April 17, 2014

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. Hi I had a tear repair on Feb 18,2014
    Is it normal that I’m experiencing ALOT
    Of pain and clicking upon movement?
    What is going on?

    • Some people have a lot of pain for the first month or two. The clicking is probably the rotator cuff tendons gliding over parts of the humerus bone, which happens more often when the shoulder muscles are weak.

      I seriously doubt that you re-tore anything. You would have to have done something extremely jarring, like a fall.

  2. Im about four months and two weeks out from my SLAP surgery had six anchors in. Im feeling better and have pretty much full range of motion for a normal person, although I always had some extra.

    Most of the pain in daytoday has pretty much subsided. I do occasionally get a little pain around my rear delt. Was curious what that might be from. I originally got the surgery after feeling something along the front area of my shoulder, so curious why this pain is there. Its not sharp, just during certain motions like the backswing of a hard step out of the blocks on a sprint. Sometimes it’s there, sometimes it’s not. What might that be from.

    Doug

  3. I’m at my 4 month mark and definitely clicking when i raise my arm at certain angles and a good click/clunk when I act like I’m throwing at a specific angle. Did I reteae it!???

  4. Hi. I am 9 months out from my surgery on a torn labrum on my right. I am 16 and have played a season of volleyball and basketball since. However, I am yet to feel 100%. About 3 months ago I dislocated my left, but luckily no tear. Is it normal for my right to still hurt while writing and doing daily repetitive activities? It’s along the back of the top of my trap and causes me to take breaks in my clases. Thanks for any advice

    • Lindsey

      You sound very hyper-mobile. You should talk to a PT and get some stabilizing exercises to do on a weekly basis (if you are not already). It sounds like your scapular muscles need some conditioning.

  5. Darrell says:

    Hi, I am five months, one day out from left shoulder labrum surgery, a big tear from 12 to 6 needed six anchors to fix. I’d been doing really good went back to the gym, and back to doing almost everything except pullups. Then yesterday during my back workout I was doing some straight-bar rows, and it felt like my left bicep tightened up some. I stopped immediately, and I haven’t been in any huge pain, but my bicep has felt tight ever since then. I’m afraid I may have re-torn or something. Theres definitely not much pain at all and I havent lost any range of motion but was just concerned I guess.

    Thanks, Darrell

    • How heavy were the straight bar rows?? If you were “heaving” the weight with a heavy load I might be a bit concerned, but this sounds more like a biceps strain. Remember that your biceps is going to be quite affected and weak from the surgery given that it attaches right on tot he labrum.

      Let it rest for a week or two. Afterwards try some light work and see how it goes. There is certainly going to be some more strength to be gained at onyl 6 months post-op.

  6. I fell of my bicycle May 2013. Although at the time it didn’t hurt, when I returned to the gym a week later I started to experience pain in my ac joint. MRI showed edema is the ac joint with some arthritis and a torn posterior labrum (noon – 5 o’clock). After months of PT, I decided to have surgery on Jan. 15th 2014. They anchored down the labrum, did an AC resection and decompression. I was in a sling for 4 weeks. PT has progressed fairly well and I think pretty aggressive. My ROM is getting better. I can lift my arm across my body and nearly above my head. I’m doing a lot of band work and light weights, mostly rowing type exercises on a machine, cable or DB. I’m also doing light shoulder presses (10-15 lbs) and cable triceps pushdowns. I’m also doing a lot of stretching exercises. My ac joint still hurts occasionally and I have a pain in my bicep tendon (long head). That is pain I did not have before surgery. My MRI showed the tendon to be in good shape and this was confirmed during surgery. Is it normal to have bicep tendon pain after a posterior labral repair? ? The back of my shoulder is tight, I’m wondering if it is pulling that tendon tighter than it did before I had surgery. I want to return to working out and riding my bike. I’m hoping things get back to normal here in the next few months.

    • Shoulder capsules will at times tighten as a result of a trauma such as surgery. If your capsule is tight, all sorts of pain can occur. Your rotator cuff muscles and biceps are also in a weakened state given that your surgery was not that long ago. I would back off the amount of weight that you are doing with the exercises and keep it very light.

      Expect at least six months before things feel more normal. You did after all have two injuries to deal with.

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