Glenoid Labral Tears in Football Players

What Is a Glenoid Labral Tear?

The glenoid labrum is a fibrocartilaginous ring structure that lines the glenoid cavity of the scapula and helps to make up the joint capsule of the shoulder. The function of the labrum is to increase the depth and stability of the glenohumeral (GH), or shoulder joint. The glenohumeral joint is a ball-and-socket joint and allows the greatest range of motion compared to all other types of joints. Because of this, the GH joint has been found to be rather unstable, and therefore very susceptible to injury. A glenoid labral tear is a tearing of the labrum, which typically results in major instability and a loosening of the GH joint. Labral tears are typically classified based on the location of the tear. Tears can be classified as anterior, posterior, SLAP (superior labrum, anterior-posterior, which may involve biceps tendon), or Bankart (a result of shoulder dislocation). Glenoid labral tears typically occur as a result of overuse (common in overhead athletes), or via direct trauma to the shoulder. In football players, the most common mechanism for labral tears is through direct trauma.

Prevalence & Risk Among Football Players

Various studies investigating labral tears among football players have been performed, and it has been found that this injury is very common among this population. In a study performed by Mannava, S., et al. in 2018, it was found that out of 581 collegiate NFL prospects with shoulder injuries at the NFL combine from 2009-2015, 340 (or 58.5%) of these players were confirmed to display labral tears upon MRI (the gold standard for diagnosis), or 14.9% of total players evaluated (2,285). This was the most common shoulder injury seen in this group of collegiate NFL prospects, and raises a flag for concern for this injury. The most common type of labral tear in this study were posterior tears, which 262/377 (69.5%) players with labral tears displayed upon MRI. It is also worth noting that in this same study, linebackers were found to have the highest incidence rate of labral tears among all positions at 19.2%, while lineman also had a significantly high rate for tear in at least 1 shoulder (17.2%) compared to non-lineman (13.7%). 

How Do Labral Tears Occur Among Football Players?

As stated above, posterior labral tears have been found to display the highest prevalence rate among all football shoulder injuries. We also know that positions such as lineman and linebacker see higher incidence rates than all other football positions. The reason for this is believed to be the techniques that these positions use while playing their position. In a study performed by Crichton, J., Jones, D. R., & Funk, L. in 2012, two common mechanisms of labral injury in rugby players are highlighted, called the "try-scorer", "tackler", and "direct blow" mechanisms. Although this study investigated rugby players, the general idea can easily be translated to similar football techniques such as blocking or tackling another player. What these mechanisms have in common is that they all include an anterior force that is directed upon the shoulder. These anterior impact forces or "blows" direct their force upon the posterior labrum, causing trauma to the posterior labrum. It is hypothesized that this is the reason why posterior labral tears display such a high prevalence rate in football players.

How Are Players Affected by Labral Tears?

Signs & symptoms of glenoid labral tears according to https://www.ucsfhealth.org include:

• Pain with overhead activities
• Catching, locking, popping, or grinding of the shoulder
• Night pain or pain with activities of daily living (ADL's)
• Shoulder instability
• Decreased range of motion
• Decreased strength
• Shoulder dislocations

A study performed by Murphy, C. P., et al. in 2018 found that offensive and defensive lineman with posterior labral tears displayed a significantly lower percentage of snaps played in their first NFL season compared to those without tears (23.8% vs 27.7%, respectively; P = .014). Football players with labral tears are unable to perform to the best of their ability, and this is reflected in the number of snaps played by these injured players in their first NFL season following injury.

Treatment & Returning to Play

After a football player has sustained and been diagnosed with a glenoid labral tear, what steps can we take in order to treat & rehabilitate these individuals? According to a study performed by Robins, R. J., et al. in 2016, it was found that 85.4% of Division-I collegiate football players who underwent arthroscopic surgery to repair labral tear returned to play. Before injury, the athletes averaged playing in 49.9% of games, which then rose significantly to 71.5% of games following surgical intervention. Based on these findings, players who opt for arthroscopic surgery are more likely to return-to-play and will see an increase in the number of games they are able to participate in. Conservative treatment such as physical therapy & rehabilitation alone does not yield these same results. Allowing this injury to heal without surgery does not appear to be a viable option in most cases. For more information on treatment of labral tears, please visit https://www.sports-health.com. 

What Sports Medicine Professionals Can Do

Now that we know that glenoid labral tears are such a common injury in the sport of football, steps can be taken to minimize the risk for injury among football players. This knowledge should also be spread among the sports medicine community to increase awareness of this injury, especially to Athletic Trainers, Physical Therapists, Physicians, and even Coaches. Some steps we can take in terms of prevention & rehabilitation of this injury include:

• Limiting the forces placed on the shoulder during blocking and tackling plays. This may be achieved by investigating new blocking & tackling techniques that reduce forces placed on the shoulder
• Developing a type of shoulder brace that can reduce the forces placed on the shoulder as result of anterior impacts
• Incorporating preventative exercise regimens to strengthen & increase the flexibility of the rotator cuff muscles in at-risk positions (with a focus on the posterior muscles)
• Perform further studies that incorporate biomechanics to investigate the mechanism of injury for labral tears in football players (as opposed to referencing similar rugby studies), as research is still scarce for this topic
• Encourage players who have sustained labral tears to opt for arthroscopic surgical intervention as opposed to conservative treatment methods

What Football Players Can Do

If you are a football player and are experiencing any of the symptoms listed above, or if your mechanism of injury is similar to any of the listed mechanisms, I encourage you to be evaluated by your primary care physician, athletic trainer, or even an orthopedic specialist for a glenoid labral tear of the shoulder. Signs and symptoms vary among individuals, and some may only experience very minor symptoms. These signs & symptoms should not be brushed off as nothing, as you may very well have sustained a labral tear. Players should also refrain from playing if they fear they may have developed a labral tear, as further participation can only worsen the severity of the injury. Your best chances of being able to return to your pre-injury level of participation is by not ignoring the issue, but rather seeking professional medical guidance.

About the Author

Collin DeBarber is a senior at Westfield State University studying Movement Science with a concentration in Sports Medicine along with a minor in Biology. He currently works in the healthcare field as a Patient Care Technician in the Emergency Room and hopes to continue his career in healthcare by obtaining a Master's Degree in Physician Assistant Studies. He can be contacted at cdebarber4@gmail.com.

References 

Crichton, J., Jones, D. R., & Funk, L. (2012). Mechanisms of traumatic shoulder injury in elite Rugby players. British Journal of Sports Medicine, 46(7), 538-542. https://doi.org/10.1136/bjsports-2011-090688

Mannava, S., Frangiamore, S. J., Murphy, C. P., Sanchez, A., Sanchez, G., Dornan, G. J., Bradley, J. P., LaPrade, R. F., Millett, P. J., & Provencher, M. T. (2018). Prevalence of shoulder Labral injury in collegiate football players at the National Football League scouting combine. Orthopaedic Journal of Sports Medicine, 6(7), 232596711878398. https://doi.org/10.1177/2325967118783982

Murphy, C. P., Frangiamore, S. J., Mannava, S., Sanchez, A., Beiter, E., Whalen, J. M., Price, M. D., Bradley, J. P., LaPrade, R. F., & Provencher, M. T. (2018). Effect of posterior glenoid Labral tears at the NFL combine on future NFL performance.Orthopaedic Journal of Sports Medicine, 6(10), 232596711878746. https://doi.org/10.1177/2325967118787464

Robins, R. J., Daruwalla, J. H., Xerogeanes, J. W., & Greis, P. E. (2016). Return to play after shoulder instability surgery in NCAA division I intercollegiate football athletes. Orthopaedic Journal of Sports Medicine, 4(7_suppl4), 2325967116S0018. https://doi.org/10.1177/2325967116s00180