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

Discussion

  1. Denise says

    Hi, Dan:
    Up all night due to not being able to sleep after a 200 degree labrum tear and biceps tendon repair six days ago. Your site has great information that is so helpful for me. What I really need to know is: when can I go back to work safely? I am a bedside registered nurse directly involved in patient care. CPR is a pretty common occurrence on my unit as is a lot of moving of patients (boosting/bathing, etc). I’m already bored at home! Thanks…

    • says

      Denise it will likely be a while before you are doing the very physical stuff. Maybe 3-4 months? You could do more “light duty” type tasks sooner, but it sounds like a lot of your job is very physically demanding. Everybody recovers a bit differently based on age, fitness, body type etc., so I would ask your PT the same question.

      Better to be bored short term than to give yourself a more chronic problem.

  2. chuck says

    Hi Im 7 weeks out of labrum surgery, and I feel going up the stairs a week after. My question is. I stood have a lot of pain on and off. I’m about 110% at forward range of motion, after that my pain is bad. At night when I sleep I wake to out of control paon. It feels like my shoulder is being torn off. Is the normal. Thank you.

  3. Jack says

    Hey dan, not quit sure if my last question went through. (Phones been acting weird lately). But I’m a thrower on my track team in the shot out and discus. I had surgery on October 14th. Everything was successful, did 6 weeks in a sling, 12 weeks therapy. I am wondering if by July I can start training in the shot put?

    • says

      Jack my guess would be yes, but clear it with the doc. Do you guys have access to a strength coach???? I would also get on a strengthening program for prep work. Shot and discus require a lot of strength and control as you know.

      If you don’t have a strength coach, it may be worth your time to see a good sports med PT to get a basic idea of what training to do and when to do it.

      • Jack says

        We don’t have a strength coach for our school, but my gym has A few exercise physiologists who are gonna help me get back in the mix this summer. They doc said no throwing this track season(March-May), but he never said anything about training in the summer. My PT said I should be able to throw for next years track season though. I just wanted to get another opinion, just to be sure! Thank you sir!

  4. Erin says

    I’m 5 weeks out from a SLAP repair (3 anchors). This may be a silly question, but can weather, especially changes in air pressure, effect the pain level of a post surgical joint like it in can in arthritis patients?

    Thanks!

  5. Joe B. says

    Hi Dan,

    I’m about 11 week outs of a SLAP/Bankart repair (4 anchors total). Things have been going great until this past week. Over the last three days I have been in a good bit of pain. The only thing I can think of was I had to fly on Monday and at one point I put my other carry on bag over my right shoulder (the one operated on). Not sure of the exact weight that the bag was (typical carry on weight) and it was probably on my right shoulder for about 2-3 minutes at most. I’ve been in a lot of pain after being relatively pain-free for weeks. I worry that I “ruined” the surgery. I have PT later today and will be seeing my surgeon for my 10-12 week checkup on Monday.

    Is it possible to “ruin” the surgery from this? I hear that the sutures are fairly strong and it takes a lot to damage them but now I am really starting to get worried.

    • Kurt says

      Joe b,
      I am currently 7 weeks out and just experienced the exact same thing you are like a week ago… Flew to louisana and the next day my shoulder was very sore, I just spent a good two hours before bed icing it and woke up back to normal

    • says

      Carrying a strap over the shoulder in question for a few minutes would probably not do anything major unless the bag weighed one hundred pounds or more. You probably just strained it a bit. Eleven weeks isn’t bad for not having any pain at all.

      You are in the area where you are starting to use the shoulder, that will usually coincide with some strain on the weakened rotator cuff.

  6. Jamal says

    Hello,
    I am a baseball player and I tore my off throwing shoulder labrum by dislocating it. The doctors that I have talked to believe that I will be able to return to normal level of play in about 4 to 6 months; do you think they are being overly optimistic?

  7. says

    So helpful .
    I was getting anxious from the noise I am hearing like a crackling in my shoulder . I am 13 days post op from a slap repair.

    I thought I must done something to ruin my newly attached tendon. But from reading your article it seems it allighg be normal ; maybe

  8. ryan says

    hello this is my 2nd slap surgery on the same shoulder.
    my doctor thinks the first one must not have healed properly. I was moving during this time period and remember I had a violent fall. I think that might have pulled the anchors . well I’m 1 week into my 2nd surgery and just wanted to ask, “how dificult is it for me to rip out an anchor”? I am worried that anything I do might rip it out. are these fears reasonable or does it take something quite traumatic to destroy the work done on the operating day? thank you!

    • says

      Ryan it typically would have to take something like a violent fall that you described to dislodge an anchor. I would just be careful and wear the sling according to what the doctor prescribed. No crazy movements and no high-risk exercises please.

  9. Len says

    Just wanted to add some insight. I had labrum surgery October 24th, 2014. I am on my 5th month of recovery and was just cleared to start light lifting (10 lb. dumbbell curls) and light jogging. I am an athlete, I injured my shoulder during a heavy bench press in 2012, I waited 2 years to get it looked at because I am hard headed. Getting to my point without taking away from Dan’s site, once again I am 5 months into rehab, and in my opinion it will take 5 more (possibly up to a year) before I start heavy lifting, fully swinging a golf club, etc. Just be patient, do not rush the process, even when you have days where you think you feel fully healed. Physical therapy is key, and ice is your best friend. Good luck to all!

  10. Danita says

    Hi….Iim a CNA andI have a labrum tear on my left shoulder from work. I have been on light duty since August. I am suppose to see a surgeon by the end of this month. My question is; is my injury likely to be worse due to the time elapsed? (It hurts constantly) and how long before I can return to my CNA job do you think? I work for a retirement home and there’s lifting involved plus I’ll be 50 in October. So I’m no youngster per say. :-)

    • says

      If you are doing heavy lifting all of the time, it is possible that you might be slowly extending the tear. Overall though, I do not think that waiting will make your recovery any more difficult.

      Given your age and what your job description is, I am guessing that it will take a minimum of six months to get back your ability to assist in lifting patients. It will be a long process, you need to be patient and stick to the rehab outline that the doc and PT give you.

  11. Jordy says

    Hi, I am coming up 7 weeks post bankhart lesion surgery I had four anchors. I had repeated dislocations from Judo. I stopped wearing the sling this week. Today while lying on the couch I randomly flinched thinking something was on me like a bug and my arm had slight external rotation, I had a sharp pain in the shoulder immediately, is this something that could ruin the surgery??

  12. Nico Scherer says

    Just wanted to give a short feedback here for all those close to despair:

    After having my posterior (180°) labral tear repaired in November 2014, I’m by now (but only recently) able to perform all actions of daily living without pain. Climbing-sports are yet to come.
    It was a really long way with many ups and downs.

    Keep thinking positive and have patience!

    Greetings

    N. Scherer

  13. Jayton Brown says

    I just had labrum surgery yesterday. I hurt it playing basketball the diagnosis was that my labrum was detached. What I the absolute fastest recovery time possible? I’m am 16 looking to play basketball a sap season starts mid November

    • says

      Jayton I think that you are young enough to have a speedy recovery, but I would still say that it will probably be 5-6 months before you are playing again. That should put you on course for being able to play in November. Stick to the PT’s plan and don’t go past what you are supposed to be doing, even if you feel great.

  14. Ashley says

    Hello, I am six weeks out of the bankhart surgery with five anchors and was allowed to take my sling off a few days ago. I’ve been using my arm a lot since and the shoulder has been doing a strange creaking/ vibrating quite often. In addition it was been extremely sore. If this normal? Should I avoid using my arm completely?

    • says

      If you are just out of the sling, make your transition in to arm usage more gradual. It does sound to me like you may be using that shoulder too much. It is still weak and that weakness is often manifested with creaking of the tendons over the boney ridges with movement.

  15. David says

    Hi, Dan.

    I’m roughly 8 months out of surgery for a posterior labrum repair done on the right shoulder. Since January, my shoulder started to crack, grind, and pop quite consistently. In fact, running or putting the shoulder in a swinging motion triggers these symptoms quite frequently. There also is minor residual pain in the armpit region. For lack of a better term, the shoulder still feels very ‘weird’.

    I was examined by my physician in March regarding this and she confirmed that the shoulder is lax (I do have a Sulcus sign). Before making any decision, she sent me off for a second opinion with another doctor. He too confirmed that the shoulder was lax, but stable (he did a few physical tests). I did not really understand this statement, but he said the shoulder was solid (I do not have apprehension or pain in positions from the tests done). He told me to really go back and work on strengthening and stretching as he was not happy with my current strength during the resistance tests. He did offer me an MRI, but he thought it would be unnecessary due to the aforementioned. He seemed very confident that this was the case and that improvement would be down the road. Regardless, I do have a follow up in June with him again.

    Seeing as you run a very nice physical therapy program, I’m curious to know your thoughts are on my situation. I’m just surprised issues are still occurring 8 months out. I thought I was doing a good job on my workouts given by my PT, but it was not the case. I’m not sure what to do at this point. Any opinion from you would be wonderful.

    Thank you for reading and make it a great week!

    David

    • says

      If you are not having excessive laxity and dislocation at this point the surgery was at the very least moderately successful.

      I think that most of what you are describing can be explained by weakness of the surrounding rotator cuff. I would stay away from stretching for a while and focus more on the stabilization / strengthening aspect of rehab. I am a huge fan of the “Body Blade” as a rotator cuff stabilization tool. Ask your PT about getting one, and have him or her show you some stabilization exercises to do with it.

      You probably still have a few months to go, but all in all it is not uncommon to be where you are at 8 months post-op.

  16. Meghan says

    I am two weeks post-op from my SLAP repair in my right shoulder and I begin PT tomorrow. I have a weird question- I was attempting to put my hair in a ponytail this morning with my left hand. I did use the arm that was operated on to help fix my hair but as soon as my shoulder starting hurting from that, I stopped doing my hair. However, my should has been sore all day. Any chance I reinjured my shoulder? I know it’s a really strange question but I appreciate any advice.

  17. Leigh says

    I am on my 7th week out of surgery for a bone spur removal, a very slight rotator cuff repair (literally just a few stitches), bursitis cleared out and a posterior (6-11 o’clock i think, 3 titanium anchors) labrum tear. I have been very good about trying to push myself through physical therapy and i am now out of the sling completely. I know my Dr had to tighten up the tendon as i went about 8 years without getting help. I am concerned because i have been getting a very sharp, shooting pain across the front of my shoulder. It also feels as if my scapula is grinding into the ground when i do and overhead exercise (with a very light curtain rod). Is this something of concern? I did ask my Dr and my physical therapist, but neither seemed to have a good explanation.

    • says

      You are probably just impinging the rotator cuff at the very top of that curtain rod exercise. I would back off the range a little bit. It sounds like your range is already doing well, there should not be a pressing need to aggressively push the end ranges.

      • Leigh says

        Thanks Dan, after more prodding with my PT he thought maybe some kind of knotty tissue formed while being in the sling so long. Since my scapula was away from my rib cage. He knuckled under the shoulder blade (ouch) in hopes of breaking it up. I don’t feel much different so i don’t know.

Ask a Physical Therapist a Question

Your email address will not be published. Required fields are marked *

Disclaimer: By clicking on the I Agree button below, the individual posting a question fully understands that any response to the question is merely the opinion of the physical therapist and should not be taken as a prescribed course of action. Any advice given by the therapist must be cleared with the treating physician involved in direct patient care. The person posing the question absolves the responder of any liability in regards to opinions given.