A shoulder labral tear is damage to a ring of tough, rubbery cartilage that lines the rim of your shoulder socket. This cartilage, called the labrum, deepens the otherwise shallow socket by about 50%, helping keep the ball of your upper arm bone centered and stable. When it tears, the shoulder can feel painful, unstable, or like something is catching inside the joint.
What the Labrum Does
Your shoulder is the most mobile joint in your body, but that freedom of movement comes with a tradeoff: the socket is remarkably shallow. The bony socket covers only a fraction of the ball-shaped head of the upper arm bone. The labrum compensates for this by wrapping around the entire rim of the socket like a gasket, increasing the surface area and creating a deeper cup for the arm bone to sit in.
Beyond adding depth, the labrum acts as a seal that helps maintain pressure inside the joint, which keeps the arm bone suctioned into the socket. It also serves as an anchor point for the biceps tendon, which attaches at the top of the labrum, and for the ligaments that connect your arm bone to the shoulder blade. When the labrum is intact, it contributes roughly 10% of the shoulder’s overall compression stability. Remove it, and stability drops by about 20%, particularly in the downward direction.
Types of Labral Tears
Labral tears are named for their location around the socket rim. The two most common types are Bankart lesions and SLAP tears, though tears can occur anywhere along the labrum’s circumference.
- Bankart lesion: A tear of the lower front portion of the labrum. This is the classic injury associated with shoulder dislocations. When the shoulder pops out of its socket toward the front, the arm bone shears off the labrum on its way out. These tears are considered the “essential lesion” of shoulder instability, meaning they are the primary structural problem that allows the shoulder to keep dislocating.
- SLAP tear: Short for “superior labrum anterior to posterior,” this tear runs along the top of the labrum where the biceps tendon attaches. The damage extends from the back of the upper labrum toward the front, often pulling the biceps anchor away from the bone. SLAP tears are more common in overhead athletes and people who fall on an outstretched hand.
Some tears combine both patterns. A type V SLAP lesion, for example, is a Bankart tear at the bottom front that continues upward to include separation of the biceps tendon at the top.
Common Causes
Labral tears generally fall into three categories: acute trauma, repetitive overuse, and age-related wear.
A single forceful event can tear the labrum in an instant. A fall onto an outstretched arm drives the arm bone upward into the socket, compressing and tearing the upper labrum. A shoulder dislocation, common in contact sports, peels the lower labrum off the bone. Any hit or fall that forces the shoulder into an extreme position of rotation and abduction can do similar damage.
Repetitive overhead motion is actually the most frequent cause of SLAP tears. The repeated cocking and throwing motion in baseball, swimming, volleyball, and tennis creates cumulative microtrauma at the top of the labrum where the biceps tendon pulls. Over hundreds or thousands of repetitions, the labrum gradually frays and separates from the bone.
Degenerative tears become increasingly common after age 40. Studies examining patients with an average age of about 52 found labral damage even without any recent injury, simply from decades of normal wear. These degenerative tears often accompany rotator cuff problems and may not cause symptoms on their own.
What a Labral Tear Feels Like
The most common symptom is a deep, hard-to-pinpoint ache inside the shoulder. The pain typically worsens with overhead movements, reaching behind your back, or any activity that puts the shoulder near its end range of motion. You may feel a sense of instability, as if the shoulder could slip out of place during certain movements.
Some people experience clicking or catching sensations when they move their arm. This happens when a flap of torn labral tissue gets caught between the ball and socket during movement. That said, clicking and catching from a labral tear is actually quite rare. Most tears produce pain and a feeling of looseness rather than mechanical catching.
Bankart-type tears tend to produce a feeling of the shoulder “giving way,” especially during activities that put the arm in a throwing position. SLAP tears often cause pain at the front of the shoulder and during overhead motions, sometimes with a sense of weakness when lifting or throwing.
How Labral Tears Are Diagnosed
Diagnosing a labral tear starts with a physical exam. Your doctor will move your shoulder through specific positions designed to stress the labrum and reproduce your symptoms. One widely used maneuver, the active compression test, involves holding your arm out in front of you and pressing downward while the examiner resists. Pain deep in the shoulder during this test suggests labral involvement. Other tests apply a shearing force across the labrum or tension the biceps tendon to isolate the source of pain.
No single physical test is definitive on its own. Imaging is usually needed to confirm the diagnosis. A standard MRI can detect labral tears, but its sensitivity for SLAP tears specifically is low, around 29% in some studies, meaning it misses the majority. An MRA (MRI with a contrast dye injected directly into the joint) performs significantly better, with sensitivity jumping to about 74% for SLAP lesions. The dye fills the joint space and outlines tears that a standard MRI would miss.
In some cases, the definitive diagnosis only comes during arthroscopic surgery, where a small camera is inserted into the joint for a direct look.
Non-Surgical Treatment
Not every labral tear requires surgery. Conservative treatment typically starts with rest and anti-inflammatory medication to control pain, then progresses to a structured physical therapy program. The goal of rehab is not to heal the torn cartilage itself (the labrum has limited blood supply and doesn’t regenerate well) but to strengthen the muscles around the shoulder so they compensate for the lost stability.
Physical therapy focuses on several priorities: restoring normal movement of the shoulder blade, strengthening the rotator cuff, improving core and lower body strength, and correcting any flawed movement patterns in your sport or daily activities. For overhead athletes, this means rebuilding the entire chain of motion from the legs through the trunk to the arm, not just rehabbing the shoulder in isolation.
Conservative treatment works better for some people than others. In a comparative study tracking outcomes over two years, about 45% of patients managed without surgery achieved meaningful pain relief, and 40% had notable functional improvement. Those numbers are modest, which is why surgery is often considered when physical therapy alone doesn’t restore adequate function.
Surgical Repair and Success Rates
When conservative treatment falls short, arthroscopic surgery is the standard approach. The procedure uses small incisions and a camera to either reattach the torn labrum to the bone with small anchors or, in cases involving the biceps tendon, detach the tendon from the damaged labrum and secure it elsewhere on the arm bone (a procedure called tenodesis).
Outcomes vary by procedure type. Arthroscopic repair produces pain relief in about 85% of patients and functional improvement in roughly 70% at two years. Tenodesis shows even higher numbers: 97% pain relief and 95% functional improvement at the same follow-up point. The best option depends on the tear location, your age, and your activity goals.
Recovery After Surgery
Recovery from arthroscopic labral repair follows a structured timeline that typically spans five to six months before return to full activity.
For the first six weeks, you’ll wear a sling almost constantly, removing it only for prescribed exercises and physical therapy. During the initial two weeks, the focus is on gentle pendulum exercises at home several times a day to prevent stiffness. Between weeks two and four, a physical therapist begins guided passive motion, moving your arm for you without requiring your muscles to do the work.
Around weeks four to six, you start assisting your own movements and begin light resistance band exercises for rotator cuff strengthening. At six weeks, the sling comes off. From weeks six to ten, you progress to active motion, isotonic strengthening with gradually increasing resistance (up to six to eight pounds), and neuromuscular control drills to retrain the shoulder’s coordination.
By three months, most people have full range of motion and begin traditional weight training with machines and free weights. Throwing athletes start sport-specific strengthening programs at this point. Light tossing begins around four months, with a formal return-to-throwing program starting around four to five months after passing strength testing. Return to contact sports is not cleared before five months at the earliest.
What Happens Without Treatment
Leaving a labral tear untreated doesn’t always lead to worsening problems, particularly for small, degenerative tears that cause minimal symptoms. But for tears associated with shoulder instability, the long-term risks are real. A shoulder that continues to dislocate or subluxate damages the cartilage surfaces of both the socket and the arm bone with each episode.
The link between untreated instability and arthritis is well documented. Studies report that the incidence of shoulder osteoarthritis after conservatively managed traumatic instability can reach as high as 60%. Each dislocation event causes additional bone and cartilage damage, accelerating joint degeneration. For young athletes with recurrent instability from a Bankart tear, surgical stabilization is often recommended to break this cycle before cumulative damage sets in.