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. says

    My wife had a labrum tear a little over a year ago. She had surgery and started pt about 4 weeks post op, upon going to pt for around 2 months she heard a pop in her shoulder with extreme pain. After another scope it was realized that her labrum had tore again and could not be fixed due to the tissue around the tear being deteriorated. She now has no rom
    or strength in her arm and she is in extreme pain if you move her arm, her dr has sent her to a specialist. The specialist
    has sent her for a nerve test which come
    back great and now wants to do a nerve
    block because he claims he doesn’t see a
    reason for the extreme pain. Is this something to worry about since her last surgery was 4 months ago when her dr told her it couldn’t be fixed

    • says

      That is a very tough question to comment on. If the shoulder is not getting any better and pain is a huge issue, a nerve block might lessen the pain so that she could be able to function with her daily activities. I just do not know how long a nerve block will last.

      It can’t hurt to get the opinion of another orthopedist at some point. The nerve block will likely not get rid of the root cause of the pain, but it should “cover it up”.

  2. Chris says

    Dan, I had a tear in my labrum and bone spurs taken off my rotator cuff at the same time. I’m 33 weeks out, surgery on Oct. 13, 2014. Did my stretching and rehab diligently. Still stretch and do rehab exercises 3-4 times a week. I started back at the gym after 6 months, doing very light weight and of course perfect form. My shoulder still feels loose at times, almost how it felt before surgery just when I am walking on the stairmaster or walking on the treadmill for a short period of time. I know it’s normal to take between 9-12 months to feel normal, but I feel like it should be stronger at this point. Should I be concerned or just put my head down and keep plugging away in a careful way? Thanks.

    • says

      My guess is that it will take a few more months to get a full stabilizing effect. Keep up with the exercise, and do allow for rest days. I have seen some patients who over-train and end up with rotator cuff muscles that temporarily lose their stabilizing effects because they are trying to recover.

      I have always been a huge fan of the “body blade” for RC stabilization. Ask your PT if he or she uses one, and if it would be appropriate for you to work out with one occasionally.

  3. Sarah says

    Hi Dan,

    Thank you for this very helpful post. I am scheduled for shoulder surgery June 17. I live in DC, so I’m hoping to visit you and your team at PhysioDC soon after! I am a 30 year old moderately active female and have dislocated my dominant shoulder four times since I was 21. The first three times were traumatic dislocations (two throwing, one falling on the arm), the last was “atraumatic” (as far as that goes with dislocations!) when I inadvertently placed the arm in traction overhead opening some blinds in my apartment and just kind of lifted the shoulder out of the socket. Other than dislocating it every few years, my day-to-day quality of life isn’t really impacted. I have full ROM and no pain (even lifting overhead, like luggage on a plane). That said, I’m tired of dislocating and feeling apprehensive about athletic activities. Plus, the relative ease of my last dislocation really freaked me out, so I think it’s time to fix things.

    I had an MRI arthro that showed an anterior labral tear (Bankart maybe?) and Hill-Sachs lesion. My surgeon anticipates using four anchors, and maybe performing a capsular tightening. After reading many of these comments, I’m really worried the surgery will negatively impact my ROM or result in lasting niggling pain forever. In addition, I’m currently enrolled in an MBA program at Wash U that requires monthly air travel to St. Louis, which I’m certain will be tough with only one arm! And, if that’s not enough, I am planning a cross country move with a three week drive at about 11.5 weeks post-op. My doc seems to think I will be fine for traveling to school and the move, as long as I have help packing and loading. Is he being overly optimistic? Would it be feasible, recovery-wise, to have a PT in both DC and St. Louis? Like everyone, I want to heal and progress as quickly as possible, while of course staying within the bounds of what my doc and PT recommend.

    Thanks, and hope to see your team in a few weeks!

    • says

      At 11.5 weeks you should be able to at least tolerate a cross-country move Sarah. I wouldn’t be lifting boxes and hauling things around, but light things would probably be okay. Hire movers or con some friends into helping you out.

      From what you are saying, if the shoulder heals back with a tiny bit of rotational tightness that may actually be a good thing. We don’t need you dislocating ever again, and too much external rotation tends to lead to dislocations.

      Congrats on getting in to the Olin school!!!!!

  4. Mike says

    Hi Dan, I had a SLAP repair on July 29th 2014 and then I had to have a manipulation surgery in Dec of 2014. My ROM is good not %100 but acceptable. However I am still experiencing a loss of strength in the shoulder but only when extending my arm out, up or to the side.I’ve endured 80 PT sessions and went through 4 weeks of work hardening and still the strength has not improved past 8lbs. My obvious concern is 10 months after the first surgery and 6 months after the second is what is the likelihood of the strength not returning. I’ve researched this and could not find this scenario anywhere, so I’m hopeful it will return. Thanks

    • says

      Mike if it was just a SLAP repair without rotator cuff tears I see no reason why you wouldn’t get back more strength than you currently have. The manipulation and tightness has probably slowed your progress down quite a bit. It may take a few more months to see more concrete results.

      Yo may already be doing this, but I would focus on strengthening your scapular support muscles (middle traps, lower traps, and serratus anterior). Try to allow for a day of rest in between work outs as well.

      • Mike says

        Hey Dan, thanks for your response. I have been consistently working out every other since a month after the manipulation. That’s partly why I’m so concerned/frustrated that the strength has not returned. I guess my question is it a matter of when or if the strength will return and is this common?

  5. JoJo says

    I’ve dislocated my shoulder 6 times. First time was in 2000. I was messing around with my friend & was thrown to the ground, my elbow hit first & my shoulder popped out. Went to the ER & had it put back in place. I was 22 when it first happened, I’m 36 now. Everything was fine until 2009, I was falling down some steps in a cabin, I grabbed something to prevent me from falling & it came out again. My friend put it back in for me but it took awhile. That dislocation was a bad one. It has come out 4 times since then. I finally went to the DR this year, had an MRI done, he said I have a Burkart tear in my Labrum & I also have a Hill-Sachs lesion. He doesn’t think PT will help & recommended surgery. After reading things about recovery time I’m wondering if I should do the surgery??? I can honestly say I have no doubt that there is a big chance it will continue to come out.

    Do you think I should have the surgery? Thanks for any feedback.

    • says

      Based on your history Jojo I would have the surgery. Your shoulder just sounds too unstable at this point. My guess is that you would probably continue to dislocate, maybe even with ordinary activities.

  6. Kurt says

    Hi dan,
    Great site by the way!! Has really been great for the months of healing! I’m currently 17 weeks out and am two weeks away from being cleared for everyday activists/sports.. My question for you is am i okay to start throwing overhand a little bit harder, I have throw very lightly with my buddies but have not pushed it at all yet.. Are my chances of dislocation or re tear not to be worried about now or should I still take it easy for a bit.. I haven’t had any pain/soreness at all through my whole recovery process, I didn’t pre surgery either.. Just want to make sure I’m not getting going to early, I am clear to golf July 1st so shall I be worried or no just listen to my body?? Thanks

    • says

      I would increase the intensity of the throwing very slowly. 4 months is still a bit early to be throwing hard, even for you youngsters. Ramp it up very gradually over the next several months. Same goes with the golf swings, start very conservatively….I would maybe start with hitting a half-bucket at the driving range and give it a few days to see how it feels.

      Do listen to your body, if you encounter sharpness back off. As always, stick to the doc’s timeline.

  7. DeMareo says

    Hi Dan.

    I had SLAP repair dec 16th.
    Was cleared for football at 4 months.
    Rehab and everything went great. ROM is almost completely back to normal. I typically play QB. (Minor league tackle) I played on the tear for 2 or 3 years. (So my doc thinks).

    So I’m 6 months out at this point and the tendon in my shoulder is still very firm almost solid feeling and it hurts to throw with any velocity.

    Lift heavy. All push and pull exercises. Feel a little pinch doing heavy curls in the front of the ahoulder though.

    Is there anything i can do to loosen that up or is it going to be like that ppermanently now.

    Thanks
    De

    • says

      It may still take several more months to get the full benefit from the surgery. It might also be worth it to check in with a PT one more time to have the strength of your scapular muscles checked out. If you are even a little bit weak in certain muscles it can drastically increase the demand on your shoulder.

      Lighten up on the curls.

  8. says

    I am a 40 year old recreational bodybuilder. I had SLAP repair surgery in October 2014 to repair a Torn Labrum. It’s been 8 months and I’ve been back in the gym since April. I have been taking it slow and easy. Light weights with good form. At this point (June) I am using weight where I fail at about 12-15 reps and I feel okay. I need to start using heavier weight where I would fail at 3-6 reps so I can rebuild the strength and size I had before the injury. Unfortunately, I don’t feel ready for that yet. I tried one heavy set whlie doing a lat pull down back exercise and it didn’t feel good. Had pain during the exercise and now it is very sore. Before injury I was 195lbs with a 29inch waist. I am 5’8. Currently I am 175lbs and waist is 32. I need the heavy weights to get back to pre-injury form. At what point, if ever, can I comfortably resume heavy weight traing?

    • says

      I think that you will probably gain back some more muscle………but a 3-6 rep max is risky long term. After about 1 year from the surgery you should have a feel for what is appropriate in terms of weight and reps. Remember Michael to listen to what your body is telling you, if it feels pathological you need to back off. The unfortunate truth is that your tendon strength and capacity to recover is not the same as when you were in your twenties.

  9. BIG BEN says

    Hi there I am 27 and I was a heavy lifter until i had a grade 3 ACJS. The MRI determined that i had a tear in my LABRUM Anterior to Posterior. Thats bankhart and slap at the same time. get this: ON BOTH SHOULDERS. so i am trying to hold on to my sanity. I had the surgery AUGUST2014 and now recently in FEBRUARY. the later operation was to add a couple sutures to my retore labrum and WEAVER-DUNN was performed on my AC JOINT. I am exactly 5 MONTHS post op and she is stable. BUT, I feel a light sting CENTER MASS on the front side of my deltoid where my bicep tendon probably is. it isnt terrible and it HAS been there since surgery. i have full ROM but feel pressure at the last 5 degrees.. minor clicking. but when i hold weight it is stable. if i hold weight in my other arm i sublux LOL I have strange shoulders. I can gran a pole and without letting go turn MORE THAN 360 DEGREES. is my Clavival ever going to stop having referred pain? and how can i convince SSD that i am indeed disabled? i need my right shoulder scoped asap. thats 3 surgeries in 2 years with zero income….thanks

    • says

      Ugh. This sounds like a mess Ben. It may be a year or more before that referred clavicular pain goes away. I hope that you are not planning on becoming a heavy lifter again. If your shoulder is still subluxing then I would be very careful about end range motions.

      You cannot convince SSD that you are disabled, that needs to come from an independent medical evaluation (I think). I think that it depends on what your line of work is and how much lifting and carrying you need to do.

  10. says

    Hi my name is Sandy I am 32 yrs old. I am having a lot of pain since I had arthroscopic labrum repair on April 2, 2015.
    I had a very significant tear repair with two anchors put in place and bone spur removed during my surgery. The doctor says that i am heeling slow and I have alot of inflammation in my bicep and shoulder. He says I don’t have frozen shoulder and my motion is good thus far but I can only stretch as far as he moves me but it is very painful when he does.
    The nurses and doctors said that when I woke up from surgery I was very agitated and fighting and moving the shoulder that they just repaired around profusely. Of course I don’t remember any of it! But could I have messed up what the repaired during that time? Could there be something else wrong in my shoulder or am I just a slow healer?

    • says

      I forgot to mention that I have had several surgeries on that same arm since 2010. I had A TFCC tear repair in 2010 which healed fine. In 2012 I had ulna bone shortening due to an injury at work. That surgery didn’t do so good and they ended up taking out the plate in September 2014 and 2 months later the bone separated and now I have non-union in my ulna. Its stays inflamed and hurts constantly.

    • says

      Sandy it is possible if you were thrashing your arm around that you may have done something to the repair. It all depends on how violent the movement was. If the pain is slowly going down from week to week that is a good thing. It may take many more months for that pain to go away entirely. Having multiple surgeries on the same arm might also make it more sensitive to pain. All in all, this will probably just take a significant amount of time to recover from.

  11. Adam says

    Our son Adam was a pitcher since 3rd grade and pitched through high school (going in his college junior year). In retrospect, toward the end we are quite sure he pitched with multiple tears. Currently he is 11 months post torn Labrum surgery. I believe all 4 ligaments were completely torn so it was reattached with anchors. Last week (June 2015) he got an MRI because of a continued feeling of instability, crackling and neck pain. He also feels unstable on the left side. The MRI showed the right shoulder was structurally in tact. The problem and reason for this email is that he was kind of dismissed by his surgeon when the MRI indicated his original surgery still looks in tact. Unfortunately he went because he still has issues. Is it possible it is something simple like he needs more time? Is neck pain and instability in the opposite shoulder common (he was never a lefty in anything)? Where does one go from here? Thanks, Ron

    • says

      It is great that there is no issue with the original surgery.

      This might be a mechanical issue, especially if he is experiencing neck pain. I would ask or call around and find the best PT in your area who deals with shoulders and get a fresh sets of eyes on his mechanics and alignment. It may be that he has a few weak scapular support muscles that are causing an imbalance with his shoulder girdle and neck.

      The loose feeling in the opposite shoulder might be part of a larger picture of instability that your son has in his joints. Some people are just born “stretchy”. A good PT should immediately be able to see that with an evaluation.

  12. Jimmy says

    I had SLAP repair surgery 6 months ago this week, 12:30-6:30, 5 anchors. I followed Dr’s protocol exactly, had PT onsite at work so was religious about going at least 2X per week and never missed a session. Saw the doctor every two weeks as scheduled and was progressing. I’m close to full range of motion, probably 95% of the way there, still some tightness in front (pec) but have been in the gym for 6-7 weeks, light weight, high reps. Haven’t started increasing yet and do my stretches daily still. Doctor cleared me to chip and putt at about 3 months and progress to bigger swings at about 4.5 months. At 5-5.5 months, cleared me to play and discharged me. I played 3-4 times in a 2 week period, easy swings no issues – actually it felt better than ever. Haven’t picked up a club in 2+ weeks but continued my gym workouts – now I’m having more intermittent pain than I have for a couple months in the front and back of my shoulder and sometimes down the sides. Some non-painful clicking and popping too, especially when I try to stretch my arm across my chest. Not debilitating pain, but noticeable at times. I picked up a club and swung it in the yard and it felt different than it did 2-3 weeks ago. Is it likely to have re-injured at 6 months without having any major trauma and not doing something stupid in the weight room (which I haven’t). Or is this just normal ups and downs of SLAP repair recovery?

  13. Sam says

    Hi Dan, my son had labrum surgery 9 months ago he is a HS QB. He was cleared to throw a couple months ago. We have taken it slowly. He has gradually increased his distance but now he seems to have some set backs. Is it normal for him to have a sore bicep? He ices every night after practice but he is getting impatient. We just want to know could this be a sign of a larger issue?

    Thanks
    Sam

    • says

      The long head of the biceps attaches directly on to the labrum, so I would take that seriously, especially if it worsens.

      I would have the shoulder checked out by a really good PT to get an assessment of the lengths and strengths of all the involved muscles.

      • Sam says

        Hi Dan, we went to his PT he was told that his capsule was inflamed that is causing the pain. Is 9 months to optimistic to be 100% and is the pain normal for a thrower? The pain is no longer the bicep it is now at times tricep, a little pain in the front labrum area and sometimes back of the shoulder

  14. daan says

    Hi Dan,

    I am 34 years old healthy sporting male and had a labrum operation in January this year. The operation was successful and they used 2 bone anchors to attach my labrum to the bone. They also found a Hill Sacks defect. The surgeon told me after surgery to pick kitesurfing (my passion) after 6 months. But… recovery was quicker than average according to the surgeon and PT. After 2-3 months I was able to do strength exercises in the gym again. I also still have PT 2 times a week for my shoulder. Strength is almost back to normal (17% difference in max torque) and the PT lets me do almost every exercise. But there is still some discomfort with some exercises and stretching. Surgery is now 20 weeks ago (so about 5 months).

    Because I felt confident in my shoulder again I went kitesurfing yesterday. Although I was careful I crashed and went head over heels in the water. Not that bad, but still… Yesterday when I went to bed I felt a whining(nagging?) discomfort in the shoulder again and the shoulder felt tired. Alarms bells went off because this was the feeling that I knew from before the operation. My question is: can the pain come from putting the labrum operation wound under stress again with the fall and can it just be irritated, or are the symptoms telling me it is torn again?

    Hope you can help!

    Daan

    • says

      That is tough to tell Daan. If you don’t have full strength in the shoulder, higher level activities such as what you described can put you at more of a risk for causing damage to the shoulder. The stress could go to the labrum or even the rotator cuff. Give it a good week of very little activity and assess how it is feeling. It probably would be a good idea to follow up with the doc or the PT for a quick evaluation.

  15. John B says

    Thanks so much for this site.

    I’m about 9 weeks post-op from a anterior labral repair. Out of sling and doing PT. Three days ago I slipped in loose gravel and fell. Out of instinct I kept myself from doing a face plant by using my arm and hand – the surgical side. I immediately felt odd like I had an adrenaline rush. 10 minutes later my entire shirt was wet with sweat and my stomach starting cramping. I’ve been in significant pain since then, not feeling well at all. I’m actually on vacation and won’t be able to see my doctor until the following week. How concerned should I be that I have re-torn it? Any suggestions for me until I can see my PT and doctor?

    • says

      Ice it and try not to use the arm too much. With a hard fall there is the possibility of a re-tear, but by 6 weeks the anchors are usually set pretty well.

      The nausea and sweating may have something to do with the jarring motion on your spine, not necessarily the shoulder. When certain nerve are quickly jerked they can produce what is called a “vast-vagal” response ,which kind of sounds like what you are describing. Regardless of my thoughts, you should certainly see the doctor.

  16. Erin says

    I’m 27 and had a slap repair at the beginning of March. I’ve been healing very slow especially with rom, and doc says now I have a lot of scar tissue built up. I Still can’t lift my arm passed 90 degrees when upright (though I can get to about 150 or 160 when laying flat, external rotation is much worse). Even when I do lift it that much, it looks “funny,” like the ball isn’t moving but rather my whole shoulder pops up. Doc says nothing to do but give it time and stretch, which is quite painful still but I push through as much as I can. I’m wondering if there are any alternative treatments you’ve seen work for helping with scar tissue issues?

    • says

      It does sound like the shoulder is tight. Some people just lay down more scar tissue that others, and unfortunately you cannot “get rid” of scar tissue. I would stay on course with some daily stretching under the guidance of the PT.

      In extreme cases, the doc can put you under for a few minutes and manipulate the scar tissue to break it.

  17. Kristen says

    I had surgery to repair a SLAP tear and anterior/inferior tear 4 weeks ago. My pain was steadily decreasing until last week. Now it’s aching more and harder to sleep. During isometric internal rotation at my therapy, I get a localized pain near the deltoid insertion site but it’s not tender to palpation. I don’t recall any specific traumatic movements since surgery, but am sure I’ve unknowingly tensed up at times in my shoulder and bicep. Is there any way that I may have messed something up? I don’t go for a follow up for another couple weeks.

    • says

      When exercise is introduced post-operatively, there is quite often pain like you have described. From what you are describing I do not think that you messed up the anchors. Stick to the doc’s protocol and make sure that you give it adequate rest, especially if you are feeling inflamed. It is fine to skip a day of PT exercises.

  18. says

    I had tore my Labrum in 2 different area’s. 1 tear was in around 5 oclock and other was I think 8. if I’m right.. 1 tear was about 1cm the other was 1.5 cm. My injury was not sports related but acute. I was recovering minor foot surgery which I was to be non weight baring on one foot. My other leg I am missing a Kneecap. Leaving it unstable. When discharged I was only given or told to use MY Forearm crutches.The following morning I went to get up my leg that has no kneecap is unstable when I get up the other foot I was to be non baring. when I went to step the knee gave and being on forearm crutches the shoulder slide and popped..Thats injury

    I am now 9 weeks post op.. I have been telling the surgeon how much pain I am in.. it is worse that before the operations. The pain is more now in Bicep to elbow into hand.. I had Bicep pain from beginning. Now it is much worse. Shoulder and Shoulder Blade awful. I cant press down on anything simple like soap dispenser. Sometimes simple hand rotations sends pain up my arm into my shoulder. I cant sleep the amount of pain builds up so bad. I sleep on a slant. I did all I was supposed to do.

    I am doing very little in rehab and haven’t changed it in the 3 weeks since I started it.. I don’t at times want them touching it. If someone bumps my shoulder the wrong way side to side it brings tears to my eyes..

    Im frustrated because the Dr feels he did a good Job while he was in there and felt it looked good when he repaired it.. Now he is in God mode and as a wall put up. I have what is called Chiari’s and had 4 Brain operations to correct. I told him that there was the possibility of Connective Tissue Problems..

    Something is wrong and he isn’t listening and its frustrating.

    Any help would be great.. Please I know this isn’t me..Btw Im not old either mid age .. Lol A Lot of like with great humor just not finding it in this..

    Thank you for reading

    Amy

    • says

      Amy I am wondering if your prior diagnosis (Chiari’s) is having an effect on your brain’s perception of pain? This surgery can produce a lot of pain for a long time, but your amount of pain does seems more than what is expected.

      You might get some help if you were to see a “pain specialist”. There are doctors out there that deal with pain that is limiting your ability to work on strengthening etc.. In the mean time I would at least try to do a little bit of what the PT and doc are recommending in terms of range of motion.

  19. Doreen says

    I am a 48 yr old female. I injured my right shoulder in a bad fall in Oct 2013 but thought what I was feeling in my right arm/shoulder was a results of the herniated disc in my neck that I received as a result of the same fall. Oct 2014 I started taking martial arts and the excessive stress on the shoulder, coupled with a fall on the shoulder, caused my shoulder to start hurting constantly. Went for an MRI in April 2015. Diagnosed with high grade rotator cuff tear and Labral tear (that’s all I know). Dr immediately said surgery, I asked for PT first, he said ‘well I guess it wouldn’t hurt.’ Just went back to dr, said surgery again. I have a clicking in the front, and pain in the deltoid area upon little repetitive movement, which my Physical Therapist said could be muscle strain or referred rotator cuff pain.
    I am considering surgery but am afraid that I will be left with limited range of motion, or limited strength…
    I have plans to travel extensively to rough areas in the future, and am concerned I could regret the surgery. Yet not doing survey leaves me in pain with minimal repetative movement (like PT). Do i take the risk? If i was just the average 48 yr old female, I would not even consider surgery. But I do missions tripz, just came back from the primitive Amazon Jungle, and have been out in the bush or Africa. Planning on going back to the jungle, and planning on going go Iraq in A year, which would have to get pushing zck if i get the surgery….do I get the surgery? What are the chances i will be worse off after surgedy….

    • says

      Doreen based on your physical demands it might be a good idea to have the surgery. You did indeed have a bit of damage to the shoulder, and I am not sure that rehab alone will make you functional for what you need to do.

      The problem of course is that the surgery will limit what you can do for a good 6-12 months. It is a tough decision for you to make. Based on the damage that you reported I would guess that one year after the surgery you would probably have less pain and more stability.

  20. Nate Schenker says

    Dan,

    I’m 27 years old and got into rock climbing about two years ago (bouldering specifically, which is a more physically intensive discipline). I can’t remember exactly when, but maybe 6 months after I started, something happened (not an acute injury if I remember correctly) to my left shoulder. Lots of popping and clicking and occasional aches and pains, especially when laying on the arm. Despite aggravating it a few more times (the last of which was about 3 months ago, leading to quite a bit of pain/temporary loss of ROM), I have been able to climb through it for the most part.

    However, due to growing frustrations, I finally got an MRI and found out I have a small tear (3 to 5) of the anteroinferior labrum and “superior labral recess at the 12:00 position with anterosuperior sub-labral foramen”, according to my results. The doctor said it is up to me and suggested I could try PT and see if that works. Since then, I have tried a lot of rotator cuff strengthening exercises, as well as exercises aimed at resetting and strengthening the scapula, but just when it appears the discomfort is decreasing, it always tends to pop up again.

    I have never dislocated, but the pain/discomfort is just enough to affect the level at which I want to climb. Before the initial injury (I wish I could remember when/what it was), I progressed very rapidly. However, since then, I have slowed quite a bit, with my shoulder limiting what I can do. That being said, I have not yet committed to a full-fledged PT routine.

    My question for you is this: considering the history I have given you, do you think extended PT is worth a shot, or would I just be delaying an inevitable and necessary surgery to climb and progress at the level I want to climb at? At this point I know how to manage the tear very well, understanding what moves to avoid and how to lay off the shoulder if need be, but this really affects my climbing at times. I do go through periods where the discomfort seems to disappear altogether, which is amazing, but it never seems to last. Do you think PT and continued strengthening would remedy this, or would it be better to just opt for the surgery sooner than later? What about a focus on general strengthening of the core and antagonist muscle groups (triceps, etc.)? Thanks for reading!

    -Nate

    • says

      It sounds like you are in one of those “grey areas”. In my opinion it is always worth the time to do the conservative routine and see how it responds. Find a really great PT and work on the scapular and RC strength and mobility for a full course of treatment (2-3 months worth at least). At the very least that would make any surgical recovery easier to tolerate because of the increased strength.

      The real question here has to do with how badly you want to rock climb? If it were me, I would probably just find other things to do with my recreational time that are less offensive to the shoulder. But then again I am lazy and cynical.

  21. Amy says

    Hi

    I had surgery 15 weeks ago to repair a bankart lesion. My shoulder had been regularly subluxing for 4 months after an initial dislocation. MRI showed labral tear and hill sachs lesion.

    2 weeks after surgery I woke up during the night in excruciating pain that ended up in hours of muscle spasms and inability to move my srm – I had all the symptoms that I was getting after a dislocation. I had been cleared to sleep without the sling which I shouldn’t have listened to as I am a thrasher. A week later I saw my surgeon for a post op appointment and told him about the incident and the increase in pain I had since – he dismissed it. A few weeks later I woke up with the same pain and saw my physio the following day who said I needed to see my surgeon. Once again he dismissed it and said the surgery was a success and my shoulder was stable.

    Over the next 6 weeks I started getting a sensation that my shoulder was slipping out slightly with certain movements, which I discussed with my physio and he said the muscles needed strengthening. I followed all instructions given to me and at my 12 week following up with the surgeon I expressed my concern that my shoulder didn’t feel right and that I felt it was coming out of place – once again I was dismissed, however this time he seemed quite annoyed that I was questioning him.

    My physio also seemed frustrated that I was questioning whymy shoulder was feeling more and more unstable, and why my pain was increasing. He told me to stop thinking about my shoulder and have a glass of wine – not helpful! So I decided from then on to keep my mouth shut and just follow the set protocol. I just wanted to get it all over with so I never had to worry about surgeons or physios again. Unfortunately just a few days ago I had a slight incident while vacuuming and my shoulder disclocated. By the time I registered what was happening I suddenly grabbed my shoulder and it popped back into place. I now feel back to square one with constant pain, the sensation that it’s out of place, and this time I have pins and needles in my fingers and palm. After the initial severe pain and spasms settled I decided I’d just ignore it and hope for the best. However, it has since come out partially two more times.

    I’m at a loss as to what to do now. I don’t want to go back to that surgeon, he clearly didn’t fix it well enough the first time and I’ve been telling him for months it didn’t feel right! I also don’t want to start fresh with another surgeon, it’s just all so disappointing. Is it possible to dislocate and not do any damage? Is it likely to rip out the anchors after 15 weeks? I’m thinking I might just be able to handle this by continuing my strengthening exercises as I just don’t trust anyone anymore. I am mostly worried that I l might have anchors floating around, but if that’s unlikely I think I’ll just live with the instability.

    I would appreciate your thoughts.

    Amy

    • says

      It does sound to me like the surgery is not a success.

      Amy as much as you don’t want to hear this, I would recommend that you find another surgeon who comes recommended from multiple sources. I have found that a good way to find the surgeon that you need is to call a bunch of physical therapy clinics in your area and get a PT on the phone. Do not tell them who your surgeon was. Ask them directly who he or she would use if he or she had to have shoulder surgery.

  22. Stu says

    I’m a 53 male in good physical condition. December 2014 I awkwardly lifted a wooden frame storm window up and over my computer monitors and tower that are sitting on my desk with my arms fully extended from my body. I felt a strange, not painful sensation, in the posterior part of my right shoulder as I lifted the window over and down. In the coming weeks/days/months I was in a lot of pain. I tried maintaining my regular exercise activities as much as possible. Some where painless to do (pullups and chin ups) and some not so much (shoulder presses and punches) were really painful. Finally, I went to a orthopedic and have been in PT for the past 8 weeks. It’s better. I can now do things I couldn’t before PT, like start my lawn mower and remove my shirt and jacket from my right shoulder with my right arm with little to no pain. The doc says he’ll do an MRI at anytime I want. How will I know if/when I should get the MRI? For instance, will they be able to adjust my PT any to better target my recovery based on an MRI? I really want to get back my strength and am getting frustrated with how long this is taking. The past week, I’ve been noticing more popping in my shoulder. It doesn’t hurt, but is that an indication, one way or the other, that the PT is working? Thanks for your help!

    • says

      At this point Stu I would probably get the MRI. If something is torn we need to know that, because that type of pathology will not really “heal”. If there is indeed a tear you can make an informed decision in regards to what you are willing to live with.

  23. JPP says

    I had labral repair surgery about two weeks ago. After doing some of the stretches suggested by my surgeon and his PA I am worried I have re-torn the labrum, as I am having soreness in the region as I did pre-surgery in the same postures. As pre-surgery, it comes and goes. I have not extended my arm above my head, or to the side. The three stretches: rotating my arm in a clockwise motion while it is fully extended downward, holding my hands behind my back, and one that looks like this image, but standing up, bent over a table, where I inch backward: http://tinyurl.com/qy5zmmx

    Is this soreness/pain normal, or should I be worried?

  24. says

    Hi Dan,
    i had labrum repair 3 years ago and i recently started doing cross fit, it’s been only 3 weeks that i started and today after exercising i felt pulsating pain on the shoulder where i had surgery. It felt like when i first had the pain prior surgery. At this point i don’t know if i should wait a couple of days and wait to see if the pain goes away before calling my doctor. i only hope i didn’t damage my shoulder again.

  25. Maddie says

    Hi Dan,
    I torn my labrum from swimming in November 2014 and had surgery in February 2015. I’ve been doing physical therapy since then and was cleared by my orthopedic to swim again about a month ago. Once I’ve started back though it still hurts. I don’t know if it’s because I’m starting back with too much yardage or is that just expected for awhile until things get back to normal? I’m still doing physical therapy at home and icing and taking Advil when needed. I’m just wondering if a little soreness is expected with getting back into sports.

  26. Jeannine says

    Hi Dan,
    I have just gotten my MRI results and I have a superior (SLAP) tear as well as deteriorated rotator cuff muscles. My Doctor said that the newest research shows that doing a biceps tendensis in place of a SLAP tear often is more effective for healing and recovery. Especially in patients over 40 (I’m 47). I’m wondering what your thoughts are on this procedure and would they usually do the tendensis in replace of the SLAP repair or would they do both? I do not want to have a labral repair done and then find out it’s done nothing or even worse, it doesn’t heal properly and my pain is worse. This is a chronic issue – it wasn’t diagnosed until now and I originally injured it 3 years ago. So I really want to be able to exercise and be pain free again so I want to make sure I make the right decision.

    Thank you,
    Jeannine

    • says

      Jeanine I have heard of that being done instead of a labral repair, and it is generally true that labral repairs in the over 40 crowd tend to not have fantastic outcomes. I do also believe that a biceps tenodesis would be easier to recover from.

      If you have tried PT / strengthening and have gotten nowhere then the tenodesis may not be a bad option for you.

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