Arthroscopic Labral Repair of the Shoulder
Labral repair is an operation designed to restore the stability of your shoulder, where the labrum is repaired back to its original position. This restores the normal anatomy around the ball and socket joint. I perform labral repair as an arthroscopic procedure. This is ‘keyhole’ surgery – I generally use 2 or 3 small incisions approximately 1-1.5cm in length through which a fibre-optic camera and surgical instruments can be inserted to access and repair the structures in the shoulder.
Labral Repair: Background
The shoulder is a ball-and-socket joint, with a large ball (humerus) and a shallow socket (glenoid). This arrangement allows the shoulder to be the most mobile joint in the body, but makes the joint less stable. Additional stability is given by:
- The labrum, a cartilage rim which surrounds the socket and makes it larger and deeper.
- Ligaments, which are thickenings of the capsule surrounding the joint.
- Rotator cuff muscles, which surround and move the joint.
Dislocation of the shoulder joint occurs when the ball (humerus) moves completely away from its normal position in the socket (glenoid). This may resolve spontaneously or require relocation by a doctor. Subluxation refers to partial dislocation of the shoulder joint, where the ball is not completely separated from the socket. For many people, the first episode of shoulder dislocation is a traumatic experience. If dislocations continue to occur, they may be triggered by even trivial shoulder movements.
Labral Repair: Day of Surgery
You will be admitted to hospital on the day of surgery. My assistant will provide you with your admission time and fasting instructions prior to your arrival.
First 2 weeks
There will be an adhesive dressing over the incision. Provided this dressing stays dry and clean, it does not need to be changed when you return home. The stitches within the skin do not need to be removed as they are dissolvable.
Regular icing of your shoulder is helpful for reducing pain and swelling post-operatively. You should aim to ice your shoulder for 20 minutes, 4-6 times per day, depending on your level of pain and swelling. Physiotherapy and Exercises A physiotherapist will see you the morning after your surgery to discuss some light exercises that can be performed in the post-operative period. The emphasis in the first 2 weeks after the labral repair is to return to light range of movement, which prevents excessive stiffness in the joint.
You will wake up after your operation with your arm placed in a sling. The sling helps to rest the shoulder, reduce discomfort, and protect the surgical repair. You may come out of the sling for the exercises prescribed by the physiotherapist, or for times of rest when the arm is relaxed and close to your body.
Labral Repair: Follow Up
I will review you in the rooms approximately 2 weeks after surgery. If you are unsure of your follow-up appointment time, please call my assistant.
The focus during this phase is on maintaining comfort and preventing excessive joint stiffness. I encourage some light range of movement exercises, with your opposite arm assisting your operated arm to prevent excessive stress. Your physiotherapist will go through these exercises with you after surgery. You will start to spend more time with your arm out of the sling towards the end of the 6-week period.
From the 6-week period you will be out of your sling completely. Between the 6 to 12- week period the goals are to regain further range of movement and to strengthen the shoulder joint.
3 months plus
Higher level shoulder activities are introduced depending on your pain and tolerance levels. The shoulder can be ‘tested’ more, with a bigger focus on strengthening and returning to your desired activities.
Labral Repair: Return to Play
In general, patients will feel like they’ve recovered the majority of their shoulder function at some stage between 3 and 6 months.
Labral Repair: Pain Relief
Regular paracetamol and anti-inflammatories (if appropriate) are the mainstays of pain relief. You will be prescribed some stronger medications which can be helpful in the early post-operative phase.
For many patients, the anaesthetist will discuss the option of using a ‘nerve block’ to help reduce your pain levels in the time just after surgery. This is a procedure where the anaesthetist injects long-acting local anaesthetic to the nerves supplying the upper limb using ultrasound guidance. This procedure eliminates or greatly reduces pain in the first 12-24 hours after surgery, and is very helpful in maintaining your comfort levels in the early post-operative period. There’s no absolute need to have the nerve block. The anaesthetist will discuss the option with you prior to surgery.
Labral Repair: Driving
You should not be driving whilst you are still wearing a sling. In general, you can expect a 6-week period of not driving after your operation.
Labral Repair: Return to Work
It is usually feasible to return to light duties after the two-week post-operative check.
For those doing heavy work, return to work can be between 6 and 12 weeks, depending on work requirements.
Labral Repair: Problems
Superficlal Infection is not very common but can happen. It usually presents as redness and increased tenderness of the skin around the surgical wound, and generally resolves with a short course of oral antibiotics.
Deep infection is rare representing between 5-10 days post-operatively, with increasing pain, swelling and marked decrease in your range of movement. Joint infections require admission to hospital, with washing out of the shoulder and intravenous antibiotics commenced as soon as possible.
If you are concerned about an infection, please contact me as soon as possible. During business hours the best point of contact is via my assistant on 08 9212 4292. After hours, please contact the hospital where you had your surgery, and ask them to contact me. Failing this, present to your nearest Emergency Department for assessment.
Stiffness All shoulders undergoing surgery will feel somewhat stiff in the first 6-12 weeks. Occasionally, patients develop ‘frozen shoulder,’ which can make the stiffness quite marked. Rarely, I might suggest a manipulation or a further arthroscopic procedure to release the shoulder capsule if stiffness is severe.
Re-Dislocation following a labral repair is uncommon. If you do experience a redislocation, please contact my rooms for review.
Nerve Damage supplying function to the arm is possible with any surgery around the shoulder, although the overall risk is low and permanent injury to nerves is rare. If nerve damage occurs, it is often temporary (known as neuropraxia) and partial or full recovery can be expected with time.
If you are considering having a shoulder stabilisation, make an appointment with Dr Radic to discuss your treatment options.