Labrum Tear
The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. The labrum also becomes more brittle with age, and can fray and tear as part of the aging process.
Signs and Symptoms:
Depends on where the tear is located, but may include:
· An aching sensation in the shoulder joint
· Catching of the shoulder with movement
· Pain with specific activities, occasional night pain
· Popping, locking or grinding
· Decreased range of motion
· Sense of instability in shoulder
· Loss of strength
In addition, some types of labral tears, specifically a Bankart lesion, can increase the potential for shoulder dislocations.
SLAP tear
A SLAP tear is an injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within.
A specific type of labral tear is called a SLAP tear; this stands for Superior Labrum from Anterior to Posterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum.
How does a SLAP tear occur?
Common reasons for a SLAP tear include:
◦ Fall onto an outstretched hand
◦ Repetitive overhead actions (throwing)
◦ Lifting a heavy object
The area of the labrum where the SLAP tear occurs is susceptible to injury because it is an area of relatively poor vascularity. Other parts of the labrum often heal more easily because the blood supply delivers a healing capacity to the area of the tear. In the area of SLAP tears this is not the case, and chronic shoulder pain can result.
Signs and Symptoms
· catching sensation and pain with shoulder movements, most often overhead activities such as throwing.
· pain deep within the shoulder or in the back of the shoulder joint.
· SLAP tears with associated biceps tendonitis, patients may complain of pain over the front of the shoulder.
Diagnosis of SLAP tear
· shoulder physical examination.
· History taking
· SLAP tears tend to be seen best on MRI when the study is performed with an injection of contrast. A contrast MRI is performed by injecting a fluid called gadolinium into the shoulder; the gadolinium helps to highlight tears of normal structures, including SLAP tears.
· Sometimes the diagnosis of a SLAP tear is made at the time of surgery.
Bankart Lesion
The Bankart lesion is a specific injury to a part of the shoulder joint called the labrum. A Bankart lesion occurs when an individual sustains a shoulder dislocation. As the shoulder pops out of joint, it often tears the labrum, especially in younger patients. The tear is to part of the labrum called the inferior glenohumeral ligament. When the inferior glenohumeral ligament is torn, this is called a Bankart lesion.
Signs and Symptoms
◦ a sense of instability
◦ repeat dislocations
◦ popping, shoulders locking up
◦ catching sensations
◦ aching of the shoulder
Often patients will complain that they cannot "trust" their shoulder, fearing it may dislocate again.
Diagnosis
Most young patients (under the age of 30) who sustain a shoulder dislocation will sustain a Bankart lesion; therefore, there is a high suspicion of this injury whenever a patient dislocates their shoulder. On examination, patients will often have a sense their shoulder is about to dislocate if their arm is placed behind their head.
Shoulder Dislocation
A shoulder dislocation is an injury that occurs when the top of the arm bone (humerus) loses contact with the socket of the shoulder blade (scapula). The shoulder joint is made of three bones which come together at one place. The arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle) all meet up at the top of the shoulder. A shoulder dislocation occurs when there is an injury to the joint between the humerus and scapula.
The joint between the humerus and scapula, also called the glenohumeral joint, is a ball-and-socket joint--the ball is on the top of the humerus, and this fits into a socket of the shoulder blade called the glenoid. This joint is incredible because it allows us to move our shoulder though an amazing arc of motion--no joint in the body allows more motion than the glenohumeral joint. A shoulder dislocation generally occurs after an injury such as a fall or a sports-related injury. About 95% of the time, when the shoulder dislocates, the top of the humerus is sitting in front of the shoulder blade--an anterior dislocation. In less than 5% of cases, the top of the humerus is behind the shoulder blade--a posterior dislocation. Posterior dislocations are unusual, and seen after injuries such as electrocution or after a seizure.
Signs and Symptoms
◦ significant shoulder pain
◦ Arm held at the side, usually slightly away from the body with the forearm turned outward
◦ Loss of the normal rounded contour of the deltoid muscle
Shoulder Separation
A shoulder separation is an injury to the acromioclavicular joint on the top of the shoulder. The shoulder joint is formed at the junction of three bones: the collarbone (clavicle), the shoulder blade (scapula), and the arm bone (humerus). The scapula and clavicle form the socket of the joint, and the humerus has a round head that fits within this socket.
A shoulder separation occurs where the clavicle and the scapula come together. The end of the scapula is called the acromion, and the joint between this part of the scapula and clavicle is called the acromioclavicular joint. When this joint is disrupted, it is called a shoulder separation. Another name for this injury is an acromioclavicular joint separation, or AC separation.
A shoulder separation is almost always the result of a sudden, traumatic event that can be attributed to a specific incident or action. The two most common descriptions of a shoulder separation are either a direct blow to the shoulder (often seen in football, rugby, or hockey), or a fall on to an outstretched hand (commonly seen after falling off a bicycle or horse).
Signs and Symptoms
· Pain, usually severe at the time of injury.
· swelling and bruising
Diagnosis
The diagnosis of shoulder separation is often quite apparent from hearing a story that is typical of this injury, and a simple physical examination.
• Type I Shoulder Separation: A type I shoulder separation is an injury to the capsule that surrounds the AC joint. The bones are not out of position and the primary symptom is pain.
• Type II Shoulder Separation: A type II shoulder separation involves an injury to the AC joint capsule as well as one of the important ligaments that stabilizes the clavicle. This ligament, the coracoclavicular ligament, is partially torn. Patients with a type II separated shoulder may have a small bump over the injury.
• Type III Shoulder Separation: A type III shoulder separation involves the same type of injury as a type II separated shoulder, but the injury is more significant. These patients usually have a large bump over the injured AC joint.
• Type IV Shoulder Separation: A type IV shoulder separation is an unusual injury where the clavicle is pushed behind the AC joint.
• Type V Shoulder Separation: A type V shoulder separation is an exaggerated type III injury. In this type of separated shoulder, the muscle above the AC joint is punctured by the end of the clavicle causing a significant bump over the injury.
• Type VI Shoulder Separation: A type VI shoulder separation is also exceedingly rare. In this type of injury the clavicle is pushed downwards, and becomes lodged below the corocoid (part of the scapula)
Shoulder Fracture
A fracture involves a partial or total crack through a bone. The break in a bone usually occurs as a result of an impact injury, such as a fall or blow to the shoulder. A fracture usually involves the clavicle or the surgical neck (area below the ball) of the humerus.
Signs and Symptoms
· Extreme pain
· Within a short time, there may be redness and bruising around the area, skin abrasions, swelling around back of shoulders
· bones appear out of position.
Diagnosis
X-ray
Sources:
1. http://www.uscfhealth.org/
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