Glenoid labral tears in the shoulder, categorized as superior labral tears (SLAP lesions), anterior labral tears (Bankart lesions), and posterior labral tears (reverse Bankart lesions), represent common injuries with well-established classifications ^[1]. Notably, the superior and anteroinferior labrum are frequent anatomical sites for tears, with SLAP lesions described by Andrews et al. As posterosuperior labral tears extending anteriorly [2, 3]. Snyder et al., further, classified SLAP lesions into four categories, with SLAP type II being the most prevalent ^[4]. While combined tears of the anterior and superior labrum, as well as combined Bankart and SLAP tears, have been reported earlier [5, 6], recent descriptions include various combinations of labral lesions[7-9]. Powell et al. expanded the SLAP lesion classification with the introduction of type VIII and type IX, the latter being a circumferential or pan-labral tear involving multiple aspects of the labrum ^[9]. Circumferential glenoid labral tears, a rare entity in labral injuries, are often associated with traumatic events leading to instability and pain. Although it is hypothesized that these tears may initially be non-circumferential and evolve with subsequent instability events ^[10], it is noteworthy that a pan-labral tear can also occur with a single episode of dislocation. Due to potential limitations in imaging accuracy, diagnosis relies heavily on a thorough history, clinical examination, and heightened suspicion ^[7]. Arthroscopic repair of circumferential 360° labral tears has demonstrated success in restoring stability and reducing shoulder pain, allowing patients to return to pre-injury activity levels ^[10]. Surgeons should be prepared for intraoperative findings that may reveal a more extensive labral lesion than initially seen on imaging modalities. In this case report, we present the unique case of an athlete with a history of left shoulder trauma, demonstrating a pan-labral tear of the glenoid, who subsequently underwent successful arthroscopic repair. To the best of our knowledge, this represents the first documented case of its kind, highlighting the rarity and clinical importance of circumferential glenoid labral tears.

A 27-year-old right-hand dominant male presented with a single episode of anterior shoulder dislocation sustained during a cricket game. Following the incident, he reported persistent pain and limited range of motion in the left shoulder. Denying any neurological deficits, prior dislocations, shoulder injuries, or familial musculoskeletal disorders, the patient underwent a comprehensive clinical examination. Physical assessment revealed no deformity or muscle atrophy. Pain was noted during active and passive range of motion, particularly in abduction and flexion (Fig. 1). Laxity tests produced negative results, except for positive findings on the O’Brien and Apprehension tests. Neurological examination indicated preserved upper extremity strength and sensation.

Initial X-rays showed no abnormalities (Fig. 2), but subsequent MRI revealed an anteroinferior labral tear (Fig. 3). No rotator cuff abnormality was detected. Arthroscopy was planned to assess and address the confirmed 360° labral tear. Under general and loco-regional anesthesia, the patient underwent arthroscopy. A systematic examination explored various shoulder structures, confirming the extensive labral tear. The procedure began with addressing the superior-anterior labrum and biceps anchor tear. An accessory anterior-superior lateral portal was established with precision to avoid supraspinatus tendon violation. Using an outside-in spinal needle technique, the supraglenoid tubercle was freshened with a barrel burr.

Arthroscopic inspection revealed the comprehensive nature of the labral tear, involving anterior, posterior, superior, and inferior aspects (Fig. 4-6). A meticulous repair processes followed, involving the use of portals and percutaneous techniques. Anchors were strategically placed to reattach the labrum and biceps anchor complex, ensuring proper tensioning and alignment (Fig. 7). The procedure concluded with subacromial bursectomy, closure, and placement of a shoulder immobilizer.

Postoperatively, the patient had an uneventful hospital stay and was discharged on the 2^nd day after a post-operative check radiograph (Fig. 8). The case underscores the importance of clinical examination, advanced imaging, and arthroscopic confirmation in diagnosing and treating circumferential glenoid labral tears, even in the absence of recurrent dislocations.

Combined lesions of the glenoid labrum, involving multiple quadrants, are recognized as a unique glenohumeral pathological entity [1, 11]. The circle concept of instability proposes a biomechanical mechanism leading to circumferential glenoid labral tears. According to this concept, shoulder instability in one direction should be accompanied by a lesion on the opposite site; for instance, anterior shoulder instability should coincide with a posterior lesion [12, 13]. Although circumferential tears are commonly associated with multiple shoulder dislocations, they can also occur after a single traumatic event, challenging the notion that recurrent dislocations are a prerequisite ^[14]. MRI, despite being a widely used imaging modality, exhibits poor sensitivity in preoperatively identifying circumferential labral tears ^[15]. Surgeons should anticipate more extensive intraoperative findings, emphasizing the importance of obtaining preoperative information through medical history, physical examination, and imaging. It is crucial not to neglect even a single episode of shoulder injury and dislocation with a painful range of motion, especially if radiographs appear normal, as it may indicate a pan-labral lesion ^[16]. Left untreated, such lesions can lead to future instability and subsequent painful osteoarthritis ^[17].

Circumferential glenoid labral tears, typically associated with recurrent dislocations, can also occur after a single traumatic shoulder dislocation. Recent research challenges the assumed relationship between dislocation frequency and tear extent. Comprehensive evaluation, including arthroscopic inspection, is crucial as pan-labral tears may be missed in MRI studies. Arthroscopic repair yields favorable outcomes.

It is crucial to consider pan-labral tears even in cases of a first-time shoulder dislocation to avoid overlooking extensive injuries that may lead future instability and osteoarthritis, emphasizing the need for a comprehensive diagnostic approach and early arthroscopic intervention for favorable treatment outcomes.