What is the labrum of the shoulder?
 
The shoulder is a remarkably mobile joint, however this flexibility comes with the cost of less stability. The glenohumeral joint, where the upper arm meets with the shoulder blade is a ball and socket type joint. The surface area of the ‘socket’ part of the joint (the glenoid fossa) is much smaller than the ball part of the joint (the head of the humerus). A fibro-cartilaginous ring called a labrum surrounds the edge of the glenoid fossa which acts to increase both the depth and width of the fossa. 
 
This labrum provides increased stability and is also the attachment for a part of the biceps muscle via a long tendon. The labrum can provide flexibility and stability that a larger glenoid fossa might not be able to, however being a soft structure it is prone to tearing which can be problematic. 

​What causes the labrum to tear?
 
The most common way the labrum is torn is through a fall onto an outstretched arm or through repetitive overhead activities such as throwing or painting, as the repeated stress on the labrum can cause it to weaken and tear. 
 
Suspected labral tears can be diagnosed in a clinic by your physiotherapist through a series of tests, however, an MRI is usually required to fully confirm the presence of a labral tear. Labral tears are classified into different grades, which are determined by their location and severity. This grading is used as a guide to help determine the correct treatment. 
 
What are the symptoms of a labral tear?
 
A labral tear is often associated with other injuries, such as a rotator cuff tear, which can make the clinical picture a little confusing. Commonly there will be pain in the shoulder that is difficult to pinpoint and the pain will be aggravated by overhead and behind the back activities.
 
 Severe labral tears can lead to instability and can also be related to dislocations of the shoulder. 
 
How Can Physiotherapy Help?
 
The severity and grade of the labral tear will guide treatment. Smaller tears can be treated with physiotherapy that is aimed at increasing strength and control of the shoulder. Other tears may require surgical repair after which physiotherapy is an important part of treatment to rehabilitate the shoulder.  

Tendons, the connective tissues that join muscles to bone are known for being notoriously difficult to treat once injured. The reason for this is that often they are injured through stress or overuse, and compared to muscles they can have relatively poor blood flow, which is essential for healing. 
 
Tendons and muscles work together to move your joints and together are called a contractile unit. As muscles are exercised and gain strength, the attaching tendons are also placed under tension and adapt to this to become stronger. If the load placed on the tissues exceeds their capacity, the tendon fibres can begin to break down and become stiff and painful. 

Is my pain related to a tendon injury?
 
For an accurate diagnosis, you will need to be assessed by a physiotherapist. However, some signs that your pain might be coming from an in issue with a tendon are; 
 
· The pain is quite specific and can be felt over the tendon itself; 
· The pain is worse when under stress and improves when rested; 
· The pain improves after exercise has started, but it might be worse once you cool down; 
· The area around the tendon may feel stiff after periods of rest, particularly in the morning. 
 
How are tendon injuries treated?
 
When it comes to recovery, tendons are often treated differently to other injuries. While each tendon injury is unique and will require assessment and intervention by a physiotherapist, there are a few general approaches that usually help with all tendon injuries.  
 
Reducing your activity to a comfortable level is the first step to recovery. Complete rest can actually delay healing as the tendon simply becomes weaker and less able to cope with subsequent loads. Your physiotherapist can provide you with a targeted exercise program to aid your recovery. Eccentric exercises, which are exercises that work alongside gravity, have been shown to stimulate tendon healing and strength.
 
Stretching may aggravate your injury and should be used with caution. Assessment of any biomechanical faults or stresses that are placing undue load on the tendon is also a central component of treatment. Your physiotherapist is able to guide you with your recovery and return to sport to avoid aggravating any injury. 

What is it?
​ 
Shoulder instability is a term used to describe a weakness in the structures of the shoulder that keep the joint stable, which can lead to dislocation. As one of the most mobile joints in the body, the shoulder maintains stability through a balance of support between the dynamic structures (muscles and tendons) and static structures (ligaments and joint shape).
 
Shoulder instability most often occurs in one of two directions, anterior (forward) or posterior (backwards). Anterior instability or dislocations are more common than posterior. 

​What are the symptoms?
 
The most noticeable symptom of shoulder instability is dislocation or subluxation of the joint. This is often accompanied by pain, clicking sensations, a feeling of instability and in some cases weakness, and pins and needles in the arm. Many patients report a feeling of apprehension or instability, as if ‘something is not quite right’. Posterior instability can also cause reduced range of movement and might mimic other common shoulder conditions, which need to be ruled out first. 
 
How does it happen?
 
Shoulder instability can be classified as traumatic, occurring after an injury or atraumatic, where the shoulder is exceptionally flexible and prone to dislocations from everyday forces. Instability can also occur from chronic overuse where the shoulder joint is damaged slowly over time.
 
Traumatic shoulder instability is the most common form. Often the joint is dislocated by a strong force and damaged, leaving it more unstable and vulnerable to future dislocations. Rugby and football players are commonly affected. However, dislocations can occur in the general public from something as simple as falling onto an outstretched hand. 
 
How can physiotherapy help?
 
Shoulder instability is a complex condition and each person will have a different combination of causes and structural deficiencies. Physiotherapists are trained to identify issues of coordination, control and strength that may be contributing to instability and provide an extensive rehabilitation program. For some patients, surgery is recommended to help restore some static stability to the joint. However, this is not the best pathway for everyone. If surgery is indicated, a full rehabilitation program is recommended post-operatively for the best possible outcome. 
 
Helping patients to understand and manage their condition is an essential part of recovery. Physiotherapy is usually recommended as the first line of treatment before surgery and can have excellent outcomes, with or without going under the knife.