Labral Tears in the Mixed Martial Arts Athlete
by Steve Mora MD and Justin Haghverdian MS4
The shoulder joint enjoys a high degree of motion thanks to a unique ball-and-socket mechanism. The ball (humeral head) of the upper arm bone fits into a socket known as the glenoid. The glenoid is relatively flat, however it is deepened by a ring of cartilage around its rim. This ring of cartilage is known as the labrum.
The labrum helps to stabilize the shoulder by keeping the ball centered on the glenoid. Injuries to the labrum can occur with common traumatic mechanisms, including a fall to the outstretched arm or a blow to the shoulder. These traumatic mechanisms are commonly encountered in mixed martial arts. Labral tears can also happen after forceful Jiu Jitsu shoulder locks such as a Kimura or Omoplata. They can also happen after a dislocation or even with simple overhead punches or hammer blows.
These injuries are known in medical terms as a “superior labral anterior to posterior tear” (SLAP tear). As the name suggests, a SLAP tear involves the top portion of the labrum.
In cases of a “Bankart lesion” the anterior-inferior portion of the labrum is ripped off the edge of the anterior glenoid rim. This occurs in conjunction with a shoulder dislocation. The torn labrum allows the ball to slide out of the joint. Any movement of the arm will cause severe pain and or another dislocation. It is a very painful injury. Fighters who sustain this injury during a fight might loose all power and stability of their shoulder. The worse issue for an injured fighter is that no matter how hard they try to punch their power and intensity is diminished. These problems will continue to happen until the labrum is reattached to the rim of the socket.
Bankart lesion of anterior labrum being repaired back to bone.
These injuries are diagnosed by understanding the mechanism of the injury, doing a physical examination, getting X-rays and a MRI. The MRI images are clearer when contrast is injected into the joint. This is called an arthrogram.
MRI Arthrogram of shoulder with a SLAP tear
Certain labral tears can heal on their own if they are partially torn or not displaced. For example a SLAP tear might heal with rehabilitation focusing on flexibility. In the active athlete, such as a MMA fighter persistent instability and or pain associated with a labral tear, especially a Bankart tear may be unacceptable. A medical evaluation at the time of injury is therefore prudent to determine whether early surgical intervention will benefit the athlete.
Bankart lesion repaired back to anterior glenoid rim SLAP tear extending posterior SLAP tear repaired
For surgical repair, the procedure is performed under general anesthesia and with the use of an arthroscope. The torn portion of the labrum is reattached with sutures to the bony part of the socket. After surgery, the patient will need to recover with the arm immobilized for up to 6 weeks. In the first 6 weeks of recovery, the shoulder is protected to allow the labrum to heal back to the bone. After the 6 weeks, gentle range-of-motion exercises are begun with slow progression to more force-producing exercises. Patients are usually able to return to full contact after 4-6 months. One of the biggest problems after surgery is regaining full range of motion of the shoulder. This is a critical issue for MMA fighters, therefore emphasis on rehabilitation is very important. Stretching and soft tissue work around the shoulder and scapula are emphasized.
The prognosis after surgical intervention is usually very good especially if the shoulder has not dislocated numerous times. In cases of chronic dislocations, i.e. a shoulder that has come out of its socket greater than 5-10 times there will be other injuries beyond the labral tear. Chronic shoulder instability associated with a labral tear can lead to additional bony damage. If this occurs repairing the labrum is not sufficient to stabilize the joint. These complex procedures may lead to sub optimal outcomes.
The take home message for patients who have injured their shoulder and who have persistent pain or instability is to see an Orthopedic Surgeon or a musculosketal specialist. Ask for a MRI arthrogram. If the study shows a labral tear and there is persistent instability, consider arthroscopic repair before the damage worsens.
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