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. RJ says

    After many years of lifting and sports, I hurt my shoulder to the point where It hurts whenever I lift, throw, or do anything that requires my arm/hand above my head for a short time. I went to an orthopedic doctor and got an MRI done after 2 months of PT didn’t work. I have a decent labral tear in the front of my shoulder. The doctor said If i get the surgery I might not be as strong as before and less range of motion can be expected. I am 20 and have dealt with the pain for almost a year now. I am afraid to get the surgery because of the side effects (I enjoy lifting and playing sports) and am not sure if I should continue just dealing with the pain? I was advised that the tear more than likely wouldn’t get worse with either decision.

    • says

      RJ it sounds to me like the labral tear is keeping you from doing what you want to do. Since you have tried the conservative route, the next measure could be a cortisone shot? You would need to consult with an orthopedic surgeon about this.

      In terms of having the surgery, I would guess form your age that you would ultimately have a good outcome. It may take 6-12 months for total rehab time however.

  2. Craig says

    I am so glad to have found your article about managing expectations after surgical repair of a SLAP Tear – this is exactly the type of information that I have been looking for. I was particularly intrigued by the fact that the author, himself underwent 2 such surgeries.

    In my case, I am a 49 year-old Chiropractor who will be undergoing surgery in 1 week to repair a slap tear (Type II C). Given that the activities that caused the injury are the very ones that I will be looking to get back to for my occupation, what would your expectation be for the amount of time that I might realistically be looking at before I am able to perform manipulative procedures involving downward thrusting movements such as those involved with manipulating the thoracic and lumbo-pelvic regions?

    Any input that you might have would be appreciated!

    Craig

    • says

      Craig I really do think that you should be able to do all of the manipulative treatments after a labral repair such as one you described. You may have to modify your body positioning for a few things. I would just try to keep all movements below shoulder level (downward thrusting sounds fine).

      In terms of the time frame, I would give it a good eight months of recovery time. You ought to be able to do a lot of work activity before that (maybe by four months??), but eight months is a realistic time to allow for strengthening etc. .

      • Annoyed says

        Hi there I had a slap repair with bicep tendonese done around 7 weeks ago around 2 weeks into healing I was geting sharp pain to the point u couldn’t walk pain was down the arm to relive the pain I had to take it out off slign now this is were the problem lies I fell down and put pressure on that arm and pain was the worse it felt could I have damaged it again

        • says

          I would see the doctor and get the shoulder checked out. You are close to the time where the anchors will have healed well in to place, so it is very possible that you just strained the shoulder significantly.

          • Annoyed says

            Thank u for the reply I did see the dr today he said it has prob pulled the anchors and wants a mri done ASAP I hope his wrong

      • Craig says

        Thanks so much for your reply. You have given me a personalized and therefore realistic time-table around which to align my expectations for the next several months. Thank you for your help!

  3. pranhav says

    Hi Dan,
    I just underwent a shoulder arthroscopic surgery around 2 weeks back I. E. 3rd of July 2015 and had a bankart repair done.

    I also had floating loose bodies in the shoulder joint which were removed.

    It was a tear from 2 o’clock to 5 o’clock position in the labrum but the symptoms of my chronic injury as told by my surgeon were those of dislocation.
    Though the shoulder never actually got totally dislocated, but it was almost there..coming almost out and then again going back in.

    Now, the little issue that occurred which my surgeon told me after surgery was the fact that my cartilage was also damaged and injured.

    He told me that all the repairing work has been done and the loose bodies have been removed but the cartilage is something which cannot be repaired and does not regenerate naturally either.

    Sir, I’m a state level badminton player and being on the court is my LIFE.

    Infact the only reason why I got the surgery done was because I wanted to be back on the court soon.

    I’m following the post operative exercises diligently at home before the actual physical therapy starts in the near future.

    My main worry is that once I have shown a lot of patience for almost a year, done all the exercises and therapies as prescribed and done strict compliance of everything, please let me know how big an issue can the cartilage be in my case as I’m a very High intensity player playing vigorously for at least 2 hours everyday.

    Lastly, please do let me know the chances of recurrence after such an injury and the effect this surgery would have on my game.

    Looking forward to hearing from you soon.

    Thank you sir

    Best regards,
    Pranhav.

    • says

      If the labrum is repaired and you have adequate recovery time, I think that you ought to be able to get back to playing at a high level. It may take until the end of the year to get back however.

      The cartilage damage may or may not be an issue in the next several years of your career. I would make sure that you receive excellent rehab for this surgery. I think that you will be able to deal with the cartilage issue for your career, but down the road it may lead to more degenerative changes and arthritis. Make sure that you get good rehab and guidance as you go through this.

  4. bader says

    Hi Dan,

    I’ve read your article, superb by all means, so few of them covering SLAP repair, I have a question if you don’t mind, I’ve done SLAP repair back in march “4 months ago” and I started ROM workouts but I feel tightness around 150 degrees and If I push harder with my other hand I start to feel pain, if I’m laying down my elbow reaches just above my forehead when I stretch back, I kinda hit a wall here and I feel desperate, is there hope? will be able to reach 180? or even 170? I’m using hot packs for 10 min before starting.

    Best regards

    • says

      Bader it sounds to me like this is either some residual scar tissue from the surgery, or perhaps some active muscle tightening around the shoulder. Once in a while the connective tissue around the chest area can restrict overhead motion like that as well.

      It might not be a bad idea to get a 90 minute massage to see if that can loosen things up in the shoulder, chest, and upper back. I would find a massage therapist that specializes in that type of work. I would also try doing some stretches immediately afterwards per the recommendation of your PT. Remember to also clear this with the MD!

  5. Wayne Whitehead says

    Hi Dan,

    I had a slap repair a stability op on the 7th July. I have been fine the until the last 4 days. The doctor who performed the op advised I was looking at 6 weeks in a sling. Also no excercises to the side only out in front. This was because he has tightened the tendon across the front of my shoulder. I had my first visit to physio and he gave excerises contradictory to this. I explained what the Doc advised he checked his notes and said there was no evidence of this and his protocol advises otherwise. I started to follow his exercises and found that my shoulder began to catch. I do know If this is a coincidence or that I have damaged my shoulder. Today I have felt a pain in bicep and tingling in hand. Could you please advise what you think I should do. I’m worried and do not see my doc for another 2 days. i have tried to contact doc but haven’t had much luck. Sorry to ramble on I’m just a little worried that’s all.

    Thanks
    Wayne

    • says

      I would go over the exercises, one by one, with the doc and see which ones he does and does not want you doing. Having pain and catching sensations is not uncommon this soon after the surgery. In the mean time I would avoid any of the exercises that you are worried about. The doctor’s opinion legally trumps the opinion of the PT.

  6. J.D. Flores says

    Hi Dan.

    I am roughly seven months post-op recovering from a SLAP tear. This is actually a re-repair since the first one failed last summer. However, I have run into some issues since last month. I am running out of resources and have no idea what to do. Here is my problem.

    Recently, my shoulder has felt very lax. It feels like the humerus droops out of the socket. Whenever I hold onto dumb bells or anything that has weight, a small visible sulcus appears below the acrominion. Even during my walks, occasionally my shoulder feels unstable inferiorly as it glides during the swinging motion. It just feels loose in general.

    The catch, however, is that during physical activity the shoulder feels fine. As far as I can tell, there is no pain or apprehension whenever I do push ups, military presses, or bench press. Bear in mind I still don’t do extreme amounts of weight, but it seems fine. I was even tested with the O’Briens and a few other labrum tests and most didn’t seem to bother me. The only one that caused pain was during the apprehension test. I didn’t feel unstable at all, but the shoulder mildly hurt when put in external rotation. These tests were done recently.

    Maybe I still have a lot of strengthening in the shoulder area to do. I just don’t know if this is a normal complaint for an individual like myself who is getting close to the eight month mark in a few weeks. Any help would greatly be appreciated. Thank you for reading.

    J.D. Flores

    • says

      I would get another opinion from an orthopedist who specializes in shoulders. I would in the mean time try to avoid anything that causes a sulcus sign.

      It probably wouldn’t hurt to re-visit rotator cuff strengthening once the doc checks it out.

  7. John says

    Hi Dan- I underwent my second labral repair on the left side for shoulder instability in late May. Things had been going great up until a couple of days ago. I have 95% motion back already in all motions except external rotation 90 90 position. Previously there has been little to no clicking or popping in the shoulder at all.

    Just this past weekend, the shoulder became very painful in the underarm area. I took it easy on the shoulder and kept it in the sling when I went out as a precaution. The pain eventually subsided but now the shoulder is clicking and popping constantly. The shoulder feels a little loose again too. There were no instances of note where the shoulder was hit or overexerted in anyway. The most intense action my shoulder has went through was stretching at PT. I am freaking out, I can’t get in to see my doc for another couple of weeks. Do you have any thoughts on this?

    • says

      Definitely see the doc. Take it easy for the next few days and let things calm down. If your range is already almost normal, there is no pressing need to chase that. Let your PT know what is going on as well.

      If there is a little bit of inflammation in the joint it can cause the head of the humerus to move in a slightly ratchety pattern. I wouldn’t freak out quite yet, get the docs opinion.

  8. Jennifer says

    This is all very helpful information!

    I have been through a lot of pain with my right shoulder for a couple years (I am right handed.). I am 44/female and healthy and active, but I would not describe myself as athletic, and I have no current goals to be a quarterback or cross-fit champion :) I work out 2-3 times a week (cardio) and I do a lot of hiking, bit I’m not a weight trainer. I have a desk job, or rather, a laptop job.

    Due to severe pain in shoukder and bicep, and restricted ROM 2 years ago (cause unknown) I had an MRI which showed “maybe” a tiny labral tear, but inconclusive. I most definitely had frozen shoulder at that time and almost zero ROM, so since then I have had 3 cortisone shots in 2 years, and about 10 weeks total of PT in two separate series. As of late, since it’s been about 4 months since last shot, the constant burning pain between top of shoulder down bicep is back. My ROM is currently good, but this pain is like a constant migraine, in my arm! Doc ordered another MRI last week which now clearly shows a decent, but not huge, labral tear., with edema and lots of inflammation. The doc said that he is very confident in his surgical skills and success to repair this surgically, but he quite fairly explained the recovery is long and tough. So, we are going conservative; for one more round of PT and reassessing in 6 weeks. And, we are avoiding any more cortisone shots, unless the shoulder freezes again.

    basically, I am struggling with the decision how to move forward. Unfortunately I am so worn out from the constant pain that keeps resurfacing, that I have low expectations for this 3rd round of PT. I don’t *want* surgery, and I can’t imagine the discomfort and inconvenience of the recovery. but I also don’t want to get 10-15 years down the road when I’m older and perhaps weaker and then find surgery is really mandated. I have seen advice to others that if their lifestyle is not restricted by their tear (as in, if they’re not an athlete, etc), then surgery could or should be avoided as its so challenging to recuperate. I have not seen many comments from people here who simply have and don’t want chronic pain (like me). Again, I am grateful to have good ROM now and maintaining that with home PT exercises, but Is it possible that a third round of PT could really, truly eradicate or drastically reduce the pain? In your experience, have you witnessed many people like me, who don’t have major immobility or a huge tear decide to get surgery and ultimately regret it? Or, conversely, can tears get bigger and worse by avoiding surgery? I just feel like I’m in such a grey area, but with pain in the red area.

    Thank you!

    • says

      Jennifer I would do the PT, but get it from somebody new. Sometimes it helps to get a fresh set of eyes on the problem. Ask around and find out who the best shoulder PT in your area is.

      If you are still having the same pain after that, I would consider the surgery.

  9. Rachel says

    So questions…I dislocated/injured my shoulder May 19th. Torn labrum & bony bankart break as well as fractured humerous and frayed bicep.
    #1 is it normal to make someone wait 1 or 2 months before having surgery? (I had surgery June 30, lucked out with a cancellation or I’d still be waiting)
    #2 after injury ortho #1 sent me home in an immobilizer and told me to wear it for 6 weeks only to be removed during bathing. I wore it for about 2 days it made my shoulder burn to wear it. I did use a sling for a couple of weeks. never mind my point is I had a lot of scar tissue build up. When I finally saw the surgeon he said I should have been moving it and needed to do drastic PT. I’ve since been told and through reading that the older you are the less sling time you should do especially for women. I was/am a very active 52 female. I’d like to know your thoughts on that. I’m just curious as it is water under the bridge now.
    #3 I’m 3 weeks out from surgery and have chosen to only wear the sling the first week, after that I’ve worn it only when the arm was really tired. It feels better I’ve been very careful, I’ve been doing PT on my own, I did see a PT once he spent a whole of 15 min with me. I want to know if it’s okay if I just let my body guide me with pain etc on how much I can work the arm. I am very fearful of the scar tissue coming back. I can feel it tightening up.
    #4 Have you heard of Serrapeptase? (enzyme from silkworms supposed to dissolve scar tissue) do you have any thoughts on that?
    #5 how soon can I start massage A.R.T? and accupuncture?
    Thank you so much for any information you can give me. I’ve feel like I’ve gone through this completely alone, DR’s & PT are so busy their time is stretched too thin.
    Thanks,
    Rachel

    • says

      Waiting a month for the surgery would not necessarily be a bad thing.

      The sling is a necessary evil. It protects the labral anchors. Once they are healed in to place, I think that the sling can be “weened off”. Scar tissue formation is going to happen, you really can’t avoid that. In my opinion it is better to have the anchors healed with stiff scar tissue rather than damaged anchors from too much range of motion too early.

      Don’t let your body guide you, at the very least make sure that you have a written protocol form the doctor that outlines what you can do and when you can do it.

      I have never heard of Serrapeptase. Sorry.

      You could probably start acupuncture now, but run it by the doc. A.R.T. is a form of stretching and is probably also a good idea, but once again ask the doc as to when it would be okay to start.

  10. Doug says

    I was diagnosed with a Slap tear and have been dealing with it for a couple years. I am heavy into lifting but have never been able to do any shoulder lifts at all without pain/popping. Recently injured it further at work and was diagnosed with it again, therapy for 2 months only regained ROM. The decision of surgery is up to me and I am supposed to decide this week. I am a 21yr old male and work construction. Will I ever be able to get back into my weight lifting and continue growing and gaining strength if I have surgery? Or should I learn to deal with the pain and never do shoulder exercises? Also could I tear it more if I don’t get it fixed. And will I risk another surgery for my shoulder if I get it repaired?

    • says

      If you are having tons of pain that is interfering with work I would consider having the work done to the shoulder. The rehab will take at least a good six months, and you would probably be able to get back to weight lifting. I would just avoid the aggressive overhead exercises once everything is healed. You are going to have to be super patient about this if you decide to have surgery.

  11. Benjamin Cotton says

    Good morning!

    I have appreciated this resource since having my SLAP tear repaired 10 months ago. Everything has been going well — albeit a bit slower than advertised — and for the past several months I have experienced excellent ROM with little to no pain. Thought I was in the clear! Then a few days ago, I started to feel pain associated with certain movements — particularly at the furthest limits of my motion, but also with certain more subtle movements. It’s not unbearable, but it’s a problem with sports and exercise. I’ve been playing tennis again for a couple of months, as well as paddleboarding, swimming, push-ups, and pull-ups, but there has been no clear trauma or single incident involving pain.

    Just curious if this is a common bump in the road to recovery, and wondering if physical activity is bad for my shoulder while in this state. Any advice is welcome!

    Thanks again for the resource.
    Ben

    • says

      I would ditch anything that involves overhead motion for two weeks and let the shoulder heal. I would also make sure that the strength around the shoulder blade is ideal. It might not be a bad idea to do a follow up visit with a PT to get an idea if any muscles in particular need work. This sounds to me like a repetitive action irritation.

  12. Jess S. says

    Dan,

    I am so thankful for this article. It’s helped put a lot of things in perspective for me. I was hoping for guidance on the issue I’m currently dealing with.

    I am a very loose-jointed person. After a fall last year, it appears to have thrown my left shoulder more out of whack. Feels loose, achy / painfulespecially at the end of the day, difficult to hold heavier things for very long, running causes pain, can’t road bike, no core work without angering the shoulder, etc. As an active person, it’s been difficult to deal with!

    I have had a few opinions. One doc, post arthrogram with contrast, says I have a labrum tear and recommended surgery with debridement / maybe an anchor. Scheduled me for surgery on 8/11. My second ortho (he had the same images) said maybe or maybe not a tear, would say if I wanted to have surgery, could improve it by general tightening in surgery with 3-4 anchors. With that information, I felt a bit lost, and decided to go for a third opinion, thinking I’d get some average of the two. No such luck. He said no surgery, and head back into PT for six months then re-assess.

    Feeling a bit lost right now on what my best course of action is. While I am hopeful to get past the pain, etc., I’m not sure on the right way to do that. I get worried that I’m having surgery because it’s the next logical thing, whereas maybe I’m just stuck with it as a loose-jointed person. I could absolutely wait longer and see how things play out, but my husband and I are thinking about having kids before too long. So I’m thinking shorter term as opposed to longer.

    I appreciate your help.

    Jess

    • says

      That is a tough one Jess. It does sound to me like your shoulder is unstable. The accident probably exacerbated that. Another issue to consider here, pregnancy will probably make your joints even more loose (hormonal changes).

      I would try to rehab it for a few months and see if that helps. You should know within 8 weeks if it is going to be helpful or not. If you don’t get anywhere with it, having the shoulder surgically stabilized might be a good alternative.

      • Jess says

        Thanks Dan. I worked with a therapist from April until June. A lot of deep tissue work and exercises against gravity / rotator cuff stabilization exercises. We worked under the idea of, “do the exercises day 1, if on day 2 you feel more pain than day 1 hold off, otherwise do them again.” I was usually to day 3-5 before I was doing them again / until it had in-angered, for lack of a better term.

        It seems calmer now sans PT. Will still flare when I sleep on my bad shoulder side (something that is hard to convince myself NOT to do while sleeping unfortunately), while running (burning across top of my shoulder), etc. Based on this, do you think more PT could still help?

        What you said re: pregnancy echoes what my ortho said as well. Could pregnancy negate the positive effects of the tightening from the surgery?

        Thanks again. I really appreciate what you’re doing with this site. It’s such a gray issue and the “we won’t know really until we get in there” can be nerve wracking for those of us with first time surgeries. Good to know there are active resources out there — THANK YOU!!!

  13. Richard says

    Thanks for all of the information. These are frustrating injuries. I tore my labrum (I believe) multiple times, the first time being when I was 19 and overhead weight lifting. It eventually got to where I could do everything again without much trouble, but I hurt it again while throwing an overhand punch when boxing a couple of years later. It got better in a couple months, and then gave out while bench pressing. The final straw was wrestling, I felt it and knew it was messed up and decided at the age of 24 I’d finallyget it looked at.

    After an mri I was told that it was torn, and knowing that I wouldn’t be happy not being able to do the things that I enjoy, I had the surgery on January 29th when I turned 25.

    It’s been six months now and the shoulder feels pretty good most of the time. As long as I stretch, my ROM is pretty good. I get lots of cracks and pops still, but was told not to worry about them when I was in PT. I have recently started trying to strengthen it, and I do seated Rows and I bench press with just the bar. I can only do it a few times, and it hurts, but I assume this is normal.

    It’s been feeling pretty good and more normal lately, so I decided to try shooting my new gun, a 30-30. I was apprehensive, as I wasn’t sure if the recoil could re injure my shoulder. After shooting a round, it wasn’t too bad so I shot about five more. Afterward, it’s feeling a bit different, maybe extra poppy, a bit sore or tender, and slightly burning. I suffer from OCD,and I can’t stop thinking about it, so I wondered what your thoughts are, and if shooting a gun could cause reinjury this far along, if at all. Thanks for your time.

    • says

      Richard unless if you are firing a bazooka I do not think that you could have dislodged anchors given that your surgery was in January. Admittedly I do not know what a 30-30 is, I am assuming that it is a hand gun that is less powerful than a 44?

      Let the shoulder rest for a week and see how the soreness is. It might be sore for a few weeks. You can also run it by the doctor if it doesn’t get better.

      • Richard says

        Thanks, I appreciate the response. Is a lever action rifle, typical for deer hunting. It feels pretty normal today, but I’m glad to hear I cam shoot without messing anything up. Is the repair pretty sturdy? I’ve always wondered how easy/hard it is to reinjure after the surgery. Also, is it still normal to have pops and occasional minor pains when using it at this stage?

        • says

          After 6+ weeks the repair is typically sturdy, but there are always a slew of other variables to consider Richard. If the shoulder is weak you need to be careful with the recoil motion of the rifle. Listen to what your body is telling you, if it gets painful I would stop using the rifle for a bit and talk to your PT or doc about it. Pops and pain btw are very common for up to a year.

  14. stephen says

    I had labral repair surgery on my right shoulder exactly 4 months ago by a reputable surgeon in Brisbane, Australia. At the same time the surgeon performed decompression of the bone, he suggested both of these procedures were necessary in order to ensure the pain I was experiencing would be healed. My labrum had torn and leaked fluid and caused cysts etc. After surgery the surgeon was confident everything went well.
    My concern is that I am now 4 months into recovery and have 95% range back after what was a very stiff shoulder however I am experiencing more pain now in various locations around my right shoulder than prior to surgery, especially when my arm is bent 90 degrees and rotated, but I have some pain also behind my right shoulder blade, around my shoulder and in my bicep now, I’m really worried that I have more issues which have not been addressed. I see my physio every week and he remains optimistic but I’m not seeing any progress in pain reduction ????!!!

    • says

      Stephen in my humble opinion it is way too early for you to be worried like that. Give it another 4-6 months of slow and gradual strengthening under the supervision of a good physio. It sounds like the scapular control and rotator cuff strength are not there yet, which is totally to be expected. The acromion decompression adds a bit of time to the rehab as well.

  15. says

    Hi, I am three weeks post op, having had SLAP repair to my right shoulder. I have had three anchors put in and had my bicep tightened and bone shaved. The first two and a half weeks post op were okay, I had something pain but nothing unexpected. However, the last few days I have experienced excruciating pain and feellike my shoulder is going to pop out every time I take the sling off to do my exercises. I would just like to know if this is a normal part of recovery as I haven’t done anything to damage it, or is it a sign of something being wrong? Thanks.

    • says

      Kieran what you describe is very common for this stage. The sling is a necessary evil that will protect your surgery, but at the same time it often places the shoulder in a position the facilitates pain. I would back off the exercises a bit and talk to the MD and PT about it as well.

  16. Matt says

    Great website Doc. I have a question regarding my post op slap repair.Following a crash in the car I damaged the left shoulder. I found any lifting resulted in pain at the front of the felt. An MRI and series of slap tear tests by the surgeon confirmed a slap tear. The most painful test was the O’Brien test. I opted for surgery with 3 anchors. I am now 8 weeks post op. I have been following the surgeon and pt. My range of movement is now very much improved and I no longer have the constant ache and pain, especially at bedtime. Even tho I am a self confessed gym weights addict I have listened to the advice and am only doing static bike, and and elliptical with not using my arms. My question is this Doc…even tho I am very happy with the gains I have made with r.o.m. and I know repair can take a long time, the level of pain I have during the o Brien test is exactly the same and in the same place. Should I be concerned or am I just being Impatient?? Any advice would be fantastic thank you.

    • says

      Matt you still have a lot of time to go through before you are back to normal. Don’t worry about the O’Brien’s test, if you keep testing that you may actually be irritating the tendons and labral by doing so.

      Stick to the rehab protocol. If you don’t have one, get one from the doctor. Resistance training usually does not begin until at least 12 weeks. Be patient, you will get there.

  17. Cindy says

    I had a slap repair 10 weeks ago with bone spur removal and a clean up of a partial tear on my rotator cuff. At my 6 week post op appointment my range of motion was at 5 and 10 degrees so they sent me for a repeat MRI. I had a post op infection and have had terrible pain since the surgery. At about 5 weeks post op my forearm hit my doorknob and it pulled my arm backwards. The pain is mostly while lifting arm away from body and when sleeping. If I turn on my side and my arm falls across my body I get a sharp excruciating pain. What could I be looking at being wrong?

    • says

      Cindy your rotator cuff muscles are probably super weak from the infection swelling and the trauma of the surgery. Unfortunately the infection throws a monkey wrench into all of this in terms of the recovery timeframe. You very well may have no damage from the doorknob incident, but that certainly could cause a bit more inflammation and slow down the whole healing process. The scope of the work that was done to you also adds time to the rehab. It will probably take 6-12 months to get the shoulder rehabbed well. Be patient, and I would look for small improvements from week to week rather than day to day.

      It is of course a good idea to follow up with the doc so that he or she can make an assessment.

  18. Chris says

    I had my SLAP surgery almost six weeks ago. So far, my shoulder has been only minorly sensitive. The last several days, however, I’ve been having significant “cramping” pain in my bicep. The pain has started migrating down to my forearm. Is this normal? I’m concerned that I might have damaged something, but don’t want to be a worry wart over something that may be part of the normal recovery process. Input is appreciated.

    • says

      Your pain probably has to do with the forward positioning of your shoulder, maybe from early sling wear or your body’s protective response to the surgery. It also may have to do simply with an increase in activity? Talk to the PT or the doc about it. It does sound like the bicep is irritated.

  19. Jennifer Carpio says

    I had left shoulder impingement from a bone spur and a torn labral (sp?!) repaired three months ago. My Dr. had me out of my sling the day after my surgery and five days later I began physical therapy. Is this common? I’ve read most patients remain in their sling for at least 4 weeks. I’ve been in physical therapy three times a week for nine weeks now and I can my hand above my head at 170 degrees, however I still have to gain shoulder strength and lift 40 lbs in order to return to my job. I’m struggling to lift 20 lbs at PT..will I ever get back to “normal strength”.

    • says

      There are different protocols for post-op shoulders. My guess is that the doc didn’t do much in terms of labral repair. The protocol can be much more aggressive with a spur removal as the main intervention.

      You will most likely get back almost all of the strength, although it will likely take another 4-6 months to get there.

  20. Themi says

    Hi I’m a little over 7 months out of slap tear surgery. My labrum was torn on the front and back so surgery was a necessity. I attended physical therapy for the first 3 months and then began doing the workouts on my own. I recently started lifting again but there are many workouts that give me problems. I have not even attempted any over head workouts. I do not bench till the bar hits my chest anymore I go to 90 degrees but I did lat pull downs three days ago and my shoulder is still significantly sore. I thought by now I would be 100% but I am no where near. I’m 20 years old and plan on going back to mixed martial arts and also working construction. Do you think there is a chance I re-tore my shoulder? And also do you think I should go back to physical therapy and stop lifting? Thank you

    • says

      It is probably going to take a few more months of lighter weights and rotator cuff exercises to get the strength in line. It wouldn’t hurt to see the PT one more time to get some training ideas to deal with any strength issues that you still may have. Most people really take a full year to get back to the weight routine. From what you said I do not think that this sounds like a re-tear. The only way to be 100% sure is a follow up with the doc.

  21. Brian says

    Hi, I tore my labrum in my left shoulder about 4 years ago from a fall (fully extended arm to catch fall from 3′ ledge). The doctor said it most definitely needs surgery (complete tear, said he was surprised it took me a couple months to go get it checked out as most can’t tolerate the pain). He had stated 6 weeks immobilized in a sling. I have held off on surgery mainly due to recovery concerns.

    I am at the point where I am tired of dealing with the pain and finding limitations (steering with left arm straight out hurts; learning to ride motorcycle was put on hold due to issues turning handlebars).

    Considering I have a desk job, how much time off from initial surgery is realistic? Doctor I believe said maybe a week. If the shoulder is in a sling, can the forearm be turned out away from the body so I can type on a keyboard or will I need to one-hand everything for 6 full weeks? I could bring my keyboard onto my lap to reduce arm extension if needed.

    After reading your article regarding times, I have another question. I’m on a HSA (health savings account) and insurance is set where once i hit my yearly responsibility, everything is covered (which clearly the surgery would meet). Based on the expected recovery time, how long should you plan on medical expenses post surgery (including PT visits)? I’m trying to decide whether I should try to get it done in the fall and have time to handle appointments before year end or if I should hold off till Spring (once snow is gone)?

    Thanks

    • says

      Brian I would estimate a bit more time than what the doctor said in terms of getting back to the desk job. Maybe 2-3 weeks. You should be able to type by the time you get back to work, it may take some gradual increasing of typing times. In terms of the shoulder, having your elbows at your sides and using a keyboard might slightly irritate the shoulder early on, but I highly doubt that you would effect the anchors.

      The PT can last anywhere from 2-6 months depending on your outcome. I know that is a wide range, but people react differently to soft tissue trauma.

  22. says

    Thank you for taking the time to help many of us struggling with shoulder issues. I dislocated my right shoulder last December. (Right handed) Pretty substantial injury. This was following a couple of minor shoulder injuries that did not require treatment. Since December I have had a dozen minor dislocations that I was able to self-reduce. I don’t have any pain outside of temporary pain when a dislocation occurs. I am 58 years old, pretty active. Tennis, skydiving, backpacking etc. An MRI indicates a detached labrum and a tear in the supraspinatus. I am scheduled for surgery next Wednesday. I don’t like the fact that I have to think about every move I make with my injured shoulder. I have even dislocated once while sleeping. I would like to be able to play tennis again. I am told by my surgeon that they normally don’t recommend labrum repair for a man my age, but it’s the only way to stop the repeat dislocations. Do you agree? Remember I am in zero pain in my shoulder. Are there exercises that could help the dislocation problem short of surgery? From what I am reading here, I stand to lose a lot of mobility and strength in my arm. Even with the labrum injury, today I do about 100 push ups a day with no problem. Thanks again for the help!

    • says

      I agree with the surgeon John, you need to have something done given that your shoulder dislocates so readily. You could do stabilization exercises, but from my experience your shoulder sounds too unstable. I do no think that an exercise routine will totally prevent dislocations. And so far as tennis goes, an overhead serve does not sound like a great idea in your current situation.

      The rehab will be chore for a while. It may take you up to a year to get back a good amount of function and strength. you are going to have to be a very patient patient.

  23. Will Hughes says

    I had the labrum & tendon surgery last October 2014 so it’s been 9 months since I have had the surgery, I do PT everyday with gum bands and stretch and take ibuprofen daily and ice it, but like last week I was throwing a football and it will flare up for a few weeks and be sore anything I do but I’m trying to test it out? I try lifting light weights and it irritates it too! I don’t know if this is normal being that it’s almost been a year or what I should do

    Thank you

  24. says

    Hi, I have a SLAP tear procedure being done in a few weeks, and may need one done in my other shoulder too. How long would I need to wait between surgeries, most likely? Thanks!

    • says

      Dave I suppose that depends on what you do for a living. If you have a very physical job you may have to wait up to a year to let the strength in the surgical arm catch up. If your day to day activities are not so bad, you could cut that time down in between surgeries considerably. Maybe 6 months?

  25. Shawn says

    Dan,
    I’m an ortho doc’s dream. 2 right ACL reconstruct (95′ and 04′), 1 left ACL recon 96′, 1 left separated shoulder/broken clavicle 93′, and a shattered left humorous with external fixation device 97′ car accident. Other than being accident prone, everything was pretty calm until mid-last year when shoulder would be in pain during infrequent movements but nothing too crazy. Just had our 3rd child and after discovering that the pain I was having while holding her in my left arm during her bottle was related to a clavicle bone spur (probably from 93′ and 97′ incidents), an MRI revealed gnarly bone spur and, you guessed it, 360 tear of labrum. Doc had cancellation come up 2 days after MRI. so I had surgery on 7/30, “one of the worst tears he’s seen” but Rotator and AC Joint were in great condition. Other than the typical junky noises I hear now and then from water, tissue and everything else, my wife also assists in a doc prescribed exercise where she raises my bent arm to a position parallel to the floor, then while supporting my elbow, she rotates my lower arm to 10-30 degrees.
    Yesterday, during this movement, my humeral bone felt like it moved either out of socket or got caught in other minutia. Though I had to slowly lower it and massage/maneuver it back into place, no serious pain after or today, but can you help all of us and future candidates understand expectations of bone movement given the operated areas are in the process of healing and being retrained. I’m nervous that some of the noises and movements I experienced must be common, but there were no initial expectations or disclosures. I’m going to Disney with big family on 10/18 and want to be in a condition to enjoy all that I can. Sorry for the novel, but thanks

    • says

      After a surgery such as yours you basically lose total strength of the rotator cuff muscles for the first month or two. The rotator cuff muscles are vital in controlling the head of the shoulder bone in the socket. What you probably felt was the head of the humurus getting slightly caught on one of the tendons while it was trying to rotate. Probably no biggie but it can be painful.

      Do me a favor and have a PT look at how your wife is ranging you. There is probably a way to range you in a safer manner. If you are being ranged in a seated position, your supraspinatus muscle in particular will kick in unconsciously. Not the best idea.

  26. Ciru says

    Hello Dr. Dan,
    I had a bankhart lesion in my labrum repaired and am now 16 weeks post surgery. I have full range of motion back with no discomfort and only a bit of tightness at times. Strength wise I am at 3 sets of 10 at 35 pounds on lat pull downs and 3 sets of 10 at 45 pounds for seated rows. I am a female college athlete and was wondering if my strength is still pretty under average or if it’s average now. Also my therapy protocol says I shouldn’t be sprinting, but my shoulder feels so stable that sprinting is easy. Also my right shoulder (the injured one) is now more stable than my left shoulder. I am a goalkeeper and was wondering if I’m pretty close to field player shape and if there’s any chance that I’ll be in shape to train as a goalkeeper anytime soon.

    • says

      You are ahead of schedule Ciru. You likely have your age and your prior fitness level to thank for that. I wouldn’t be doing dive catches quite yet. You do need a final clearance from the doc to go back to training for goalkeeping. If I were to guess I would say maybe he or she could give you the green light at about 20-24 weeks?

  27. Lynn says

    Hi,

    I am about 3 weeks away from SLAP surgery (single anchor). I have an office job and do a lot of typing and writing. What is a realistic goal to be able to sit (with good posture) and use a keyboard/mouse, and write. I know lifting, pushing, pulling, crawling and climbing won’t be possible for 2-3 months, but the computer work I have no expectations for outside of being in the sling for 4 weeks.

    Thank you for this article and all the comments, It has been a valuable resource.

  28. Michael says

    Hi,

    I had surgery to repair a SLAP tear about 5 weeks ago. I’m still in a sling and will be for one more week (6 total). I am experiencing an achy kind of feeling in my shoulder. It feels like it is cramping up almost. I am worried that this is not normal and that I may have to wear the sling longer. I never take my arm out of the sling unless I am taking a shower. I just want to know, if I reinjured my labrum would it be obvious to tell? And also, is this feeling normal?

    • says

      Michael the feeling that you are describing might actually be because you are wearing the sling. The sling does protect you, but it also does place it in a position that is not ideal for the normal mechanics of your arm. When you get the OK from the doc, wean off the sling a bit at a time. I would also get a good battery of PT exercises to work on your scapular and postural muscles. It does not sound like you re-tore anything. Having pain like that is quite common for 5 weeks post op.

  29. says

    Doc ,
    I’m 61, just diagnosed with torn labrum and degeneration of the acromioclavicular and glenohumeral joints. I work a physical delivery job with a lot of lifting above the shoulder. The last 6 months 11 hour days with no option for less time in the future. I can’t see myself doing this work anymore with this injury. Would surgery allow me to go back? With my age , I’m not sure with the surgery and rehab time it’s likely. Any advice would help.
    Thanks,
    Mike

    • says

      At your age (and I am not inferring that you are old Mike) I would guess that even having the surgery might not get you back to withstanding the full demands of your job.

      You could try doing physical therapy and gently strengthening the rotator cuff and scapular stabilization muscles. That might help, but I doubt it would get you back 100%. I would give serious consideration to doing something less physical.

  30. Jeff Stewart says

    Physiodc, you have lifted my spirits once before, but now I am down again: Four months post labrum surgery this past weekend. I was feeling great, ie running and biking again and getting back into shape. ROM was getting there but still some soreness. Then, too risky, I had a fairly serious bike crash while passing a slower biker that was turning off the trail. I fell pretty hard on non-operated shoulder and scraped up my side. It seems my operated shoulder survived in tact, held tightly to side that was away from ground, but what are the chances the trauma/impact to other side dislodged any anchors? (Again four months post-op). I will now be more cautious . . . is it too late?

  31. K says

    I had surgery for a GLAD tear about 6 weeks ago, a d this included microfracturing. Now I’m out of the sling, but still very limited. Today I had a small FOOSH on the side that surgery was done on. It doesn’t really feel any different, and if anything my ROM may have ever so slightly increased. How hard is it to undo the repair? I was given the impression a FOOSH is about the only thing that will do it.

    • says

      The normal window for anchor healing is about 6 weeks. A small FOOSH probably wouldn’t disrupt the anchors, especially if you are not feeling pain. If you are worried about it, you can always follow up with the doctor and have him evaluate it.

  32. V says

    Thanks for all the information on this site. I am 55, had two labral tears. Rt shoulder turn 12 to 4 and left 12 to 9.
    Recovery very slow but progressing. how er, I have clunking in one shoulder when lifting and lowering arm. It’s been almost 2 years since that surgery. Is clunking or clicking normal at this point?

    • says

      If it is not painful V, I would not be too worried about it. It may have to do with the overall strength of the rotator cuff or the muscles that surround the shoulder blade. It wouldn’t hurt to get it assessed by a PT to see if there are any glaring weak points.

  33. says

    What very interesting reading, thank you for being here. i haven’t found any more information like this! I go to a surgery doctor in 2 days and I have been told I have posterior labral tear. So far I have completed 18 physcical therapy visits and a few weeks of workouts with a personal trainer, focusing on strengthening all areas. I am 44 yrs. old and have lost 45 lbs this year with weight lifting. Now I have a tear. I have regained being able to raise my arms with some difficulty recently. My front of the shoulder seem to hurt more than in the back. Pain isn’t bad, just uncomfortable aching and soreness, more now than earlier. My biggest problem is i have no strength in my arm for resistance. I have lower strength but none when I raise it. Fist doctor told me I’ve done all I can, now i have to decide for surgery or not. She also said I could keep tearing it more but at the same time she couldn’t answer a lot of my questions, that i had to ask the next doctor. I have come so far with strengthening my body and so afraid of losing it during recovery. I guess I’m asking how much exercise can I get away with durning recovery, like with leg weights and using the other arm for lifting dumbbells? I’ve also read a lot of other people comments here and I don’t see much on any one talking about losing strength in the arm. Why do I have full motion regain but no strength? Without surgery will the strenght return (its been 2 months now since accident) and can I keep tearing it or is what done is done? Thank you.

    • says

      Given that it has only been a few months since the accident I am guessing that you will get more of a strength return in the next few months. In terms of the long-term prognosis, it is a bit of a guessing game. Surgical outcomes for the over 40 crowd tend to be less positive that for the younger patients. That is not to say however that you will not be better off long term, if you have the surgery you will most likely have some good long term improvements. Arm weakness by the way is a common complaint with labral tears.

      In terms of the workouts, you really can do quite a bit of leg exercise etc. as tolerated after the surgery. You just need to be super careful about it and make sure that it is run by both the physical therapist and the doctor. I would say that a recumbent bicycle is a relatively safe place to start.

      You are going to need to be very patient with this process Denise/ It will take many months to get back to your prior activity level.

  34. Darla says

    I had a full thickness supraspinatus tear, a labral tear, and a bicep tear, and impingement syndrome with surgery July 21. Recovery so far has been easy – except for the first couple days, never have experienced much pain. I’m curious though as to why different surgeons vary so much in when they have their patients start physical therapy. I have an appointment next week and am assuming my surgeon will have me start PT at that time but I read online about other docs who start their patients in physical therapy the first week after rotator cuff surgery. Why so much variance?

    • says

      Darla I think that this sometimes has to do with “old school” versus “new school” trains of thought. Some of the newer research points to holding off on rehab for a good amount of time to allow adequate healing of the anchors to occur. If you are not starting rehab early, don’t sweat it. Some of the patients that we see here a PhysioDC do not start structured PT until 4-6 weeks post-op. It’s no big deal. I actually think that starting PT too early can inflame the shoulder.

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