September 16, 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 Dan,
    I had 2 surgeries in the last year on my shoulder. The first one the doctor cleaned up and debrided the labrum. It never got better so I had a second opinion. The new surgeon noticed a Slap tear that was present during the first but never repaired. So in May he repaired it with 3 anchors and removed more fragments. I have a large piece of the labrum missing. I also have developed scalpular winging after the second surgery. Ive been in PT for the last month just trying to gain ROM. It gets irritated very easily to the point where I cant lift it more then 6in away from my body. The surgeon says im way behind where I should be but that it was also very damaged. This has been ongoing for the last 16 months and im worried it wont get much better. The pain is still awful and its locked up 3 times on me since the last sugery. Im worried I wont be able to return to my job as a C.O. Any thoughts or suggestions would be appreciated.

    Thank You

    • It sounds like you need to strengthen your “serratus anterior” muscle. If the scapula is winging, the serratus anterior muscle is not doing its job, and that can effect the mechanics of how you lift your arm. Work on strengthening everything very slowly and under the supervision of the doc and the PT. It takes quite a bit of time to recover from two surgeries, stick with it.

  2. Hi I have being diagnosed with a slap tear , I have had a cortisone injection and physiotherapy but unfortunately this has not worked for me , The next step is Surgery to repair the tear , Iam a self-employed hairdresser , how long will it take for me to get back to work ?

    • Sue I would guess 2-3 months. If you are doing your work on clients with your hands close down to your sides, you may be able to get back to work sooner rather than later. I would get the client chairs low in order to keep your arms in a protected position when you start back to work. Of course, the final OK needs to come from the doctor in regards to return to work activity.

  3. You all should check out this guys story.
    https://m.youtube.com/watch?v=S2ECEMZFhCo
    He is inspiring :)

  4. Stan Lewis says:

    Hello, i was diagnosed with a bankart tear and had and my ligaments/labrum repaired 11 weeks ago, i am an athlete and want to get back into playing football and basketball as soon as possible, my therapist says i am very far ahead of schedule. What is a realistic timeline for being able to play football, weeks wise, after surgery.

    • I am on the conservative side Stan. I would give it at least six months post-op, and make sure that you have a good amount of strength before you try to practice. It also goes without saying that you need the full endorsement of your doc and PT.

  5. Hello, I just had my 3rd shoulder surgery on June 27, 2014. My 1st surgery was to repair a torn labrum following a dislocation, however I had complications of a frozen shoulder so had a manipulation procedure done. Following that I had numbness in my hand as well as pain in my elbow. After a couple years I saw a new doctor and after getting a MRI it was discovered that the labrum was torn and the anchors no longer in place so an open procedure was performed. I saw improvement following that surgery however in May of this year I dislocated the shoulder again. I had an MRI with authrogram and determined that I had torn the labrum again with a bankart tear. I had an open procedure with capsular shift and bankart/labrum repair. I have been in PT for 6 weeks now and still having severe pain, alot of subluxation around the joint to the point it wont stay in place and catches especially during manual manipulation at PT. My Physical Therapist recently tried the KT tape which does help stabilize it however I can’t continue this daily due to skin irritation, I am very frustrated and don’t know where to turn at this point. I have more instability now than before. Any help or advice would be greatly appreciated.

    • Krista this does not sound like fun for you. If it were my shoulder I would back of the manual stuff for a good two to three weeks and let any inflammation calm down. It doesn’t sound to me like you need to have your shoulder moved around for a little while. I realize that the doc may be concerned about the shoulder stiffening up like it did before, but if you are feeling unstable and subluxing on a regular basis to me that is more of a problem.

      • Thanks for your response. I am going to talk to my therapist today but I do have alot of concerns regarding the shoulder freezing like before causing me to have to have a malipulation which is what caused elbow pain and nerve damage as well as all the tacks that were put in came loose from the 1st surgery causing me to have to undergo a 2nd surgery. I currently only have ROM of 82 degrees over head and hardly nothing behind my back as I still can’t even tuck my shirt in with that hand. This is all very concerning to me as it is my right hand which is my dominate hand. I am 38 years old and the pain I am currently in I cannot continue for years to come. Is being back in a sling a good option or is there any shoulder brace that may help. KT tape helped but I can’t wear that all the time as it causes skin irritation. Pain medicine/NSAIDs have upset my stomach so dealing with all this pain is definitely wearing on me. Do you think another surgery of a different kind is in my future or is there other options. Thanks again for your feedback.

  6. mark graham says:

    Iv got a torn labral iv to go for an operation i work in a shop how long would i be out of work?

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