Glenoid Labrum Injuries Lowe

Question 1

What is Glenoid Labrum Injuries

Answer 1

-damage can develop from a number of causes besides sublux/dislocation

Question 2

Characteristics:

Answer 2

In order to increase stability in the GH joint without compromising ROM, a fibrocartilaginous ring (glenoid labrum) surrounds the glenoid fossa, creating more depth to the fossa and allowing the humeral head to more fully insert into the glenoid cavity

-has fibrous continuity with the GH ligaments, long head of biceps brachii, GH joint capsule, long head of triceps brachii

-injuries include cracking, chipping or tearing (most frequent)

-tears to the rim result from falling on an outstretched arm and driving the humeral head against the opposite side of the labrum, sublux/dislocation or impact to the shoulder, sudden tensile stress when lifting something heavy

-acute injuries most common but chronic tensile forces on the capsulolabral complex can produce minor tears or separation

-superior/inferior aspects usually damaged; upper rim is primary site of damage where long head of biceps brachii tendon attaches; the bony attachment is the supraglenoid tubercle while the fibrous attachment is the superior portion of the glenoid labrum; if biceps is forcefully contracted, it can pull the superior rim of the labrum enough to tear away from the glenoid fossa (SLAP lesion: direction of tear is along the superior labrum from anterior to posterior)

-can occur at end of throwing motion as biceps contracts eccentrically to slow elbow extension

Question 3

Bankart lesion:

Answer 3

anterior and inferior side of labrum; develops when inferior GH ligament or capsular fibres tear away from the anterior or inferior margin of the glenoid labrum; may involve minor tearing or fraying of the ligament and labrum or more serious bucket-handle tear with fragments of labrum extending into the joint; biceps tendon is not involved, ligaments and joint capsule create tensile stress and pull on the joint capsule and labrum; often caused by forceful abduction with lateral rotation of the shoulder (throwing)

• dislocations produce more Bankart lesions than SLAP lesions

-pain develops from irritation of richly innervated structures (GH joint capsule); may be difficult to no pinpoint exact source of pain; symptoms are similar to other shoulder injuries

-refer to physician if labral damage suspected

-ligamentous damage often coincides with labral injury and shoulder instability is likely

Question 4

History:

Answer 4

acute injury (impact to shoulder, falling on outstretched arm, normal shoulder activities); unspecific deep pain in shoulder; not always painful; more pain with overhead activities than others, night pain; popping, catching, clicking or grinding sensations with movement; labral tissue impairs smooth GH movement; ROM loss, instability and loss of strength

Question 5

Observation:

Answer 5

no visible signs; apprehensive to avoid pain, lack of continuity throughout motion as pain and tissue damage cause alterations in biomechanical function; refer for diagnosis if significant instability

Question 6

Palpation:

Answer 6

pain is more likely an indicator of damage to other soft tissues and not the labrum; tenderness due to reflex muscle spasm; clicking or locking sensations may be felt/heard during ROM evaluation

Question 7

Range of Motion and Resistance Testing

Answer 7

AROM: pain with several directions; no correlation between pain and specific labral injury; popping or
clicking with certain motions

PROM: as with AROM; use caution with suspected internal joint injuries

MRT: pain with biceps brachii contractions with a SLAP lesion; pain not likely with other motions as other muscles do not attach to labrum; may be weakness due to reflex muscular inhibition

Question 8

Special Tests:

Answer 8

Speed’s Test, which stresses biceps brachii with SLAP lesion present

Question 9

Differential Evaluation:

Answer 9

GH subluxation, subacromial impingement, biceps tendon pathology without labral damage, calcific tendinitis, brachial plexus injury, cervical radiculopathy, rotator cuff injury, AC joint injury, shoulder sublux/dislocation

Question 10

Suggestions for Treatment:

Answer 10

treated with other approaches besides massage until it can be used as part of a coordinated treatment plan that addresses hypertonicity in surrounding muscles and increasing balance in tissues