocation. When the humeral head is forced out the front of the glenoid, the anterior labrum tears (Anterior Bankart). Much less often, the humeral head is forced out the back of the Glenoid and a Posterior Bankart lesion occurs. These tears are located along the bottom half of the glenoid rim and thereby cause laxity of the key Inferior Glenohumeral Ligament which attaches there. The result is Recurrent Dislocations or Instability of the glenohumeral joint.

C) Capsular Laxity

3. Treatment