Arthroscopic Labral Repair

What is a labrum and how does it affect shoulder function?

Ball and socket joints, like the hip and shoulder, have a protective cuff of cartilage called a labrum. The labrum helps stabilize the joint by deepening the socket of the shoulder which holds the humerus (upper arm bone) securely to the glenoid (socket). In addition the labrum serves as an attachment for the shoulder (glenohumeral) ligaments as well as the long head of the biceps tendon. These structures provide stability while allowing an incredible range of motion for the shoulder joint. A tear in the labrum however, can cause weakness and instability within the shoulder joint. This can lead to pain, limited range of motion and in certain cases, recurrent shoulder dislocations. Shoulder surgeon, Dr. Robert Boykin, serving patients in Asheville, Arden, Fletcher, Hendersonville, and surrounding North Carolina communities has extensive experience in helping patients with shoulder pain and labral tears.

What types of labral tears can occur?

The different types of labral tears are:

SLAP tears – SLAP is the acronym for Superior Labrum Anterior and Posterior. This means the tear is located at the top of the shoulder socket and involves the attachment site of the long head of the biceps tendon. Patients with SLAP tears typically experience pain deep in the shoulder (most commonly in the front) which is typically worse when moving the shoulder through a normal range of motion.

Bankart tears – Also called a Bankart lesions, typically occur with a shoulder dislocation. The head of the humerus shifts toward the front of the body (anterior instability), causing a tearing of the lower portion of the anterior labrum. This region serves as an important attachment point for the inferior glenohumeral ligaments which stabilize the shoulder. When torn patients may feel that their shoulder is loose or fear it will slip out of place or dislocate, especially when moving the shoulder to a combined position of abduction and external rotation. Aching pain and difficulty using the shoulder are also common symptoms of a Bankart tear.

Posterior Labral Tears – A tear of the posterior labrum typically occurs when the head of the humerus shifts to the back of the body (posterior instability). This is commonly seen when a patient is pushing with their arm in front of the body (such as an offensive lineman blocking) and the humerus is pushed posteriorly. When the posterior labrum is torn the patient may feel a sense of instability but more commonly feels pain when bringing the arm in front of the body or trying to push.

Do I need surgery for a torn shoulder labrum?

Whether or not a labral tear needs to be repaired surgically depends on a number of factors including location or size of the tear, associated shoulder injuries, mechanism of injury, age of the patient, level of activity and type of activity the patient participates in, etc. In older patients it is common to see “degenerative tearing” of the labrum which is a normal consequence of aging and alone does not typically require treatment. In younger patients, larger tears, those associated with a dislocation, and tears that have not responded to non-operative management it is more common to require operative intervention. Athletes who want to continue to participate in overhead sports or throwing sports typically will choose surgery as a repair option.

Patients in Asheville, Arden, Fletcher, Hendersonville, and surrounding North Carolina communities have the option of arthroscopic surgery from Dr. Robert Boykin, shoulder surgeon. Arthroscopic surgery is also called minimally invasive surgery and is performed with a small camera and small instruments used to treat injuries of the shoulder in a minimally invasive manner.

How is an arthroscopic repair for labral tears performed?

Arthroscopic surgery uses an arthroscope which is a small surgical camera, inserted through a small incision in the shoulder. Dr. Boykin can see the extent of the damage to the labrum and will use small instruments to clean up any scar tissue and rough edges of the labrum and prepare the bone of the socket (glenoid), then reattach the labrum to the bone. The repair can be performed in the anterior, superior, or posterior aspect of the joint (or any combination) depending on the location of the tearing. This is achieved with the use special implants called suture anchors. These anchors are made of different types of material (suture, or bioabsorbable material) and are inserted into the glenoid bone using these small, specialized instruments. Each anchor has a suture that is used to reattach the labrum back to the bone. While reattaching the labrum he may also tighten up the capsular tissue in a procedure called a capsulorrhapy to improve stability of the joint. Multiple suture anchors are used to hold the labrum in place and to tighten the injured shoulder joint. The sutures are usually made of  permanent material, however, the labrum must heal directly to the bone in order to avoid recurrence of shoulder instability and further labral tearing.

What happens after arthroscopic labral repair?

After an arthroscopic labral repair for shoulder instability, it is important to keep the shoulder immobile, in a sling, as determined by Dr Boykin and his team. A specific physical therapy program will be prescribed for each patient depending on the extent of the repair, associated injuries that require repair, and the quality of the tissue. This typically involves wearing the sling for 6 weeks during which time passive range of motion exercises may begin through a specified range of motion. When the shoulder sling is removed, patients can begin active range of motion exercises of the shoulder and eventually, physical therapy with shoulder strengthening exercises. It is very important that patients follow the shoulder rehabilitation protocol given by Dr. Boykin in order to achieve success with their arthroscopic labral repair.

How long does it take to recover from a torn labrum shoulder surgery?

Recovery from arthroscopic surgery for a torn labrum depends on the specific type and severity of the tear. In general patients are able to use the arm for light activities of daily living 6 weeks after surgery, progress strengthening at 10-12 weeks, and return to sports and contact type activities between 16-20 weeks post-operatively.

For additional information about arthroscopic labral repair, shoulder instability, or for a consultation about your shoulder pain symptoms, and instability, please contact the office of Dr. Robert Boykin, shoulder surgeon, serving Asheville, Arden, Fletcher, Hendersonville and surrounding North Carolina communities.