Shoulder+Labral+Tear

Glenohumeral Joint Anatomy **Joint Articulation:** Convex humeral head and concave glenoid fossa **Joint Type:** Diarthrodial ball and socket joint; Humeral head is four times larger than the glenoid fossa **Capsular Pattern of Restriction:** External rotation, abduction, internal rotation **Close-Packed Position:** Max abduction and external rotation or extension and internal rotation **Open-Packed Position:** 60⁰ abduction and 30⁰ horizontal adduction
 * INTRODUCTION **
 * Biomechanics/Anatomy **
 * Athrokinematics: **
 * During flexion and internal rotation of the humerus the convex humeral head rolls anteriorly and glides posteriorly on the concave glenoid fossa
 * During extention and external rotation of of the humerus the convex humeral head rolls posteriorly and glides anteriorly on the concave glenoid fossa
 * During humeral elevation(flexion, scaption and abduction) the convex humeral head rolls superiorly and glides inferiorly on the concave glenoid fossa

The labrum is a soft fibrous tissue rim that helps to stabilize the glenohumeral joint and adds 50% more depth to the glenoid fossa. The labrum also serves as an attachment site for the superior and inferior glenohumeral ligaments and the long head of the biceps brachii.
 * Glenoid Labrum Anatomy **


 * Mechanism of Injury **
 * SLAP (Superior Labrum Anterior to Posterior) lesion
 * Fall on an outstretched hand (FOOSH)
 * Improper stretching prior to excessive throwing (repeated bouts of excessive ER)


 * Bankart lesion
 * Humeral head dislocation
 * Posterior Labral lesion
 * Posterior humeral head dislocation


 * SIGNS and SYMPTOMS **

¡ Shoulder instability ¡ Decreased ROM ¡ Decreased strength
 * Signs: ** Objective Measures

¡ Pain with overhead reaching ¡ Catching, locking, popping, grinding, clicking ¡ May have night pain ¡ Pain with ADLs ¡ Diffuse ache ¡ Scapular pain
 * Symptoms :** Subjective Measures

====SLAP lesion is most commonly seen in overhead throwing athletes such as baseball players and tennis players. Bankart lesion is typically seen in individuals that have sustained a shoulder dislocation in the anterior direction, where as a posterior labral lesion is typically seen in individuals that have sustained a shoulder dislocation in the posterior direction. Posterior labral lesion can commonly be seen in football players. ====
 * Practical Presentation **


 * TREATMENT APPROACH/INTERVENTION **
 * See the following links for specific duration, protocols and exercises for SLAP, Bankart and Posterior Labral Tears **
 * SLAP Lesion **
 * Bankart Lesion **
 * Posterior Labral Lesion **

RICE (Rest, Ice, Compression and Elevation) Ultrasound Iontophoresis Game Ready System
 * Modalities **

NSAIDS Glucosamine Hyaluronic Acid Chiropractic care
 * Adjunct Treatment and/or Alternative Treatment**

References Picture Credits: [] [] [] [] []

[] Loudon, Janice, Marcie Swift, and Stephania Bell. "Shoulder Joint Complex." The Clinical Orthopedic Assessment Guide. Champaign, IL: Human Kinetics, 2008. 151, 179. Print.