By Thomas J. Haverbush, M.D. Orthopaedic Surgeon

Transforming patient information into patient understanding.

Best to start with a definition. The glenoid is the shallow shoulder socket that the ball of the shoulder rests in.

The labrum is a gristle like tissue structure that surrounds and attaches to the socket to make it deeper.

Why do we need a labrum? The ball is larger than the socket and the gristle rim deepens the socket and stabilizes the ball in it. Also the labrum serves as the attachment site for several ligaments. Oh, Oh! Read on.

Injuries

Injuries to the gristle tissue rim attached to the bony socket can occur from acute trauma or repetitive shoulder motion.

• Falling on outstretched arm

• Direct blow to the shoulder

• Sudden stress as in lifting a heavy object

• Sudden pull or jerk

• Violent overhead reach to stop a fall

• Repetitive shoulder motion as in throwing or lifting

• At the time of a dislocated shoulder

Key Point: The labrum can tear at different places around the socket typically at the top or in front.

Symptoms

It is difficult to diagnose a tear in the shoulder glenoid labrum, because the symptoms are very similar to other shoulder injuries.

• Pain, usually with overhead activities

• Catching, popping, “locking”, grinding

• Pain at night

• Pain with daily activities

• Shoulder feels unstable

• Decreased range of motion

• Loss of strength

Diagnosis

I just mentioned that it can be difficult to diagnose a labral tear. I can only tell you what has worked for me every time. I have to ask a lot of questions about how the problem started (history). That is very important.

The neck, shoulder and arm to the hand need to be examined well. If you haven’t had plain x-rays of the shoulder already, I will take x-rays in the office.

By now I will have a pretty good idea of why you came to see me. I will have formed a differential diagnosis as it is called, in other words a list. Occasionally I may need some laboratory tests as well.

If the plain x-rays are normal that is a good way to rule out most arthritis problems in the shoulder.

Further Diagnostic Help

I left this to last because it always should be. MRI or CT should never be used as a screening tool. They should never be done first until all the other things that I have mentioned are done.

Because the rim of the shoulder socket (labrum) is soft tissue, plain x-rays do not show damage to it. If I strongly suspect a glenoid labrum tear I am likely to order MRI with contrast medium or if the patient can’t have MRI due to a pacemaker, etc. I will order a CT study also with contrast.

Since we are out of space I will need to complete our discussion of Glenoid Labrum next week so please come back for the conclusion.

My patients put their trust in me and what I do improves the quality of their lives.

Lakeview Times Orthopaedic Zone

All Orthopaedic Surgery problems including this week’s subject can be evaluated by Dr. Haverbush at his office.

315 Warwick Drive

Alma, Michigan 48801

Phone 989-463-6092

Office is across the street from Gratiot Medical Center.

Please call to make an appointment usually the same week you call.

Attention!! Besides what you read today there is a huge amount of musculoskeletal information on the office website www.orthopodsurgeon.com. Please check it out.

Be well.

Dr. Haverbush