Tear > Treatments
Debridement or Arthroscopic Stabilization
If your labral tear does
not heal sufficiently with conservative treatment, surgery
may be necessary to repair or remove the torn tissue.
This procedure can be performed arthroscopically or
open, depending on whether the torn piece of the labrum
needs to be removed or attached to the rim of the shoulder
socket with special staples.
The decisions you make and the actions
you take before surgery can be every bit as important
as the procedure itself in ensuring a healthy recovery.
Getting a second opinion from another qualified surgeon
is often advisable, particularly in rare or unique cases.
sure you have received any equipment you will need when
you get home from the hospital. This may include a shoulder
sling, ice packs or coolers, or heating pads. You should
receive prescriptions for any of these from your doctor
when your surgery is scheduled.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
your arthroscopic stabilization of your labral tear.
There may be separate check-in areas for ambulatory
outpatient (patients who go home the same day after
surgery) and for overnight inpatient surgery, so be
sure to ask your physician or an assistant about this.
After you have checked in to the hospital or clinic,
you will go to a holding area where the final preparations
are made. The paperwork is completed and your shoulder
may be shaved, though this is not always necessary.
You will wear a hospital gown and, if applicable, remove
your watch, glasses, dentures, and jewelry. You will
have the opportunity to speak with your orthopedic surgeon
or an assistant, and meet the anesthesiologist or anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important things to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
you may be unable to drive, arrange for someone to help
take you out of the hospital and drive you home when
you are released.
a soft, comfortable shirt that will not irritate your
skin when worn under a shoulder sling.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Surgical debridement or arthroscopic
stabilization of a labral tear normally takes two hours
may be given an interscalene block, also referred to
as regional anesthesia, to numb your shoulder and neck
area. This is administered with an injection in the
side of your neck.
may also be put under general anesthesia, or given a
mild sedative to help you relax.
may laying down or placed in a sitting position with
your back at a 75-degree angle - called a "beach
chair" position, to give the surgeon easy access
to your shoulder.
an arthroscopic surgery, two or three incisions are
made, each about two centimeters in diameter. In an
open surgery, a longer incision is made to open shoulder
sufficiently for the surgeon to do the repair.
labral tear is either removed or repaired with standard
instruments or with microsurgery instruments inserted
into one of the incisions, with an arthroscope (a tiny
camera) in the other incision allowing the surgeon to
view the inside of your shoulder via a television monitor.
surgeon will usually remove some of the shoulder capsule
during repair as only securing the labrum will likely
result in persistent instability.
incsions are stitched up and you are taken to the recovery
When you awaken in the recovery room
following arthroscopic stabilization of your labral
tear, your shoulder usually is wrapped in gauze, immobilized
in a sling, and covered with an ice pack. You may feel
a moderate amount of pain. You usually stay in the recovery
room for at least two hours while the anesthetic wears
off. General anesthesia wears off in about an hour and
regional anesthesia may take about two hours to wear
off. You will be given adequate pain medicine, either
orally or through an IV (intravenous) line, as well
as instructions for what to do over the next couple
of days. In addition, you will be given an appointment
to return in two to three weeks and a prescription for
pain medicine. You should try to move your fingers while
you are in the recovery room to improve circulation.
Moving your wrist may be painful and you usually should
not try to move your elbow. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the hospital or, if necessary,
be admitted for an overnight stay. The majority of patients
leave the hospital after two or three hours. As soon
as you are fully awakened, you usually are allowed to
go home. You will be unable to drive a car, so be sure
to have arranged a ride home.
After arthroscopic stabilization of
a labral tear, you will need to take steps to reduce
the pain and inflammation in your shoulder. Rest, icing,
and anti-inflammatory painkillers such as ibuprofen
or aspirin can ease pain and swelling. Immobilizing
the shoulder in a sling for two or three days will help
keep it stabilized. You usually are instructed to remove
the sling for part of each day to perform gentle motion
exercises that will keep your shoulder from tightening
up. Here is what you can expect and how you can cope
with a sling immobilizing your shoulder:
first concern is to monitor swelling for the first 48
hours while wearing your sling. Physicians generally
prescribe ice packs to be applied for 15 to 20 minutes
at a time, three or four times a day.
the swelling has decreased after 72 hours, you may be
able to apply heat to help reduce pain. You should not
apply heat to swollen areas because heat increases blood
flow to the skin, which can prolong the healing process.
generally recommend that you wear the shoulder sling
day and night for about two or three days.
can usually remove the gauze bandage and bathe regularly
after two days. If surgeons had to make a 1 1/2-inch
"mini-incision" to suture your rotator cuff
tear, you may have to keep the bandage on and sponge
bathe for about seven days. You can take your sling
off for brief periods while you bath, but remember to
avoid moving your injured shoulder.
bleeding and fluid drainage is normal for the first
two days. Call your physician if bleeding continues.
your shoulder starts to heal, your physician may recommend
that you remove the sling for short periods to perform
some light, early-motion exercises.
should move your fingers and hands in the sling as much
as possible to help circulate blood.
you develop a rash or irritated skin around your sling,
call your physician.
you notice any abnormal wear or discomfort in the sling,
contact your physician as early as possible. In general,
do not try to "grin and bear it" if discomfort
does not go away within a few days. Slings should not
irritate your skin.
may feel some stiffness in your shoulder. Call your
physician if the stiffness does not ease after two or
The first phase of rehabilitation
exercises can normally begin the day after surgery to
repair your labral tear. Physical therapy following
arthroscopic stabilization of a labral tear usually
progresses through four phases. The first phase usually
lasts about six weeks. The second and third phases vary
depending on the patient, but often last six weeks or
more. The final phase, which is considered more sport-specific,
begins four to six months after surgery. The time you
spend in each phase, however, depends on the severity
of your injury and your body’s ability to heal.
first phase focuses on decreasing inflammation in your
shoulder. Your therapist usually helps you move your
arm and stretch your shoulder.
you feel comfortable moving your arm with your own strength,
you can work on restoring a full range of motion and
strengthening the hands, wrist, and elbow.
third phase focuses on shoulder-strengthening exercises.
These may begin with isometric exercises, which strengthen
the muscles without motion, and progress to resistive
exercises that may involve pulleys or weights.
the muscles in the injured shoulder are about as strong
as the uninjured muscles, phase four of rehabilitation
becomes more activity oriented. You usually perform
sport-specific exercises and coordination drills under
the supervision of a therapist or coach.
The best way to prevent recurring
labral tears is to make the strengthening exercises
you learned in rehabilitation part of your everyday
routine. You should remember to stretch your shoulder
and warm up before exercising. Sports that involve repeated
overhead motion, like baseball and tennis, inevitably
strain your shoulder. To prevent injury, you need to
keep all the rotator cuff muscles toned and flexible
with an exercise program. You also may need to alter
your work environment to avoid repeated overhead activities.
Physicians generally recommend that you ice your shoulder
after activities. Competitive athletes may need to use
anti-inflammatory medication, like aspirin and ibuprofen,
after sports activities that cause swelling in their
shoulders. Physicians generally recommend that if you
feel pain in your shoulder after a labral tear, you
should cut back your activity level and return to your
physician for a check-up.