Shoulder Labral Tear Repair Surgery
The labrum is a ring of tough, fibrous cartilage that lines the rim of the glenoid — the shallow socket of the shoulder blade — deepening the socket by up to 50 percent and providing a critical attachment point for the shoulder’s capsular ligaments and the long head of the biceps tendon. When the labrum tears — whether from a traumatic shoulder dislocation, a fall onto an outstretched hand, repetitive overhead throwing, or age-related wear — the shoulder loses both structural stability and the anchoring point for the ligaments that prevent the humeral head from slipping out of the socket. Labral tears are one of the most common shoulder injuries in athletes and active adults, and because the symptoms — deep, aching shoulder pain, catching, clicking, and a vague sense of instability — overlap significantly with rotator cuff injuries, biceps tendon pathology, and shoulder impingement, accurate diagnosis requires careful clinical examination and specialized imaging.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with a traveling shoulder fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins and fellowship training in arthroscopic surgery at the Southern California Orthopedic Institute/UCLA. Labral tear repair is one of the most technically demanding arthroscopic procedures — the surgeon must identify the exact tear pattern, determine which portions of the labrum are repairable, place suture anchors precisely along the glenoid rim under arthroscopic visualization, and restore capsular tension without restricting range of motion. As a member of the Arthroscopy Association of North America and Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers — where labral tears from body checks, falls, and overhead throwing are among the most common shoulder injuries — Dr. Glashow has performed thousands of labral repairs across all tear types. Named a Castle Connolly Top Doctor every year since 2000, he performs labral tear repair at his Upper East Side practice in New York City.
Types of Labral Tears
Bankart Tear: A tear of the anterior-inferior (front-bottom) labrum, caused by a traumatic anterior shoulder dislocation. Bankart tears are the most common labral injury associated with shoulder instability. For detailed information about this repair, see the Bankart Repair page.
SLAP Tear (Superior Labrum Anterior to Posterior): A tear of the superior (top) labrum where the long head of the biceps tendon attaches. SLAP tears are most common in overhead throwing athletes — particularly baseball pitchers — and in patients who sustain a fall onto an outstretched hand or a traction injury to the arm. SLAP tears produce deep shoulder pain, catching, popping, and often pain with overhead activity and the cocking phase of throwing.
Posterior Labral Tear: A tear of the back portion of the labrum, less common than anterior or superior tears. Posterior labral tears are sometimes seen in athletes with internal impingement — a condition in which the rotator cuff and posterior labrum are pinched together during the follow-through phase of overhead throwing.
Degenerative Labral Tear: Gradual fraying and wearing of the labral tissue from age-related degeneration, often occurring alongside shoulder arthritis. Degenerative tears are more common in patients over 40 and may not require surgical repair.
Symptoms of a Labral Tear
- Deep, aching pain within the shoulder joint
- Catching, clicking, or popping during shoulder movement
- Pain with overhead reaching, throwing, or lifting
- A sensation of the shoulder slipping, giving way, or feeling unstable
- Pain with the arm in the cocking position (arm back and externally rotated)
- Night pain and difficulty sleeping on the affected side
- Loss of shoulder strength, particularly with overhead activities
- A feeling that the shoulder is “dead” or weak during sports
Diagnosis of Labral Injury of the Shoulder
Labral tears can be difficult to diagnose because the symptoms overlap with other common shoulder conditions. Dr. Glashow evaluates each patient with a clinical examination that includes specific provocative tests — such as the O’Brien test for SLAP tears and the apprehension/relocation test for Bankart tears — to reproduce the symptoms and narrow the diagnosis. X-rays are taken to rule out fractures, bone spurs, and arthritis. An MRI arthrogram — in which contrast dye is injected into the shoulder joint before the MRI scan — is typically the most accurate imaging study for visualizing labral tears, because the dye fills the gap between the torn labrum and the glenoid rim, making the tear clearly visible on imaging. Same-day imaging is available at his Upper East Side practice.
Treatment Options
Conservative Treatment: Small labral tears, degenerative tears in older patients, and tears that are not producing mechanical symptoms or instability may respond to non-operative management with anti-inflammatory medications, activity modification, and physical therapy focused on rotator cuff and scapular strengthening.
Arthroscopic Labral Repair: For symptomatic tears that have not responded to conservative treatment — and for all tears associated with shoulder instability — arthroscopic surgery is the standard of care. Dr. Glashow reattaches the torn labrum to the glenoid rim using suture anchors placed through small portals, restoring the socket depth and capsular tension. Associated injuries — such as biceps tendon damage, capsular stretching, or rotator cuff tears — are addressed during the same procedure.
Labral Debridement: For degenerative tears or small, stable tears that are producing mechanical symptoms (catching, clicking) but not instability, arthroscopic debridement — trimming and smoothing the damaged labral tissue without reattachment — may provide symptomatic relief.
Biceps Tenodesis with SLAP Repair: In certain SLAP tear patterns — particularly in patients over 35 or in those with significant biceps tendon involvement — Dr. Glashow may recommend a biceps tenodesis (detaching the biceps from the damaged labrum and reattaching it to the humerus) rather than a SLAP repair, as this approach produces more predictable results and faster recovery in the appropriate patient population.
Shoulder Labral Tear Repair in New York City
If you are experiencing deep shoulder pain, catching or popping, a sensation of instability, or pain that limits your ability to throw, lift, or perform overhead activities, a labral tear may be the cause. Dr. Glashow offers comprehensive evaluation with MRI arthrogram imaging at his Upper East Side practice. Contact our office to schedule your consultation.
Frequently Asked Questions About Shoulder Labral Tear Repair
What is a labral tear?
A labral tear is a tear of the labrum — the ring of cartilage that lines the rim of the shoulder socket (glenoid). The labrum deepens the socket, stabilizes the shoulder joint, and serves as the attachment point for the capsular ligaments and the biceps tendon. When the labrum tears, the shoulder loses socket depth and ligament anchoring, which can produce pain, catching, clicking, and — depending on the tear location — instability that increases the risk of dislocation.
What is the difference between a SLAP tear and a Bankart tear?
Both are labral tears, but they occur in different locations and from different mechanisms. A SLAP tear involves the top of the labrum where the biceps tendon attaches, typically caused by repetitive overhead throwing, a traction injury, or a fall. A Bankart tear involves the front-bottom of the labrum, caused by an anterior shoulder dislocation. SLAP tears primarily produce pain and mechanical symptoms. Bankart tears primarily produce instability and recurrent dislocation risk. The surgical technique, anchor placement, and rehabilitation protocol differ for each.
How is a labral tear diagnosed?
Clinical examination with specific provocative tests can strongly suggest a labral tear, but definitive diagnosis typically requires an MRI arthrogram — a specialized MRI in which contrast dye is injected into the shoulder joint before scanning. The dye highlights the gap between the torn labrum and the glenoid rim, making the tear visible on imaging. Standard MRI without contrast can miss labral tears, which is why Dr. Glashow recommends the arthrogram technique for suspected labral injuries.
Do all labral tears require surgery?
No. Small tears, degenerative tears in older patients, and tears that are not causing mechanical symptoms or instability can often be managed with physical therapy and activity modification. Surgery is recommended for tears that produce persistent pain or mechanical symptoms despite conservative treatment, tears associated with shoulder instability or recurrent dislocation, and SLAP tears in young overhead athletes who need to return to competitive throwing. Dr. Glashow evaluates each patient’s tear pattern, symptoms, activity demands, and imaging before recommending a treatment approach.
How long does recovery take after labral repair?
Patients wear a sling for four to six weeks after surgery. Gentle passive range-of-motion exercises begin within the first few weeks, with active motion and strengthening introduced progressively over the following months. Most patients return to daily activities within six to eight weeks and to overhead sports between four and six months after surgery. Overhead throwing athletes — particularly baseball players — may require six to nine months before returning to full competitive throwing. Dr. Glashow coordinates rehabilitation closely with physical therapists and uses functional testing to determine return-to-sport readiness.
Can a labral tear get worse if left untreated?
Yes. An untreated labral tear can enlarge over time, particularly if the shoulder continues to be used for overhead or throwing activities. In tears associated with instability, each subsequent subluxation or dislocation damages the labrum further and may erode the glenoid bone — making eventual surgical repair more complex and potentially requiring a bone-grafting procedure rather than a simple soft tissue repair. Degenerative labral tears can also progress and contribute to the development of shoulder arthritis over time.
