, Gloucester, MA

December 21, 2012

Noisy shoulder could point to tendon tear

On the Mend
Joe DiVincenzo

---- — A physical therapist with a full caseload may see as many as 700 patients with shoulder problems each year.

That’s a lot of arm pain.

Typically, rotator cuff tears get the most press — mainly because of the frequency at which they tear and the grueling rehab following surgery. But tears of the labrum are also common — and can cause you just as much trouble.

Comprised of a blended group of tissues, the labrum secures the ball of the shoulder into its socket. It prevents dislocation from occurring when you move your arm in space and, in essence, forms a protective seal around the shoulder joint itself.

Typically the product of gross trauma or repetitive injury, labral tears produce a unique set of symptoms that help to differentiate them from other causes of shoulder pain.

Many patients proceed onto surgery for a more definitive fix. But there is a distinct number of people who are opposed to surgery or are not surgical candidates for various medical reasons. In these instances, conservative management may be enough to eliminate pain and restore a bulk of your function and strength — just don’t plan on pitching for the Sox anytime soon.

Here are some of the most common signs and symptoms of labral tears. If you have any, get checked out as soon as you can.

Clicking and popping, among other noises, are all symptoms of a possibly dysfunctional labrum. When the pressure seal and stability of the joint have been compromised, tendons activate out of turn, bones rub together to create tissue snags and the result is a symphony of alarming noises. We all make a little rattle from time to time, but if your arm sounds like a recording of the Boston Pops, it’s time to have it looked at.

If your arm slips out of the socket, the protective seal has likely been compromised. The labrum provides a negative pressure, much like the lids on jarred foods. Tearing the labrum will cause the ball of the shoulder to loosen and migrate out of the socket. You may even feel as if you need to support your arm or tuck your hand high in your hip pocket to keep your arm in place.

Feeling like you have “dead arm” is a common sign of labral pathology. When the labrum is torn and no longer functioning, the muscles of the rotator cuff are forced to work harder than normal. Overtaxing the cuff musculature leads to fatigue, and eventual shut-down, making ordinary tasks extraordinarily difficult.

Weakness of the arm is not necessarily the sign of a labral tear, but all labral tears will cause weakness. Weakness is a symptom of many things, and is always an indication that you need to be examined by a clinician. It could worsen on its own — even if you rest it — and can lead to more catastrophic consequences the longer you wait.

Given the natural history of labral tears and other shoulder problems, it’s worth an office visit to ensure that your arm heals properly. So if you’re making noise, see a clinician skilled in upper extremity assessment.

Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes “On the Mend” weekly. Questions may be submitted by email to