Shoulder Labrum Repair (Reconstruction)
The shoulder joint is a ball and socket joint. A ‘ball’ at the top of the upper arm bone (the humerus) fits neatly into a ‘socket’, called the glenoid, which is part of the shoulder blade (scapula). The labrum is a ring of fibrous cartilage surrounding the glenoid for stabilization of the shoulder joint. The biceps tendon attaches inside the shoulder joint at the superior labrum of the shoulder joint. The biceps tendon is a long cord-like structure which attaches the biceps muscle to the shoulder and helps to stabilize the joint.
The labrum can tear when direct injury occurs to the shoulder joint. The labrum can also tear from the long-term wear and tear that occurs because of aging process.
A labral tear can cause pain and a catching sensation in the shoulder during shoulder movements. Pain usually occurs with specific activities.
Types of labral tears:
The most common types of labral tears include:
- SLAP tear: The term SLAP (superior –labrum anterior-posterior) lesion refers to a tear that occurs at a point where the biceps tendon is attached to the shoulder at the top of the joint.
- Bankart tear: A bankart tear is the tear in the labrum of the shoulder joint that occur when the shoulder joint comes out of the socket, resulting in dislocation of the shoulder.
- Posterior labrum tears: Posterior labrum tears occur rarely, but sometimes seen in athletes who tend to suffer from a condition known as internal impingement, where the rotator cuff and labrum are pinched together.
Your doctor may suspect a labral tear based on your symptoms and medical history. You will be asked questions about your pain and history of your injury. Several physical tests are performed by your doctor to evaluate your shoulder range of motion and stability. X-ray may be used to rule out other problems. X-rays do not show soft tissues, but may be used to rule out other problems. Your doctor may also order a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan where a contrast medium is injected to determine the presence of tears. Diagnosis of a labral tear can be confirmed with arthroscopic surgery.
Your doctor may recommend anti-inflammatory medication and rest to reduce the swelling and lessen the pain. You may also need physical therapy to strengthen the rotator cuff muscles. Arthroscopic surgery may be required if conservative treatment measures fail to reduce the symptoms.
Labral debridement is a surgical procedure used to treat small labral tears. During labral debridement your surgeon cuts away any loose or frayed parts of the labrum.
In case of SLAP tears, the torn parts may be cut and trimmed or repaired by reattaching to the top of the socket.
The labral tear may need to be repaired if the tear is larger and the shoulder is unstable. Shoulder labrum reconstruction may be done either arthroscopically or with an open incision method.
Bankart lesion is repaired by Bankart operation. Bankart operation is a surgical procedure to stabilize a shoulder after a bankart lesion. In this surgery the bankart tear is repaired by reattaching the labrum and capsule to the anterior margin of the glenoid cavity. The procedure is performed under general anesthesia and your surgeon makes small incisions around the joint. Through one incision an arthroscope is placed into the back of the shoulder to view the inside of the shoulder joint. Other surgical instruments are placed through the other incision to re-attach the labrum to the glenoid using either sutures or anchoring devices. Then the arthroscope and surgical instruments are removed and the incisions are closed.
Risks and Complications
Risks associated with a Bankart procedure include:
- Nerve injury
- Poor anchor suture positioning
- Wound infection
- Tear of the repair
- Shoulder stiffness
- Recurrence of instability
- Failure of the repair
- Failure of the anchor suture
Post – Operative Care
Following surgery, your shoulder is immobilized with a sling for few days. To control pain and swelling your physical therapist may use ice, electrical stimulation, massage therapy, and other hands-on –treatments. Passive range of motion exercises are started following labral repair. Active range of motion exercises starts about 6 weeks after repair to regain your shoulder movement. If involved in sports, you may return to sports at three months.
Shoulder labrum reconstruction is a procedure for shoulder instability after labral tear. In the procedure the torn labrum is re-attached back to the socket using either sutures or anchoring devices.