Shoulder

Shoulder Labral Tear

A shoulder labral tear is an injury to the ring of cartilage that helps stabilize the shoulder socket. Depending on its location, a tear may cause deep shoulder pain, clicking, reduced athletic performance, or a feeling that the shoulder slips out of place. Our fellowship-trained shoulder surgeons provide evaluation and treatment in Bethesda and Germantown.

Ready to get started?

Schedule an appointment with a specialist experienced in treating shoulder labral tear.

Schedule Now

or call (301) 515-0900

In-network with most major insurance plans. Same-day appointments available for acute injuries.

What is shoulder labral tear?

A shoulder labral tear is an injury to the ring of fibrocartilage that deepens and stabilizes the shoulder socket. Depending on its location, it may cause deep pain, clicking, reduced athletic performance, or instability. In young patients, a dislocation is often associated with the tear.

The Role of the Labrum

A shoulder labral tear is an injury to the ring of fibrocartilage that deepens and stabilizes the shoulder socket. Depending on its location, it may cause deep pain, clicking, reduced athletic performance, or instability. Treatment ranges from rehabilitation to arthroscopic repair based on the tear pattern, symptoms, and the patient's goals.

The glenoid labrum lines the rim of the glenoid — the shallow socket of the shoulder joint — and performs three important functions:

Deepens the socket — the labrum increases the depth of the glenoid by approximately 50%, expanding the effective articular contact area and making the joint more resistant to dislocation
Anchors the glenohumeral ligaments — the inferior, middle, and superior glenohumeral ligaments, which are the primary static stabilizers of the shoulder, all attach to the labrum; a torn labrum compromises these restraints
Provides the biceps anchor — the long head of the biceps tendon originates at the superior labrum and is the site of SLAP tear pathology

Without an intact labrum, the humeral head (ball) can slip too easily within the glenoid (socket), producing instability, pain, and mechanical symptoms.

Types of Labral Tears

Labral tears are classified by their location on the glenoid clock face and their clinical significance:

Anteroinferior labral tear (Bankart lesion) The most common labral tear, occurring at the 3–6 o'clock position of the anteroinferior glenoid. A Bankart lesion results from traumatic anterior shoulder dislocation, when the humeral head forcefully displaces forward and avulses the labrum and inferior glenohumeral ligament from the glenoid rim. When the avulsion involves a bony fragment of the glenoid, it is called a bony Bankart lesion — a more complex injury requiring different surgical planning. Bankart lesions are the anatomic lesion of traumatic anterior shoulder instability.

SLAP tear (Superior Labrum Anterior to Posterior) SLAP tears involve the superior labrum at the 10–2 o'clock position, at and around the biceps anchor. There are four Snyder types, but Type II — a true avulsion of the superior labrum and biceps anchor from the glenoid — is the most clinically significant and the most common type requiring surgical intervention. SLAP tears occur in overhead throwing athletes from repetitive traction and peel-back forces on the biceps anchor, or acutely from a fall on an outstretched arm or a traction injury. They produce deep shoulder pain, particularly in the late-cocking phase of throwing.

Posterior labral tear (Reverse Bankart) Posterior labral tears occur at the 6–9 o'clock position and result from posterior shoulder instability — typically from a direct blow to the anterior shoulder, a fall on a flexed, adducted arm, or repetitive posterior loading (bench-press, offensive line blocking, swimming). These tears are less common than anterior labral tears but are frequently missed or misdiagnosed.

Pan-labral and 270° tears In patients with severe or recurrent instability, tears can involve the entire anteroinferior, inferior, and posterior labrum in a continuous arc. These complex tears — sometimes called 270° labral tears — require comprehensive arthroscopic repair addressing all affected quadrants.

Who Gets Labral Tears?

Labral tears are most common in:

Young athletes in contact and overhead sports — football, wrestling, hockey, gymnastics, baseball, softball, volleyball, swimming
Adults aged 15–45 — the primary demographic for traumatic and overhead-related labral pathology
Older adults — degenerative labral fraying becomes increasingly common after age 50, often in association with rotator cuff pathology

Symptoms — do you recognize these?

Labral tears produce a characteristic pattern of symptoms that differs based on tear location and type:

Deep, aching shoulder pain — often described as inside the joint rather than on the surface; difficult to localize with a finger
Clicking, catching, or grinding with shoulder movement — a mechanical sensation created as the torn labral tissue moves in and out of the joint space
Pain at the end of range of motion — especially with overhead reaching, cross-body movements, and rotation
A sensation of the shoulder slipping, popping, or "coming out" — particularly with the arm in the abducted, externally rotated position (Bankart tears with instability)
Pain in the late-cocking phase of throwing — the classic symptom of a SLAP tear in overhead athletes; often associated with velocity loss and accuracy problems
Night pain — discomfort when sleeping on the affected shoulder
Weakness with overhead pushing or pulling activities
A "dead arm" feeling — a transient loss of arm strength or control during throwing or overhead activity, rapidly self-resolving

If these symptoms are interfering with your sport or daily life, call Maryland Orthopedic Specialists at (301) 515-0900 — same-day appointments are available at our Bethesda and Germantown locations.

How we diagnose it

Physical Examination

No single clinical test is pathognomonic for labral tears, but a battery of well-validated maneuvers provides high diagnostic accuracy. Your MOS surgeon will perform a directed examination including:

For anterior labral tears (Bankart):

Anterior apprehension test — the arm is brought to 90° abduction and externally rotated; a positive test produces apprehension (not just pain), indicating anterior instability from labral insufficiency. Sensitivity ~72%, specificity ~96% for anterior instability.
Relocation test — posterior pressure applied to the humeral head during the apprehension maneuver relieves symptoms; highly specific for anterior labral pathology

For SLAP tears:

O'Brien active compression test — the arm is flexed to 90° with the elbow extended and adducted 15° across the body; pain deep in the joint with the thumb-down (internally rotated) position that is relieved with the thumb-up (externally rotated) position is positive. Sensitivity ~47–78%, specificity ~89%.
Speed's test — resisted forward flexion of the shoulder with the elbow extended and the forearm supinated; pain in the bicipital groove is positive for biceps-labral complex pathology
Biceps load test II — performed with the arm at 120° of abduction; a positive test produces pain with resisted elbow flexion and is specific for Type II SLAP tears

For posterior labral tears:

Posterior apprehension / jerk test — the arm is axially loaded in the flexed, internally rotated position and moved from flexion to extension; a clunk or reproduction of pain indicates posterior labral pathology

Imaging

X-ray is obtained at the first visit to identify bony Bankart fragments, Hill-Sachs lesions, calcifications, and glenohumeral arthritis. Most labral tears are not visible on plain X-ray, but bony injuries that guide surgical planning are.

MRI arthrogram (MRA) is the gold standard imaging study for shoulder labral pathology. Intra-articular gadolinium distends the joint capsule, increasing sensitivity for labral tears from approximately 65–75% on standard MRI to 84–93% on MRA. MRA is essential for:

Confirming tear location, extent, and type (Bankart, SLAP, posterior, pan-labral)
Assessing labral tissue quality and degree of displacement
Identifying co-existing pathology: rotator cuff tears, biceps tendon lesions, capsular laxity, and Hill-Sachs lesions
Distinguishing a repairable labral tear from degenerative labral fraying that may not require surgery

After your evaluation, you will leave with a clear diagnosis, a review of your imaging, and a personalized treatment plan.

Treatment options

Treatment is individualized based on tear type, degree of instability, associated injuries, your age, sport, and functional goals.

Non-Operative Management

Non-surgical treatment is appropriate for: Degenerative labral fraying in older patients without instability Partial or minimally displaced tears without significant mechanical symptoms SLAP tears in non-throwing athletes and older patients (>35–40 years) where the biceps tendon rather than the labrum is the primary pain generator — these patients often respond better to non-operative care or biceps tenodesis than SLAP repair First-time dislocations in older patients (>40 years) where recurrence risk is lower Non-operative management includes: Physical therapy — rotator cuff and periscapular strengthening to optimize dynamic shoulder stability; scapular mechanics and neuromuscular control training Activity modification — temporarily avoiding positions that provoke symptoms while strength is restored Anti-inflammatory medications — NSAIDs for pain management during the acute phase Subacromial or glenohumeral corticosteroid injection — for pain control and to facilitate PT participation; not a definitive treatment for structural labral tears

Surgical Procedure

Bankart Repair (Shoulder Instability)

Arthroscopic suture anchor repair of the anterior-inferior glenoid labrum to restore the primary capsuloligamentous restraint against anterior dislocation. Appropriate when glenoid bone loss is below 20–25%. Above that, the Latarjet is preferred.

Click for more Surgical Procedure

SLAP Repair

Arthroscopic suture anchor repair of the superior glenoid labrum (SLAP) for overhead athletes with symptomatic type II tears. Patient selection is critical. Biceps tenodesis is preferred for patients over 35 or with concurrent biceps pathology.

Click for more Surgical Procedure

Arthroscopic Labral Repair

Arthroscopic reattachment of torn shoulder labrum using suture anchors. This comprehensive procedure covers posterior and multi-region tears as well as selected anterior and superior tears; Bankart and SLAP repairs are named subtypes with their own patient-selection considerations.

Click for more

Recovery & rehabilitation

Recovery after arthroscopic labral repair follows a predictable progression. Timelines vary by repair type, tear extent, and individual healing.

Sling immobilization — 4–6 weeks (protects the repair during initial healing)
Pendulum and passive range of motion — Weeks 2–4
Active-assisted range of motion — Weeks 4–8
Rotator cuff and periscapular strengthening — Weeks 8–16
Sport-specific functional training — Months 4–5
Return to non-contact and recreational sport — ~5–6 months
Return to contact/collision sport — 6–9 months
Return to competitive overhead throwing — 9–12 months

Return to sport: Timing and likelihood of return vary by tear pattern, sport, position, associated bone loss, and the procedure performed. Clearance is based on healing, pain-free motion, strength, and sport-specific testing rather than the calendar alone.

Our in-house physical therapy team at all MOS locations manages your rehabilitation from the first post-operative visit through sport clearance. No separate PT referrals are required.

Frequently Asked Questions

Do I need surgery for a labral tear?

Not necessarily. Partial tears, degenerative fraying, and tears without instability in lower-demand patients frequently improve with physical therapy and activity modification. However, complete tears associated with instability, mechanical symptoms, or failure of conservative care in active patients generally require arthroscopic repair for reliable resolution. Your MOS surgeon will review your imaging, examine your shoulder, and give you an honest recommendation based on your tear type and goals.

What is the difference between a labral tear and shoulder instability?

They are closely related but not the same thing. A labral tear is the structural lesion — the torn tissue. Shoulder instability is the clinical syndrome that results from it — the feeling that the shoulder slips, gives way, or dislocates. Not all labral tears cause instability (SLAP tears, for example, typically cause pain rather than dislocation), and not all instability is caused by labral tears (capsular laxity in MDI is a separate entity). Your diagnosis guides your treatment.

Can a labral tear heal on its own?

The labrum has limited blood supply and poor intrinsic healing capacity in most locations. Complete tears — particularly those associated with instability — do not reliably heal without surgery. Partial tears and degenerative fraying may become less symptomatic with PT and activity modification, but the structural tear generally persists. Ongoing instability episodes from an unrepaired Bankart tear can cause progressive glenoid bone loss that makes future surgery more complex — early evaluation is worthwhile.

What is the difference between a SLAP tear and a Bankart tear?

Location. A Bankart tear is at the anteroinferior part of the labrum (roughly 3–6 o'clock) and is the anatomic lesion of anterior shoulder instability — the shoulder slipping forward. A SLAP tear is at the superior labrum (12 o'clock, at the biceps attachment) and is primarily associated with deep pain and mechanical symptoms in overhead athletes. They are distinct injuries that can coexist. Both are diagnosed with MRI arthrogram and treated arthroscopically, but the repair technique and recovery differ.

How long is recovery after labral repair surgery?

Sling wear for 4–6 weeks, followed by progressive physical therapy. Most patients are functionally recovered and returning to recreational activity by 5–6 months. Return to contact sport is typically 6–9 months, and competitive overhead throwing athletes (pitchers, quarterbacks) require 9–12 months. The repair heals biologically over 3–6 months, during which the tissue gradually regains strength — rushing return to sport risks re-tear.

What happens if I don't treat an unstable labral tear?

For labral tears associated with shoulder instability, delaying treatment carries two risks: (1) each subsequent dislocation episode can erode additional bone from the glenoid rim, progressively worsening the anatomy and potentially converting a straightforward Bankart repair into a case requiring the more complex Latarjet procedure; (2) continued instability increases the risk of secondary rotator cuff tears, particularly in patients over 40. Early evaluation is important even if surgery is not immediately planned.