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Labral Repair

Shoulder Surgery

Labral Repairs

What is a labrum? 

The shoulder is a ball and socket joint. Your labrum is a rim of soft tissue that surrounds both the ball (your upper arm bone, or humeral head) and socket (the glenoid) to make your shoulder more stable. 

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A labral injury happens when there is a tear in the soft tissue surrounding the ball and socket. Tears commonly happen in the front or back sections of the labrum, and can sometimes stretch from the front of the labrum all the way to the back. 

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Types of Labral Tears

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  • Bankart Lesion (Instability) 

    • Tears to the front-bottom part of the labrum.​

    • Tears are often due to instability.

  • Posterior Labral Tear (Instability)

    • Tears to the back of the labrum.​

    • Tears are often due to instability.

  • SLAP Lesion (Non-Instability)

    • Tears to the top part of the labrum spanning from the front of your shoulder to the back.​​

    • Tears often caused by degeneration.

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How is my Non-Instability Labral Tear repaired?

  • SLAP tears in the shoulder are repaired using a SLAP repair. 

  • During a SLAP repair, the torn part of the labrum is reattached to the shoulder socket. 

  • The labrum is reattached using anchors and sutures by the surgeon.

Shoulder Instability 

What is shoulder instability?

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Shoulder instability occurs when the head of your upper arm bone (humerus) comes out of your shoulder socket (glenoid).

 

This can occur when the shoulder joint, ligaments, or labrum become stretched, torn, or detached.  

 

The shoulder can then slide out (dislocate) in different directions. 

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How is Shoulder Instability treated?

  • Bankart Repair 

    • Anterior (Front)​

    • Posterior (Back)

  • Arthroscopic Anatomic Glenoid Reconstruction (AAGR)

  • Latarjet

  • Remplissage

  • Humeral avulsion of the glenohumeral ligament (HAGL) Repair

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  • Anterior Bankart Repair 

    • Anchors and sutures are used to reattach torn ligaments at the front of the shoulder. 

    • This repairs the labrum back to its original state. 

  • Posterior Bankart Repair

    • Anchors and sutures are used to reattach torn ligaments at the back of the shoulder. 

    • This repairs the labrum back to its original state. 

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Bankart Repair 

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Bone Loss from Shoulder Instability 

Bone Loss 

 

  • Glenoid bone loss

    • Bone loss to the glenoid (shoulder socket) can occur when the shoulder dislocates. ​

  • Humeral bone loss

    • Bone loss to the humeral bone ("ball" and upper arm bone) can occur when the shoulder dislocates. This type of bone loss is referred to as a Hill Sachs lesion.

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Shoulder Instability
Bone Loss
Rotator Cuff

What is a Rotator Cuff? 

The Rotator Cuff is a group of muscles and tendons that stabilize the shoulder and allow it to perform many movements.

 

​Injuries can occur to the tendons and can involve partial or complete tears. 

 

Injuries can be due to traumatic injury, such as falling, or degenerative changes due to wear and tear.

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Types of Rotator Cuff Injuries 

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  • Tendinitis/Bursitis/Impingement

  • Rotator Cuff Tear 

    • Small Tear ​

    • Large Tear 

    • Massive Tear 

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Rotator cuff tears range from:

 

Small Tear =  < 1cm in size

  • Can include partial tearing of a tendon where the tendon is not fully separated from the bone.

  • Can also include a complete tear of one tendon. 

Large Tear = >3cm in size

  • Complete tear of at least one tendon in the shoulder.

  • Can also include partial tearing of other shoulder tendons.

Massive Tear = > 5cm in size

  • Complete tearing of at least 2 tendons in the shoulder. 

How is a Rotator Cuff repaired? 

  • Rotator Cuff Augmentation

    • Bridging Reconstruction 

  • Rotator Cuff Repair

    • Lower Trapezius Tendon Transfer​

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Rotator Cuff Augmentation 

  • ​During this procedure, a small mesh patch of biological material is attached to repair the tear. 

  • Different types of patches can be used to promote strengthening of the repair, tissue healing, or both. 

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Rotator Cuff

Common Questions Following Shoulder Surgery

When can I take a shower? 

  • You can take a shower after 5 days after surgery.

  • Remove the white dressings and cover your incisions with waterproof bandages

How long do I have to wear my sling for?

  • It is recommended to wear your sling for 6 weeks following surgery (including while sleeping)

  • The only time to remove your sling is if you exercise your neck, wrist, elbow and hand.

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How do I take care of my compression/wicking dressings (white dressings)?

  • Leave your dressings on and keep your shoulder dry for 5 days following your surgery.

  • After 5 days you can then remove/change your dressings. 

  • Replace the dressings with clean waterproof dressings over incisions. 

When can I drive again? 

  • You can begin driving 6 weeks after surgery provided that your doctor has not instructed you otherwise

Can I exercise while wearing my sling?

  • You can take your arm out of the sling 4-5 times every day to exercise your neck, elbow, wrist and hand

When can I return to work?

  • The time needed off work following shoulder surgery can take between 3 to 8 months.

  • There are many factors involved with the return to work timeline, such as the physical demands of your job. 

Questions Folloing Shoulder Surgery

When do I follow up with my doctor?

2-5 days after surgery 

  • visit Apex Orthopedic Rehabilitation before your appointment with Dr. Wong.

  • Wound care and surgical dressing removed.  

  • Baseline measurements. 

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2 weeks after surgery 

  • visit Apex Orthopedic Rehabilitation before your appointment with Dr. Wong.

  • X-rays of your shoulder. 

  • Surgical dressing removed, stitches removed 10-14 days after surgery. 

  • Physiotherapy plan reviewed. 

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6 weeks after surgery 

  • visit Apex Orthopedic Rehabilitation before your appointment with Dr. Wong.

  • Shoulder is starting to heal. 

  • Continue with physiotherapy.

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3 months after surgery 

  • visit Apex Orthopedic Rehabilitation before your appointment with Dr. Wong.

  • Bring your physiotherapy progress report to your appointment. 

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6 months after surgery 

  • visit Apex Orthopedic Rehabilitation before your appointment with Dr. Wong.

  • Complete a survey on how your shoulder feels. 

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Annually starting at 1 year after surgery 

  • visit Apex Orthopedic Rehabilitation before your appointment with Dr. Wong.

  • X-ray of your shoulder.

  • CT scan of your shoulder.

  • Complete a survey on how your shoulder feels. 

  • Follow up with your doctor as required.

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Shoulder Rehabilitation Timeline - Click Here 

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Rotator Cuff Repair Rehabilitation Protocol - Click Here 

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Rotator Cuff Reconstruction Rehabilitation Protocol - Click Here 

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Bankart Repair Rehabilitation Protocol - Click Here 

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Glenoid Reconstruction (AAGR) Rehabilitation Protocol - Click Here 

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