The labrum is the piece of cartilage that lines the ball and socket joint of the shoulder, which is composed of the glenoid (shallow shoulder socket) and the head (ball) of the upper arm bone, known as the humerus. The labrum is where the ligaments attach in order to support the ball-and-socket joint. When torn, the shoulder can become unstable and results in partial or complete shoulder dislocation. Labral tears can occur from acute injury, or from repetitive shoulder motion.
Most labral tears can be repaired arthroscopically, which means that the surgeon will make small incisions through which a small camera and instruments will be passed to do the procedure. To reattach a torn labrum, small holes are drilled in the bone (the part of the joint that is the “socket” of the “ball in socket” formation). Anchors are inserted in these holes that hold the suture that is threaded through the labrum, effectively sewing it back to the bone. Over the next few months, this attachment should become permanent as scar tissue develops over these sutures.
Some labral repairs cannot be done arthroscopically and are therefore done in “open” procedures. Here, an incision is made that exposes the labrum and surrounding bone. The surgery then proceeds as above to sew the labrum back to the bone.
Who is a candidate?
Candidates for labral repair have a torn labrum that has not responded to nonsurgical treatment. Typically, symptoms of a labral tear include:
- A sensation of locking, popping, catching, or grinding
- Pain with movement of the shoulder or with holding the shoulder in specific positions
- Pain with lifting objects, especially overhead
- Decrease in shoulder strength
- A feeling that the shoulder is going to "pop out of joint"
- Decreased range of motion
- Pitchers may notice a decrease in their throw velocity, or the feeling of having a "dead arm" after pitching
Who is not a candidate?
Patients who have cases of labral tears that can be treated nonsurgically with pain medication and physical therapy are not candidates for labral repair.
Like other surgeries, labral repair requires certain general surgery protocol such as preoperative blood testing and the use of prophylactic antibiotic medications. Additionally, patients must stop smoking and using any pain relievers or anti-inflammatory drugs (blood thinners) one week prior to surgery. You will likely be asked to stop eating or drinking the night before the surgery.
Immediately after your procedure, your doctor will prescribe pain relief medication and possibly, a blood thinner (to lessen the risk of blood clots). You will need to use a sling for 2-4 weeks postoperative. An extended physical therapy regimen begun 4-6 weeks after surgery will likely be necessary to restore movement and strengthen your shoulder. Total recovery time can vary depending on the exact case and a patient’s overall health.
As with any surgery, there are risks of complications related to blood clots, infection, injury to nerves or blood vessels, or adverse reactions to anesthesia. Complications specific to labral repair include shoulder stiffness.
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