January 26, 2015

Managing Expectations When Recovering from a Labral Repair

I have seen many clients with post-operative shoulder labral repairs. It is a frustrating injury that takes time to recover from. Being the recipient of two labral repair surgeries myself, it is my opinion that the key to recovery with a labral injury is managing expectations.

Figure 1. A and B) Uniaxial loading of biceps tendon leading to SLAP lesion in the neutral position (Bey et al. 1998)

The shoulder labrum is a fibrous, or rigid type of cartilage. This type of cartilage is found only around the attachment of the socket. The two main functions of the labrum are to deepen the socket (thus providing added stability) and to be an attachment for other structural tissues such as the biceps tendon around the joint.

The labrum is typically torn from one of the following.

1. Damage to attaching ligaments of the shoulder resulting from repetitive actions or over-use.
2. A subluxation or dislocation of the shoulder, usually occurring from trauma. Dislocation can occur anteriorly or posteriorly.

Figures A and B show the subluxation uniaxial loading seen when holding a dumbbell. Figure two shows a throwing motion: Notice the detachment of the bicep tendon with the labrum. There are four types of SLAP classifications, which can be a factor in the recovery process.

I wanted to touch on how this injury occurs in order to point out the degree of recovery needed. Recovery depends upon many factors, such as lesion location, severity, and the quality of surgical repair. The Johns Hopkins orthopedic surgery website reports with regards to recovery that

Figure 2) during the late cocking phase of throwing (Rodosky et al. 1994).

“It is believed that it takes at least four to six weeks for the labrum to re-attach itself to the rim of the bone, and probably another four to six weeks to get strong. Once the labrum has healed to the rim of the bone, it should see stress very gradually so that it can gather strength. It is important not to re-injure it while it is healing. How much motion and strengthening of the arm is allowed after surgery also depends upon many factors, and it is up to the surgeon to let you know your limitations and how fast to progress. Because of the variability in the injury and the type of repair done, it is difficult to predict how soon someone can to return to activities and to sports after the repair. The type of sport also is important, since contact sports have a greater chance of injuring the labrum repair. However, a vast majority of patients have full function of the shoulder after labrum repair, and most patients can return to their previous level of sports with no or few restrictions.”

The Johns Hopkins orthopedic surgery website does leave recovery time open for interpretation and dependent on each case. I feel that recovery typically takes longer than expected.

The recovery time can be separated into three stages. The first is acute pain stage (difficulty when sleeping), which usually lasts 4-6 weeks. This time usually involves a formal physical therapy process.

The second stage is continued strengthening and stretching with slight discomfort (minimal to no pain). During this stage the patient/client will report “I still feel like I am going to dislocate and have this funny crackling in my shoulder”. This stage can range from 12-16 weeks (therapy to post rehab transitional stage). Don’t be alarmed. The labrum repair tightened the joint and likely causing minor pressure on the repaired tissues that are unfamiliar. This feeling will recede over time.

The final stage is the transition to your “new normal” lifestyle and exercise. This stage varies and could be 6-12 weeks of feeling “normal again”. Realistically, many patients are looking at 9 months to 1 year of total recovery time before they feel “normal” again.

I hope this information helps you when managing expectations. Frustration is common, and patience is key. The time frame may indeed be longer than you may expect, but it is better to manage your expectations and realize that you will have a “new normal”. Do not rush your rehabilitation, as many people find themselves re-injuring their shoulder.

For more information on SLAP repairs http://hopkinsortho.org/labrum_tear.html

By: Phillip Godfrey MES, PFT

Comments

  1. David Flores says:

    Hello.

    Very cool to see a community centered around laberal tears. You are a good man for helping individuals get through this experience with your knowledge.

    I myself have a few questions. I’m 24 years old recovering from a posterior labrum repair surgery. I’m fairly active and hope to get into a military officer program later this summer. My six month mark will be February 13th. I must say, however, that the shoulder is still not feeling “normal”, if that makes sense. The shoulder joint is cracking, popping, and grinding with particular movements. These things are not painful, but I genuinely thought that the noises would dissipate this far out. Moreover, I still feel minor pain and weakness on some days and there is also cracking noises whenever the posterior portion of the shoulder gets massaged. The joint isn’t subluxing from what I can tell, but it certainly feels like the bone moves around on occasion. There is a disclaimer, though. I didn’t push myself with the internal rotation stretches as I should have early on. As a result, it is slightly stiff, but slowly getting more motion each week. Perhaps scar tissue build up?

    I became paranoid that all this is connected to an event that occurred last November (3 and a half months out). I went to pet my dog and I overstretched reaching downwards on accident. The fast motion of reaching down caused a sharp pain that stung for about ten seconds or so. What is the probability of tearing something like that? Maybe coincidental, but it did seem like the cracking occurred a few weeks later.

    At five months, is any of this typical? I thought I would recover faster being fairly young, but I guess not. I have a follow up with my OS next week, but I would love to hear your perspective on this. Thank you for reading.

    Dave

    • At 5 months what you are describing is fairly common. I have seen plenty of 20-somethings many months after surgery here in DC that have very similar stories to yours. Rotator cuff tendons (and other tendons) have a tendency to make noises as they glide over boney tuberosities on the shoulder. If the noises do not provoke pain, I wouldn’t be worried about it.

      In terms of petting the dog, at 3.5 months out I highly doubt that you messed anything up. Keep up with some strengthening and stretching under the guidance of the doc and PT, yo will get there. It very well may take several more months.

  2. Thank you for having a website with so much information!

    I am just over 4.5 months from labrum surgery due to a bankart tear from anterior dislocations. I’m getting very concerned because my range of motion is not improving, in fact the last 6 weeks its only improved 2-4 degrees. I can still not lift my arm up completely above my head and my external rotation is very painful in my bicep which has been there since day 1 post surgery, despite not having a bicep tendon tear. Is it normal to have this slow of a progression? I’ve been told that my joint is very, very tight and I don’t even feel much of a stretch anymore while doing my exercises, just feels stuck. Any opinion would be GREATLY appreciated.

    • Jenn

      Many people will develop capsular tightness after this type of surgery. If I were to guess I would say 25% of people develop it, and disproportionately with women. The doctor technically would have to diagnose a “frozen shoulder” with you.

      The shoulder will probably loosen gradually with time. Unfortunately it may take many, many months. Keep up with some stretching and strengthening.

      • I had surgery in July.wasn’t making any progress come to find out I had frozen shoulder. Had manipulation done in Nov. And been doing therapy since,the range of motion has improved but still having pain in shoulder. I am troubled thinking is it ever gonna be normal. I still have difficulty tucking in shirt it still hurts and sleeping at night. What could be wrong? Is this normal?

        • Sorry to hear about that Jodi. Frozen shoulders are a monumental pain in the rear to deal with because they can last for quite a long time. We have an article on frozen shoulders in our blog post that explains a bit about the condition.

          You are going to have to be super-patient about getting through the frozen shoulder, but it will eventually go away. You also need to find the right amount of stretching and exercise to do, and to do it at the right time.

  3. I had labrum repair surgery on the 21st of October and it’s been three months now and I’m still having lots of pain while sleeping. it feels like the shoulder is hanging and pulling on the socket. it’s the exact same pain that I had before the surgery. the only position I can lay in is on my back to be pain free. I’m worried that the labrum is still torn. is this normal? my doctor just keeps saying it can be

    • My guess is that this is more likely an effect of weakness / instability. You are fewer than 3 months post-op, so it is totally common to still be feeling this type of pain. Once you are OK’d for resisted therex, start some strengthening under the guidance of the PT and doc. That should help quite a bit, albeit slowly. Be patient. If you are still having the same pain 6-8 months after the surgery I would pick the doctor’s brain about it.

  4. Sue Cousins says:

    Nice to read the blog about others who are going through the same labrum tear pain I am. I had surgery to re-attach the labrum just over 4 weeks ago. My concern is the pain I experience at night. I’ve been sleeping in a recliner since surgery and with the sling on throughout day and night. Each night I wake up with extreme pain on the top and front of shoulder along with the front of the bicep. It’s a pain that burns and feels crampy. Is this “normal”? How can I minimize it? It’s keeping me up at night and even has me not looking forward to bedtime. I even went back to a pain med to help me sleep which helped for one night only. HELP! I want sleep!

    • Sue

      People with this type of surgery will often have a hard time sleeping for a few months. I would try placing a pillow under the arm such as in the article we posted. I would also talk to the doc about different pharmaceuticals in the mean time. Talk to the PT and see if there are any other modifications that can be made to your stretching program.

  5. Hi, I am 9 months out since my surgery. I am still having pain with shoulder flexion (more towards the end range of flexion) and can’t sleep with my arm above my head without comfort. Each time I try and throw a ball (as part of my return to throwing program prescribed by my OS) I am left so sore that day as well as the day after sometimes. I am trying very hard to go light and not over do it, but even really light throwing days are sore. I am just worried Um not healing properly. Any thoughts?

    • at 9 months this is likely more of a mechanical problem. You really do need ideal strength in the rotator cuff and in the lower trapezium, middle, trapezium, serratus anterior, and a few other muscles.

      I would have the strength and flexibility of the shoulder and surrounding tissue looked at with a fresh set of eyes. Call around and find a really good PT who deals with sportsmedicine and shoudlers.

  6. Hi Dan,
    I had a labrum repair almost 5 weeks ago.
    I’ve honestly been pretty bad about my sling the last week or two, I think the relief of pain with my pills made me a little never than I should have been. But the main reason I wanted to take it off is my wrist has had major pain since being in the brace. Post-op I wasn’t given detailed instructions on how to wear the brace and I didn’t have the new thump loop portion on my brace because honestly it annoyed me at first and after o looked up a video of how my brace is supposed to be set (3 weeks later) I realized it wasn’t on correctly originally anyways. I’ve tried icing, badaging it, etc. Almost 2 weeks now its been hurting, have you heard of this before?? I’ve been wearing my brace again the past couple days. And trying to be patient, I definitely don’t feel like I’ve overused my arm by any means, but how long will pain linger? Should I still be on my narcotics? I’m having issues sleeping still. I think a lot of the pain is tightness from obviously not using my muscle but it is pretty fierce still at least at night. Thanks for your input!

    • Braver** not never

    • Jazz

      The pain can last for many months. In terms of the drugs, that is between you and your doctor.

      I would definitely see your PT and get a live opinion on everything that is going on. I am guessing that your shoulder position not great in that sling. I would also get an opinion from the doc as to when you can ditch that sling.

  7. Angela Gould says:

    Hello, I am 13 weeks post SLAP repair, I have 4 anchors. I have been trying to use the arm normally (as normally as possible within pain thresholds). I am 33 years old. Over the past couple of days certain movements of my arm are creating a grating and popping sound. My arm and shoulder are never fully comfortable either its a constant dull ache with ocassional stinging/shooting pains. I am worried I have done some damage. Is this all normal?
    Thank you

  8. Hi, this is the most helpful sight I’ve come across! :)

    I was just after some help, I had a hip labral tear repaired a week ago and 25% cartilage glued back down, I am still on crutches and doing my physio exercises each day, I have been told to weight bear on my leg and feel I can do this ok… Apart from a strange pain down the front of my quad. I am just worried about how much I should be doing at this point as I don’t want to do any damage by over doing it… I am very sore today and feel like I have took a step back. I don’t know wether to rest it for a few days or keep trying to be active! I have not started with a physio yet and any help or hints you could give me would be great!
    Thanks :)

    • Emma

      This early on it is probably better to be safe than sorry. I would walk less rather than more, and make sure that you and the PT are on the same page when you start rehab. It does take a good 4-6 weeks for any anchors to heal entirely with most of these surgeries. I highly doubt that you messed anything up given that your pain appears to be from bearing weight.

  9. Hi Dan,
    Love the website. Im 8 months out of a posterior labrum repair. 60% of labrum was torn. The tearing must of started 10 years ago as thats when my first subluxation happened. My stability and range of motion are improving and on track. The only problem im having is with a pain in the surrounding muscles. I get a pain that radiates from the lateral portion of the collar bone all the through the collar bone and to the neck when i do light weight dumb bell bench press exercises. Do you have any suggestions of how can help get rid of this pain?
    Thanks
    Elliot

    • Elliot I would have to watch you doing a bench press to tell you exactly what I think is going on. From what you are saying I would guess that something is going on mechanically that is causing your neck muscles to “kick in” when you exert. The most probable explanation would be rotator cuff weakness.

      See someone who can analyze your movement.

  10. Really enjoying the information and the encouragement as I recover from my second labrum repair. Currently
    4.5 weeks post op from a SLAP repair…huge tear requiring 4 holes drilled. I am experiencing stabbing pains,bicep cramps and spasms,and still quite a bit of swelling. I am very impatient,but trying hard to protect my shoulder!

  11. I was diagnosed w a SLAP 2 tear, plus possible bone fragment in my shoulder joint plus cysts where my collar bone meets my humerus I posted earlier about being able to take minimal time off work. Thank you for your answer on that. I am tentatively scheduled for surgery in May but lastnight I started having increased pain with movement in my shoulder & as of today I can only lift my arm a few inches from the side of my body with a very sharp pain. Reaching for the phone at my desk was very difficult today. I left a message for my doc but waiting to hear back. 800 mg rx ibuprofen hasn’t touched the pain. Im not sure if I did something I shouldn’t have, I don’t think so but does this sound like a complication of this tear?

  12. My 16 yr old had a labrum tear in his non throwing shoulder, he had surgery on Dec 8th. He has been in rehab since with no complications, no pain and has good range of motion. My question is how long before he can bounce around and do QB drills again? Like I said it’s his non throwing arm but I’m nervous about the running and quick movements in the post-op surgery. Thanks

    • Adam

      The youngsters do heal much quicker than the rest of us. I would say that the normal return to sports time for most adults will be 6-12 months. A sixteen year old could probably do it on the short end of that time frame, maybe 4-6 months????

      Football is quite ballistic in nature, so I would also consider getting him one of those neoprene stabilization sleeves that loop over the shoulder just to give him the extra support. As always, you guys need to get the final clearance from the surgeon.

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