March 28, 2015

Managing Expectations When Recovering from a Labral Repair

I have seen many clients with post-operative shoulder labral repairs. It is a frustrating injury that takes time to recover from. Being the recipient of two labral repair surgeries myself, it is my opinion that the key to recovery with a labral injury is managing expectations.

Figure 1. A and B) Uniaxial loading of biceps tendon leading to SLAP lesion in the neutral position (Bey et al. 1998)

The shoulder labrum is a fibrous, or rigid type of cartilage. This type of cartilage is found only around the attachment of the socket. The two main functions of the labrum are to deepen the socket (thus providing added stability) and to be an attachment for other structural tissues such as the biceps tendon around the joint.

The labrum is typically torn from one of the following.

1. Damage to attaching ligaments of the shoulder resulting from repetitive actions or over-use.
2. A subluxation or dislocation of the shoulder, usually occurring from trauma. Dislocation can occur anteriorly or posteriorly.

Figures A and B show the subluxation uniaxial loading seen when holding a dumbbell. Figure two shows a throwing motion: Notice the detachment of the bicep tendon with the labrum. There are four types of SLAP classifications, which can be a factor in the recovery process.

I wanted to touch on how this injury occurs in order to point out the degree of recovery needed. Recovery depends upon many factors, such as lesion location, severity, and the quality of surgical repair. The Johns Hopkins orthopedic surgery website reports with regards to recovery that

Figure 2) during the late cocking phase of throwing (Rodosky et al. 1994).

“It is believed that it takes at least four to six weeks for the labrum to re-attach itself to the rim of the bone, and probably another four to six weeks to get strong. Once the labrum has healed to the rim of the bone, it should see stress very gradually so that it can gather strength. It is important not to re-injure it while it is healing. How much motion and strengthening of the arm is allowed after surgery also depends upon many factors, and it is up to the surgeon to let you know your limitations and how fast to progress. Because of the variability in the injury and the type of repair done, it is difficult to predict how soon someone can to return to activities and to sports after the repair. The type of sport also is important, since contact sports have a greater chance of injuring the labrum repair. However, a vast majority of patients have full function of the shoulder after labrum repair, and most patients can return to their previous level of sports with no or few restrictions.”

The Johns Hopkins orthopedic surgery website does leave recovery time open for interpretation and dependent on each case. I feel that recovery typically takes longer than expected.

The recovery time can be separated into three stages. The first is acute pain stage (difficulty when sleeping), which usually lasts 4-6 weeks. This time usually involves a formal physical therapy process.

The second stage is continued strengthening and stretching with slight discomfort (minimal to no pain). During this stage the patient/client will report “I still feel like I am going to dislocate and have this funny crackling in my shoulder”. This stage can range from 12-16 weeks (therapy to post rehab transitional stage). Don’t be alarmed. The labrum repair tightened the joint and likely causing minor pressure on the repaired tissues that are unfamiliar. This feeling will recede over time.

The final stage is the transition to your “new normal” lifestyle and exercise. This stage varies and could be 6-12 weeks of feeling “normal again”. Realistically, many patients are looking at 9 months to 1 year of total recovery time before they feel “normal” again.

I hope this information helps you when managing expectations. Frustration is common, and patience is key. The time frame may indeed be longer than you may expect, but it is better to manage your expectations and realize that you will have a “new normal”. Do not rush your rehabilitation, as many people find themselves re-injuring their shoulder.

For more information on SLAP repairs http://hopkinsortho.org/labrum_tear.html

By: Phillip Godfrey MES, PFT

Comments

  1. Hi there, I had labrum surgery early October, after going about 8 months with a tear from lifting weights overhead. 6 months on from the surgery the shoulder feels much the same as before I had the surgery done, it was probably stronger/less painful before. Is this usual? I started light band resistance exercises around 2 months after the surgery as I have been encouraged to strengthen it, feels like I’m getting stronger (slowly) but there’s a lot of aching and also on my back muscles as a result of over compensating as well as occasional ‘pins and needles’ in my shoulder. Is it just a case of time as you say? Appreciate the feedback.

  2. Kaci Pittman says:

    My name is Kaci Pittman, I am 16 years old and a Junior in High School and play Softball. I am 5’2″ and weigh roughly 120 lbs. I have been playing baseball/softball basically my whole life. As of 7th grade, my main position has been catching. I plan on playing softball in college as I have some schools interested in me. Towards the end of my sohpmore year playing in high school, I started having aches and pain when throwing. I didn’t think anything of it because I caught every game and threw a lot. During Summer travel ball, I noticed it was hurting way more, and was beginning to pop and click a lot. It started hurting when I would stir things, move it a certain way, and sometimes when I would sleep. I decided to go to a doctor and he tried me out on PT, which did not help me at all. I had surgery on 10/07/14 for posterior labral repair. It has been almost 6 months since surgery and ive started a throwing program and PT for throwing. How is it supposed to feel when I first start throwing? I don’t want to do anything else to hurt it.

    • Kaci it will probably feel stiff and a bit sore when you start throwing. You need to start with a very basic, slow throw. I would also recommend phasing in to the throwing slowly (take a day of rest in between sessions).

      If you are noticing sharp pain that doesn’t go away after a few hours of throwing, talk to the PT about it.

      You also need to stick to a scapular and rotator cuff strengthening routine through this whole process.

  3. Hi my name is Juan and I recently had Slap repair 2 weeks ago with two anchors placed in my shoulder. I recently had my arm out of the sling and a cup fell next to me. By instinct I reached away from my body to the side with my recovering arm turning my shoulder. I had very sharp pain that felt like I either re-opened the labrum or did something else. I was sore the next day and very tight but also loose at the same time. How strong are the sutures that are used to reconnect the tendon and how easy is it for them to break away from the anchor screw or for the head of the anchor screw to break off? Thank you for your help!

    • Juan they are pretty sturdy. What you are describing typically will not pull an anchor loose. It usually needs to be more of a traction “yank”, but if you are concerned it cannot hurt to talk to the doctor about it.

  4. Mike Bowden says:

    I had labrum surgery for a ‘severe’ anterior tear on 3/3/15 after about a year of dealing with a pain in my shoulder. I am a part time MMA instructor and an avid practioner, which I hope to return to after healing up. I know I am very early in the recovery process, but do you think a return to competiion (grappling/BJJ tournaments) by the end of the year is too ambitious of a goal? I am very diligent in any rehab/PT that is given as well as have been blessed with a body that typically heals itself pretty quickly.

    Thanks

    • The end of the year is possible, but you need to have total clearance from the doc. The strength must be ideal first in my opinion, particularly for competition. Practice is a different story, you might be cleared for that by 6 months.

  5. Spencer Foley says:

    Hi my name is Spencer and I am recovering from a Slap and bankart tear surgery. As of today 3/18/15 I am exactly 13 weeks post op. I am now doing push ups, 10lb dumbbell shoulder press, 10lb dumbbell bench press and some TRX exercises. I’ve been told that I’m “ahead of the game” in this recovery. I have great range too. What do you think, am I right on schedule or am I ahead? I’m thinking about being the high schools varsity baseball manager because I can’t play but that would mean spending most time after school at practice and not a lot rehabbing. I have been thinking of doing it after practice but not everyday. Should I slow down how many days I rehab?

  6. Rick Stevens says:

    What is your experience with Soccer Goalkeepers recovering from labrum repair surgery?

    • The rehab itself really doesn’t waver from the typical rehab for athletes.

      The problem that a goalies have in general is falling on to the outstretched shoulder. This is a vulnerable position for the shoulder to be in regardless of whether or not the shoulder has been injured. Some goalies feel that they have benefitted from wearing a neoprene shoulder sleeve to protect the joint while playing.

  7. Chris Glenn says:

    Hello. I just wanted to say thanks for the article. I had surgery 2 weeks ago for a complete “360” tear of the labrum in my right shoulder. The repair required 8 anchors. I’ll be in a sling for another 4 weeks, and begin PT next week that will include mostly passive range of motion exercises. Currently I’m only doing the pendulum exercise as prescribed by my surgeon (which I’m doing without any pain). My biggest issue right now is sleep deprivation. It’s difficult to go to sleep in the sling, and I usually wake up after a couple of hours with my shoulder in pain. Not sure why it starts hurting so bad while I’m sleeping since I sleep on my left side and the right side is isolated in the sling? Thanks again for providing info on recovery expectations so that I can manage my own expectations. Sounds like it’s going to be a long road to recovery, but at least now I know what to expect. Take care

    • Chris you should get some sort of award for the most involved labral tear. 360 is quite the feat. The worst is over!

      Sleeping will probably take some weeks to get some more comfort. Try a semi-reclined position.

      • Chris Glenn says:

        Thanks for the tips. Appreciate it. Yes, my surgeon said that he rarely sees 360 tears, and that the repair “required a lot of surgery”. I know that I have a long road ahead of me to fully recover from this surgery. I have a desk job, so hopefully this won’t create too much of an inconvenience for me. I’m just hoping that I start getting better sleep soon!

    • For Chris, about sleeping difficulty: I rented a Lazy Boy type recliner for 8 weeks post-op in order to sleep in a more upright but comfortable position. Had surgery January 13, 2015 and just sent the recliner back last week. Am now sleeping in the bed propped up, but the recliner was a much better option for the first weeks. Still wake up in pain in early morning, but pretty much sleeping through the night. Here in Florida, chair rents for around $90-$100 per month. They deliver, set up, and pick it up when you’re through. Rent-A-Center is near us so we used them. Very easy phone call and worth it. I learned about this from reading other sites about shoulder surgery. Seems that a lot of people go this route and it helps.

  8. Luke Morse says:

    I am a 17 year old football player and I had torn my labrum in the front and back while playing. I had surgery in late November, and just yesterday I started to experience squeaking in my shoulder. I am not able to reproduce the sound myself, as it happens completely randomly. It vibrates and it does not hurt at all. I cringe when it happens as it is such a weird sensation. I have an appointment with my surgeon in about two weeks, but I was wondering if this should be of any concern? I’ve read a lot about it and seems as though it’s not a big deal. But some reassurance would definitely be appreciated. Thank you!

  9. Hi my name is Nick, I recently found out I tore my labrum from a football injury in august. I tore it on the top and in the back. I was told there would be 5-7 anchors. That being said will it still take just 6 months for full recovery? Im hoping to be 100 percent by mid august my surgery is April 3rd. Thank you!

  10. Craig king says:

    I had labrum surgery 12 days ago. The first 9 days there was little pain to manage but since day 10 I have been getting serious pain in my shoulder. Trying to describe it is difficult but I guess you can say it feels like severe Charlie horse that stops you in your tracks. Is this normal I thought this would have happened early and then subsided. Should I be concerned. Thank you for your advice.

    • Craig for ten days post-op this is rather common. The shoulder is probably quite weak and this makes it more likely to impinge on the shelf above it.

      It is always a good idea btw to keep the doc in the loop in terms of how it is feeling.

  11. Sara Mason says:

    Hello. I had SLAP repair of my right shoulder on December 9th requiring 3 anchors. I started PT in January and things were going well, steady progress with each visit. I still have difficulty sleeping, despite continuing to sleep in a semi reclined position. About two weeks ago I had to go away for work and was not able to get comfortable so I didn’t sleep much for two days. The pain was so bad. It felt like someone smashed a brick on top of my shoulder. The whole following week was unbearable as was PT. I started noticing the same pressure and popping that I would get prior to my surgery when my shoulder would dislocate on its own with every movement. I talked to my doctor and he said it was probably just scar tissue and gave me an anti inflammatory.
    Do you have any idea why after 12 weeks, the pain would suddenly be worse than ever? And what is your opinion on the onset of previous symptoms?

    • Has your range of motion tightened up? Females are a bit more likely to develop an inflammatory condition called a “frozen shoulder”. Long term it is not a big deal, but it starts with a lot of pain that comes on rather suddenly. Have the doc check it out.

      • Sara Mason says:

        Range of motion has only slightly decreased since the onset of the pain, slightly tighter as well. The joint hurts even when the arm is just hanging at my side, feels as if it’s being pulled.

  12. Hello,
    My name is Chris and I had suture anchors put in for a torn labrum on July 22nd 2014. I am still feeling a lot of instability and pains in my shoulder and when I lift any chest exercise or shoulder no matter what the weight is the movement causes a lot of discomfort. My therapy with bands does not seem to do much. Could this be a result of the anchors pulling out ? Thanks for your opinion

    • Chris that is tough to say based on the information that you gave. Chest and shoulder pressing exercises require a lot of shoulder blade stability, so if you are even a little bit weak in those muscles what you are describing can happen.

      I would have the strength and mobility of the shoulder assessed by a fresh set of eyes. A PT who has dealt with shoulders a great deal would be a good recommendation.

  13. Hello about ten years ago I had a 4th degree AC joint separation with a posterior and anterior laberal tear. The year was found 8 years later at first they thought all the damage was the separation and said I didn’t have to get surgery if I didn’t need it. So as a 20 year old kid I said no. So after years of pain and instability I get it checked and had it repaired along with a reshaping of the humerus head(it was cupped) and clavicle. I ha surgery December 1st and locked in a sling for six weeks. Stability is good strength is getting there but still pain especially in my lat, trap and scaphoid muscle region I am having trouble with mobility because of the muscles not relaxing and not sure what to do dr wants to look at my neck make sure it’s not that therapist says its just muscle and it will slowly fix it self but it’s been 15 weeks and the more I use it the more it hurts. Not sure where to go from here and suggesting would be great thanks

  14. After my third dislocation in February, I had an MRI which showed tears of the superior, anterior, and inferior labrum and a possible tear of the inferior glenohumeral ligament with Hill-Sachs. I have surgery to repair the damage in 2 weeks. A couple of questions:

    My first dislocation was almost 20 years ago, and one of the tears may date back to that time. How successful is an attempted repair likely to be if so, and what would be the next step if it doesn’t work?

    Given my age(43) is the recovery period in line with what’s outlined below? How soon would you normally recommend a return to a non throwing sport like running?

    Thanks!

    • Given your age and the long history of dislocations, the surgical recovery will be a good amount of time (up to a year perhaps?), but you should be able to run well before that (maybe at 4-6 months). I would not ever do a throwing sport again, too risky.

      Outcome measures of your age group are luke-warm. You will likely be more functional than before the surgery, but I don’t think that you will get back 100% unfettered usage of the shoulder.

      • Well isn’t that encouraging?

        Is there a chance that a 20 year old tear can’t be reattached? What is the protocol in that event? I’m concerned a little about that because the MRI findings observed truncation of sections of the labrum.

        Thank you for the information, it’s disheartening, but helpful.

  15. Jason miles says:

    Hello i had surgery for a small labral tear(just one anchor and the capsular joint tightened) 6 months ago. I started 2 months ago strentghening with thera bands. Im better but i still have days when i feel a little bit of pain. The pain days seem to be less and less and more spacious. i m progressing but very slow. I got one anchor and the capsular joint tightened. Is it normal to take so long to feel normal again? Thanks

  16. I had labrum surgery a little over two weeks ago. Six days after the surgery while still in a sling, I went to sit down and my fingers hanging out of my sling caught the edge of a table I went to sit at and cause my forearm to unexpectedly bend up some and cause my arm/shoulder to sort of jerk up a little. I felt immediate pain where my bicep and shoulder meet in the front, and then some discomfort for the rest of the day. The area was sore for a few days after, but I also started walking around more the next few days so that could have been part of the pain.

    Is there any chance I broke off the anchor/stitches in the front of my shoulder from this incident? The PA I saw a few days after the incident said that it would take a substantial fall on the shoulder to jar loose any of the work done in the shoulder.

    Thank you!

  17. Hi Dan,
    First off id like to say thanks for taking time out of your day to answer these questions. I am 27 years old, currently a little over 5 weeks in and everything has been great! After dislocating 6 or 7 times last year I decided to get the surgery done. I had 4 anchors put in to repair a torn labrum in my right dominant shoulder. I was never bothered by my shoulder pre-op, it was only painful when I would dislocate which went away immediately after put back in.
    My question for you is if I were to reinjure my shoulder, as in pull out an anchor. Would this be painful? Or would I not even know it happened? If so how would it feel? I don’t want to think everything is ok then dislocate my shoulder again. Like I said I never had pain in the shoulder before surgery. I haven’t seen any articles about pulling out the anchors so this is why I ask.

    Thanks

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