A labral tear on your MRI doesn’t automatically explain your pain. The labrum is a rim of cartilage around the shoulder socket, and it frays with age like the rest of the joint.
In people aged 45 to 60 with NO shoulder pain at all, MRI scans showed a tear at the top of the labrum in somewhere between half and 3 in 4, depending on who read the scan. After 40, a tear on your report is often just part of normal aging.
The two tears that matter most are a SLAP tear, at the top of the socket, and a Bankart tear, at the front after a dislocation. Most people start with physio. Surgery makes most sense for young people whose shoulder keeps slipping or coming out.
What the labrum does
- It deepens the socket: the shoulder socket is shallow, and the labrum acts like a bumper around the edge that helps keep the ball in place
- It anchors the biceps: one of the biceps tendons attaches to the top of the labrum
- It has a poor blood supply: so torn labrum rarely knits back together on its own. That doesn’t mean the shoulder can’t settle
SLAP tears
- Where: the top of the labrum, where the biceps tendon attaches. SLAP stands for “superior labrum, anterior to posterior,” meaning the tear runs front to back along the top
- Who: overhead athletes, especially throwers, volleyball and tennis players. Also a fall on an outstretched arm or a sudden heavy pull
- How it feels: deep pain at the top or front of the shoulder with overhead or throwing movements, sometimes clicking or catching, and a “dead arm” feeling when throwing
- In older adults: a SLAP tear on the scan is common and is often wear, not injury
Bankart tears
- Where: the front and lower edge of the socket
- How it happens: the ball tears the labrum off the front of the socket as it dislocates
- Why it matters: in young people, the torn rim often doesn’t heal back in the right place, so the shoulder is left looser and more likely to come out again. See will a dislocated shoulder pop out again?
- Bone matters too: sometimes a piece of the socket rim breaks off with the labrum. That changes the surgical plan
Treat the shoulder in front of you, not the picture on the scan.
Physio first, for most people
- Strengthen the rotator cuff and shoulder blade muscles: they hold the ball centered in the socket and take strain off the labrum
- Fix the throwing chain: for athletes, hip, trunk and shoulder blade control often matter as much as the shoulder itself, along with how much you throw
- Build load back up in stages: from easy positions to overhead and sport-specific work
- Give it a fair trial: usually a few months of a structured program before judging it
- A cortisone shot is sometimes used to settle pain enough to exercise. See cortisone shot side effects
When repair makes sense
- Young people with a Bankart tear whose shoulder keeps coming out or feels loose, especially in contact or overhead sport. See surgery after a first dislocation
- Jobs where instability is dangerous: police, military, firefighters, working at heights
- A SLAP tear in a young overhead athlete that still limits sport after a proper rehab program
- Mechanical symptoms that don’t settle: true locking or catching that stops the shoulder working
SLAP repair or biceps tenodesis?
- SLAP repair: stitches the torn top of the labrum back down to bone. It works best in younger patients
- Biceps tenodesis: detaches the biceps tendon from the labrum and fixes it lower down on the arm bone, taking the pull off the torn area
- Past your mid-thirties: SLAP repairs are less reliable, and many surgeons prefer tenodesis instead
- In young athletes, the picture is mixed: some studies favor tenodesis for return to sport, others find the two end up similar. Ask your surgeon why they recommend one
Questions to ask about your MRI
- Does the tear fit my symptoms? Where it hurts and when should match where the tear is
- Is there bone loss from the socket, or damage to the back of the ball?
- What else is on the scan? Rotator cuff changes and arthritis often sit alongside a labral tear, and may be the real source of pain. See rotator cuff tear
- What happens if I try physio first? For most tears, waiting a few months doesn’t close any doors
Get seen today if
- The shoulder has come out and hasn’t gone back in. Don’t try to put it back yourself
- The arm or hand is numb, cold or pale after an injury
- The shoulder is hot, swollen and very painful and you feel unwell
Get it checked if
- The shoulder slips, clunks or feels like it’s coming out with overhead or throwing movements
- You’re over 40, had a dislocation and the arm is still weak after two weeks
- Pain and catching haven’t eased after a few months of a proper program
- You’re weighing surgery and want to know whether your tear actually fits your symptoms
Over 40, a labral tear is often just age. Young and unstable, it’s worth a surgeon’s opinion.