The labrum is a ring of fibrocartilage that lines the rim of the glenoid (shoulder socket), deepening the socket and providing stability to the shoulder joint. A labral tear occurs when this cartilage is partially or completely torn, disrupting shoulder stability and function.
Labral tears are classified by their location around the glenoid rim — the most common types are SLAP tears at the top of the labrum and Bankart lesions at the front-bottom, each with their own dedicated page. Labral tears frequently occur alongside shoulder dislocation and are often associated with rotator cuff tears in older patients.
Causes
Traumatic injury
Labral tears frequently result from acute trauma such as a shoulder dislocation, a direct fall onto an outstretched arm, or a forceful pull or twist of the arm. Athletes in contact sports like football, hockey, and rugby are at elevated risk. A single traumatic dislocation can strip the anteroinferior labrum from the glenoid — the classic mechanism of a Bankart lesion.
Repetitive overhead activity
Chronic, repetitive overhead motions — as seen in baseball pitchers, swimmers, tennis players, and weightlifters — place repeated stress on the labrum that leads to tearing over time. This mechanism is especially common at the superior labrum where the biceps tendon attaches, producing a SLAP tear.
Symptoms
Patients commonly report a deep, aching pain within the shoulder, catching or clicking sensations with arm movement, and a feeling of shoulder instability or looseness. Pain often worsens with overhead activities, reaching behind the back, or during throwing motions. Night pain and difficulty with daily activities may also be present. Some patients describe a sense that the shoulder is about to "slip out of place" — a symptom that warrants evaluation for concurrent instability.
Diagnosis
Physical examination involves specific provocative tests — including the O'Brien active compression test, the anterior slide test, and the crank test — which reproduce labral symptoms. A dedicated shoulder MRI is the primary imaging study for evaluating the labrum, identifying tear location and extent, and detecting associated injuries such as Hill-Sachs lesions, bony Bankart defects, and rotator cuff tears. MRI arthrography — performed after contrast dye is injected into the joint — provides the highest sensitivity for subtle labral tears and is particularly useful when standard MRI is equivocal.
Tear classification by location
Labral tears are classified based on their location around the glenoid rim:
- SLAP tear (superior): Involves the top of the labrum where the biceps tendon attaches. Common in overhead athletes. See our dedicated SLAP tear page.
- Bankart lesion (anteroinferior): Involves the front-bottom of the labrum, typically following anterior dislocation. See our dedicated Bankart lesion page.
- Posterior labral tear: Involves the back of the labrum — often seen in weightlifters and football linemen from repetitive posterior loading.
- Circumferential tear: Extends around a large portion of the labral ring, often indicating significant instability.
Treatments
Treatment depends on tear location and size, severity of symptoms, patient age, and activity level.
After the initial injury, rest, ice, a sling for comfort, and anti-inflammatory medications are recommended.
Minor tears without instability: Physical therapy to strengthen the rotator cuff and periscapular muscles, along with activity modification and anti-inflammatory medications, often provides good results without surgery — particularly for degenerative tears in lower-demand patients.
Significant tears in young and active patients
Surgery is often advised for young or active patients with tears causing significant instability, recurrent dislocations, or persistent symptoms despite conservative care. Arthroscopic labral repair uses suture anchors to reattach the torn labrum to the glenoid rim. For Bankart lesions with significant bone loss, a Latarjet procedure — transferring a bone graft to the front of the glenoid — may be required to restore stability. After surgery, a thorough physical therapy program is critical to healing and recovering function.
Significant tears in older or lower-demand patients
Older patients who do not require full shoulder stability for sports or high-level activities may be managed with physical therapy, activity modification, and strengthening of the rotator cuff and periscapular muscles to compensate for labral insufficiency.
Get an MRI to Confirm Your Diagnosis
Before surgical planning or starting treatment, a clear MRI diagnosis ensures the right path forward. First Look MRI offers self-pay Shoulder MRI scans — no doctor's order or insurance required — at our locations in Georgia, Texas, and Colorado.