Physical Therapy Case Study: Sport-Related Shoulder Injury (Labral Tear)

See if this describes your shoulder pain. The pain lies deep within the shoulder. It started a while ago. Lifting weights, perhaps? Thinking back, it might have been from doing either shoulder presses or bench presses. At first, pain was mostly down inside the point of the shoulder. But now the shoulder grinds and pops. And it hurts to reach behind your back or to lift items overhead. You figure you can live with it, but working out aggravates the pain. Sound familiar? Don’t feel you’re alone.

I recently evaluated a patient with these exact complaints. A healthy looking guy, he was obviously in good shape. He was convinced this was a strength issue. Not so. When I examined his shoulder, he at first appeared to have weakness in his rotator cuff. However, when I gently tugged on his arm and then tested his cuff, he was strong as an ox.

Notably, this showed that the problem was not in the muscles but deeper in the shoulder joint. Upon further testing, it became clear he’d injured a structure deep within the shoulder. A casual glance may have led an unwary examiner to think it was a problem solely with the biceps tendon. It’s true. His biceps tendon was in fact painful with testing. But it went deeper than that.

Ultimately, anatomy prevailed. You see, the very top of the biceps tendon interconnects with a rim of cartilage that lines the shoulder socket, or glenoid. This rim of cartilage is called the glenoid labrum. The glenoid labrum deepens the socket, which keeps the ball of the upper arm bone, the humerus, from slip-sliding out of joint. The labrum is commonly injured with weight lifting, particularly when doing shoulder presses like bench and military presses.

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After applying a specialized manual therapy to the top of the biceps where it connects to the labrum, I treated the area with cold laser. (Cold laser is a form of light therapy used in sports medicine to help rebuild the strength in inured tissues, like the glenoid labrum.) When I retested, he was completely pain free and had full shoulder motion. Is his problem fixed? Not yet. Along with the treatment I did on his first visit, he’s going to need retraining for the muscles. Not to make them stronger, but to coordinate their actions so that the ball of the humerus stays centered within the glenoid during high-level sport and work activities.

For more information on injuries of the glenoid labrum, complete with amazingly detailed artistic views of the shoulder joint, click here.

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