Shoulder Labral Repair
When the labrum or cartilage that supports and protects the shoulder is torn or injured, usually due to trauma, it creates an ache in the top of the shoulder, a catching sensation upon movement, and pain. This injury is most common in young athletes, but can affect athletes through their 40s. A labral tear can occur in people of all ages, without trauma, due to normal wear and tear, a fall, and repetitive stress. A labral tear is often associated with a shoulder dislocation.
The labrum is the cartilage that surrounds the shoulder joint to allow the arm bone to fit well into the joint, and provide stability to the shoulder. However, the labrum has no blood supply so it may be difficult for a large tear to heal on its own. But when the tear is small and the patient is able to function and avoid putting stress on the injury, a small tear may heal on its own.
Often noninvasive, nonsurgical treatment with ice, immobilization and anti-inflammatory medications, activity modification, and physical therapy will help. Selective injections for pain and to stimulate the body’s own healing may be applied. When the problem fails to respond to these noninvasive approaches, surgery may be indicated.
The goal of shoulder arthroscopy is to relieve pain and repair the tissue. Common procedures include:
- Rotator cuff repair
- Bone spur removal
- Removal or repair of the labrum
- Repair of ligaments
- Removal of inflamed tissue or loose cartilage, and
- To repair recurrent shoulder dislocations
Symptoms of a labral tear
- A sharp popping or catching sensation in the shoulder with certain movements, mostly overhead extension
- An ache, or no pain at all
- Shoulder instability
Dr. Walter Thomas will conduct an evaluation of your complaints and symptoms, ask you questions, and conduct a physical exam including range of motion testing. The catching or popping sensation will be evident when the arm is raised over head, or held in front of the body with palm down.
Other tests such as a CT scan with dye, will reveal the state of the labrum and any tears. However, the most accurate diagnostic tool is the arthroscope which is also used for repair.
Then Dr. Thomas will review with your treatment options.
Once the diagnosis is made, Dr. Thomas’ primary goal is to control your pain and inflammation. Rest, anti-inflammatory medications, ice and immobilization will be recommended. Physical therapy and activity modification plus selective injections can help in achieving that goal.
When this the patient’s problem fails to resolve with this initial treatment, minimally invasive surgery may be recommended.
Minimally Invasive Arthroscopic Surgery
Most labral repair is accomplished with minimally invasive surgery called arthroscopy, in an outpatient setting. You will talk with the anesthesiologist about your options. Commonly this is done under regional anesthesia.
During the surgery, several small incisions will be made in the injured area. Dr. Thomas will insert the arthroscope to examine the labrum and the biceps tendon to confirm the diagnosis.
In another incision, tiny repair instruments will be inserted to remove or repair small tears in the labrum, and fix any other problems. If the tear is large and the shoulder is unstable, he will repair the tear, and if biceps tendon is detached and the shoulder is unstable, Dr. Thomas will repair and reattach the tendon, using wires or sutures.
After surgery the patient will need to wear a sling to support and protect the shoulder. Pain and swelling will be managed with ice and electrical stimulation.
Physical therapy is essential to full recovery which can take up to six months. Initially the focus is on gentle range of motion exercises, and stretching to restore stability and mobility. This will be followed by strengthening exercises, including strengthening the biceps.
Dr. Thomas has successfully treated a wide selection of shoulder conditions in professional athletes and normal people who just want to stay in the game of life! He is a compassionate caring doctor who will listen to you and offer state of the art solutions to your orthopedic problems.
Dr. Walter A. Thomas is a Board-Certified Orthopedic Surgeon, and double Fellowship Trained in Arthroscopic Surgery and Sports Medicine. If you are suffering with joint pain, or have been diagnosed with a hip, shoulder or knee condition, Dr. Thomas can help. Schedule a consultation with Dr. Thomas to learn more about your condition and hip arthroscopy. Our offices are located in Thousand Oaks, CA and we treat patients throughout Southern California.