Shoulder Labral Tear: Causes, Symptoms, and Treatment

What Is the Shoulder Labrum?

The shoulder labrum is a ring of fibrocartilage attached to the rim of the glenoid (the shoulder socket). It serves two critical functions:

Deepens the socket: The glenoid is naturally shallow — the labrum increases its depth by 50%, improving joint congruence and stability
Attachment point: The long head of the biceps tendon attaches at the top (superior labrum), and the glenohumeral ligaments attach around the circumference

Unlike the hip labrum, the shoulder labrum is more of a soft tissue stabilizer — the shoulder sacrifices stability for mobility, making labral integrity especially important.

Types of Shoulder Labral Tears

Bankart lesion: Tear of the anterior-inferior labrum — the classic lesion following anterior shoulder dislocation. The labrum and anterior capsule detach from the glenoid rim, allowing the shoulder to dislocate again (recurrence rates without surgery can be 70–90% in young athletes).

SLAP tear: Superior Labrum Anterior to Posterior — tear at the top of the labrum where the biceps tendon anchors (see our dedicated SLAP tear article).

Posterior labral tear: Less common; seen in "posterior instability" — pushing-type athletes (linemen, weightlifters) or from posterior dislocation.

Multidirectional instability (MDI): Global capsular and labral laxity; often no discrete tear; common in hyperlax individuals.

Causes

Shoulder dislocation: Bankart lesion in virtually every traumatic anterior dislocation
Overhead throwing: SLAP tears from repetitive traction on the biceps anchor
FOOSH (fall on outstretched hand): Compressive or traction forces on the labrum
Repetitive microtrauma: Sports with repetitive shoulder loading (rowing, swimming, weightlifting)

Symptoms

Instability: A sense that the shoulder may slip out of joint; giving way with certain movements (characteristic of Bankart lesions)
Deep shoulder pain: Often hard to localize precisely
Mechanical symptoms: Clicking, clunking, or catching with arm movement
Apprehension: Fear and discomfort when the arm is positioned in a throwing position (90° abduction, external rotation) — highly characteristic of anterior instability
Pain with specific activities: Overhead motion, pushing/pulling, contact sports

Diagnosis

Apprehension/Relocation test: Posterior pressure on the humeral head with arm in provocative position relieves apprehension — very specific for anterior instability
O'Brien's test, anterior slide test for SLAP tears
MR arthrogram: Contrast-enhanced MRI provides best sensitivity for labral tears — contrast outlines the tear
CT arthrogram: Alternative when MRI contraindicated; excellent for bony Bankart lesions (glenoid bone loss)

Treatment

Conservative Treatment

Physical therapy for rotator cuff strengthening and dynamic stabilization
Activity modification
Anti-instability muscle training

Appropriate for:

Older patients with lower activity demands
Partial tears without significant instability
SLAP tears in non-throwing athletes

Surgical Treatment

Arthroscopic Bankart repair: Reattachment of the anterior labrum and capsule to the glenoid rim with suture anchors. The standard treatment for young athletes with anterior instability after dislocation. Recurrence rates with surgery: <10% vs. 70–90% without.

Latarjet procedure: For cases with significant glenoid bone loss — a coracoid bone graft is transferred to the glenoid to reconstruct the deficient socket. More complex but highly effective when bone loss exceeds ~20% of the glenoid.

SLAP repair or biceps tenodesis: For symptomatic SLAP tears (see our SLAP article).

Recovery

Arthroscopic Bankart repair: 4–6 months to return to contact sport
Latarjet: 4–6 months; higher initial stability allows slightly earlier progression in some cases