What is a Labral tear?
A Labral (pronounced lãbral) tear is a cause of shoulder pain. The labrum is a cartilage ring which surrounds the shoulder socket. The biceps tendon, which comes from the muscle on your arm, goes through the shoulder joint and attaches to the top of the labrum. A Labral tear occurs when there is damage to the labrum, or when the labrum strips off the socket. If the tear occurs where the biceps tendon attaches, it is called a SLAP tear.
How does a Labral tear occur?
Many times, a Labral tear occurs from repetitive trauma in overhead throwers, such as baseball or volleyball. It can also occur from a traction injury to the arm, such as lifting a heavy object off the ground or getting your arm jerked.
How do I know I have a Labral tear?
Many patients with a Labral tear have pain in the front of the shoulder or deep inside the joint. There also may be a feeling of catching or grinding in the joint. The examination in the office, combined with an MRI Arthrogram, usually confirms the presence of a Labral tear.
Do I need x-rays, MRI or any other test?
A set of x-rays is usually ordered to make sure there are no fractures in the shoulder. MRI is helpful to confirm the tear of the labrum or biceps tendon and evaluate other areas of the shoulder like the rotator cuff. The preference is to order something called MRI Arthrogram. This is an enhanced MRI where the staff injects fluid into your shoulder, and if there is a tear, the fluid will leak into areas it does not belong. This is the best test for the confirmation of Labral tears.
Is there other damage to the shoulder in cases of Labral tears?
There can be other damage to the labrum seen with Labral tears, usually in the cases of shoulder instability. The biceps tendon itself can also be frayed or torn. Typically, there is not a rotator cuff tear associated with this, but it is possible depending on how the injury occurred.
What are the treatment options for Labral tears?
The treatment primarily depends on your activity level and symptoms. Since Labral tears can often be difficult to diagnose, they are often first treated with physical therapy. The therapy is designed to restore range of motion and strength to the shoulder. Untreated Labral tears do not heal because of the lack of blood supply in the area. In cases of persistent pain and disability, surgery is recommended.
How are Labral tears treated with surgery?
Labral tears are repaired arthroscopically. The arthroscope is a fiber optic instrument (narrower than a pen) that is put into the joint through small incisions. A camera is attached to the arthroscope and the image is viewed on a TV monitor. The arthroscope allows the surgeon to fully evaluate the entire shoulder joint, including the ligaments, the labrum, the biceps tendon, the rotator cuff and the cartilage surface. Small instruments ranging from 3-5 millimeters in size are inserted through additional incisions to enable the surgeon to feel the joint structures for any damage, diagnose the injury and then repair, reconstruct or remove the damaged tissue. With labral tears, the damaged labrum and biceps tendon are identified and then repaired back to the socket. This is usually performed by using suture anchors to sew the labrum back in place. Occasionally, the biceps tendon is too damaged to repair. In this case, the tendon is cut and reattached in the upper arm (biceps tenodesis).
What are some of the possible complications?
While complications are not common, all surgery has associated risks. Possible complications include stiffness of the shoulder after surgery or recurrent pain. The use of arthroscopic techniques and the use of a continuous passive motion (CPM) machine attempts to limit these complications. Other complications include an infection, bleeding, nerve damage or problems with the anesthesia.
What kind of anesthesia is used?
The surgeon uses a combination of general anesthesia and regional anesthesia. Before the surgery, the anesthesiologist will inject some numbing medicine around the nerves of the shoulder called a scalene block. This numbs the arm and helps to control your pain after surgery. In addition, you will go to sleep (general anesthesia) to help keep you comfortable during surgery. The surgery usually lasts 1 hour.
What do I need to do to prepare for surgery?
Our staff will help to set up the surgery through your insurance company and will instruct you on any paperwork that may be necessary. If you are over the age of 50 or have significant health conditions, you may need an EKG and chest x-ray. You may also need to see your internist or family doctor to obtain a Letter of Medical Clearance. The day before the surgery, a member of the hospital or surgery center staff will contact you about what time to arrive for surgery. Do not eat or drink anything after midnight before your surgery.
How long will I be in the hospital?
Almost all patients are able to have surgery and go home the same day. Occasionally, patients will be admitted for an overnight stay.
What happens the day of surgery?
The day before surgery you will be told what time to report to the hospital or surgery center. You will be admitted and taken to a pre-operative holding area where you are prepared for surgery. You will be asked several times which extremity the surgeon will operate on. Please note that you are asked this question many times on purpose.
After the operation, you will be taken to the recovery room to be monitored. Once the effects of anesthesia have worn off and your pain is under control, you will be given your post-operative instructions and your pain medication.
Please be aware that the process of checking in, preparing for surgery, undergoing the operation and recovering from the anesthesia takes the majority of the day. It is recommended that you and your family members bring some reading material to help make the process easier.
How should I care for my shoulder after surgery?
Prior to your discharge, you will be given specific instructions on how to care for your shoulder. In general, you can expect the following:
Resume your regular diet as soon as tolerated. It is best to start with clear liquids before advancing to solid food.
You will be given medication for pain before you go home. If you require a refill, please call the pharmacy or my office.
You will have a thick dressing on your shoulder. The physical therapist will take off your dressing on your first therapy visit, 2-3 days after your surgery. You may get the shoulder wet after the dressing is removed.
You will have a sling, which you will use for the first 2-4 weeks. You can remove the sling for showering and performing your home exercise program.
You may be given a continuous cold therapy unit for your shoulder. It is a pad that sits on your shoulder and provides cold to your shoulder. If you don’t have a therapy unit, apply ice over the dressing for 30 minutes every 1-2 hours for several days. Do not use heat the first week after surgery.
In general, there are no sutures that need to be removed. The surgeon uses absorbable sutures to close the small incisions. Occasionally, there are non-absorbable sutures and they will be removed on your first post-op visit.
Sometimes a pain pump is used after surgery to help control your pain. The pump is attached to a tiny thread catheter into your shoulder. It will drip pain medication into your shoulder for the first 2-3 days. Your therapist will remove the pain pump on your first post-op visit.
Sometimes the physician will order a CPM (Continuous Passive Motion) Chair for home use to help with range of motion. A technician will come to your house and give you instructions on its use. This is an important instrument in restoring full motion to your shoulder.
Follow-up office visit:
You will be instructed on when to follow-up in the office. This is usually 2 weeks after surgery.
You will be instructed prior on exercises you can begin the day after your surgery. You will start formal physical therapy 2-3 days post-op.
Return to school or work:
You can return to school or work when your pain is under control and you can manage your daily activities. If you need to use the arm to return, you may be out of work or school for a longer period of time.
What will rehabilitation involve?
The rehabilitation is based on several goals: 1) allowing the tissue to heal; 2) regaining your range of motion; 3) regaining strength; 4) returning to full duty at work or returning to sports.
When can I return to sports?
In general, you will be allowed to return to sports in 4-6 months after surgery. You must have good motion, strength and control of your shoulder and arm. How quickly you return to sports depends on several factors, including: 1) your own rate of healing; 2) the damage found at surgery; 3) if you have any complications (like stiffness); 4) how well you follow the post-operative instructions; and 5) how hard you work in rehabilitation.
When can I return to full duty at work?
In general, the physician keeps people on clerical duties for 3 months after the surgery, which means no lifting with your operated arm. This is to protect the repair. In the 3rd and 4th month you may perform light duty – lifting no more than 10 pounds. People generally get back to performing full duty work at 4-6 months.
What is the success rate?
The success rate for a Labral repair ranges from 85% to 95%. The goal is to achieve a shoulder with no pain for lifting, throwing or overhead activity.
Miller Orthopedics is committed to you — the patient. It is understandable to be anxious about your injury and the need for surgery. Please call or email me with any questions about your injury or treatment plan.