What to Expect from Your Shoulder Labrum Surgery Recovery
What is a SLAP Tear aka a Shoulder Labrum Tear?
Having a shoulder injury is stressful enough but when you start hearing latin words or acronyms from your doctor (or Dr. Google) it can add a layer of confusion on top of everything.
What is the function of the labrum?
As a brief overview to start with: the labrum is a ring of cartilage that helps to create some stability in the shoulder via a nice ball and socket joint. This is where the round head of the humerus (upper arm bone) meets the flat-ish part of the scapula (shoulder blade). One end of your bicep also attaches into this structure.
The two most common types of labrum injuries involve damage to the labrum with respect to two functions: creating a stable joint and acting as the attachment site for the bicep.
How do you tear your labrum?
SLAP tear: This acronym stands for “superior labrum from anterior to posterior” and is most commonly associated with injuries sustained by overhead athletes. SLAP tears occur when the bicep pulls excessively at the site of attachment and may cause a tear. Of the patients that we often see here at Union, that is often the climber who has an unexpected foot slip, hangs on with one arm and excessively loads the bicep/labrum. You may or may not feel or hear a pop or tear at the time of injury.
Bankart tear: These are injuries of instability. Bankart tears often are caused by shoulder dislocation where the head of the humerus is pushed out of the socket (typically forward) that the labrum helps create. The dislocation can cause damage to the ring of cartilage that is the labrum. If one experiences shoulder dislocations frequently it can cause a further wearing down of that cartilage ring. These types of tears commonly come from falls, collisions, or even overuse.
How is a diagnosis of a labrum tear made?
Diagnosing labrum tears can sometimes be a little tricky. If you go into the clinic the physical therapist or physician will likely do a physical exam and perform some tests on your shoulder. Based on the history of injury and/or results from the physical examination your provider may suspect the labrum may be involved but either an MRI or CT-arthrogram is indicated to further rule in/out injury or damage to the labrum.
Should I get an MRI of my SLAP tear?
Not to go too deep into the minutiae but when getting an MRI for a shoulder labrum tear they will likely be performing an MRI arthrogram where the contrast is injected directly into the joint rather than “with contrast” where it is injected into a vein. These tests are about 80-85% accurate in picking up labral tears and some smaller tears may be missed.
SLAP Tear Surgery
Maybe not the most helpful answer but: it depends. There are a number of factors that influence if surgery is the right option including age, severity of injury, amount of pain, strength and mobility limitations, type and/or site of tear, and sport/activity that you would like to return to. Your first line of defense will likely be conservative treatment including physical therapy. If you are able to regain your mobility and strength necessary for your sport and regular activities then great! If the tear gets worse, if the shoulder continues to dislocate or mobility and strength is not regained or preserved then it may be time to consider surgical intervention. One other thing to consider is that an important study from a few years ago found asymptomatic labral tears in as many as 55-72% of middle aged patients. In other words, that labral tear might not even be the pain generator!
Shoulder Labrum Surgery Recovery
Every surgeon has their own post-op protocols and the type of labral tear will also impact the specific timelines. As a general overview though: the first few weeks after surgery will be spent in a sling with minimal movement. After a few weeks then you will begin working on introducing some more gentle range of motion exercises. Nearing the one month mark you may start introducing some gentle strengthening exercises but there will still be significant weight and range of motion limitations. Over the course of months 1-4 there will be a slow, steady build up in strength and range of motion exercises. Nearing month 4-5 after the surgery one will likely start adding exercises that look a lot more like weight training and exercises with a speed component. It may be 6-12 months before you get cleared for return to contact sports or heavy/dynamic activities and exercises. Again, this does not serve as a postoperative protocol: every surgeon is different and each injury may require different considerations and timelines that can be shorter or longer.
SLAP Tear Exercises
It is very important to have a thorough and consistent plan in place to ensure a safe and efficient return to sport and daily activities. You and your therapist will work closely together to build back range of motion and strength. Visits will likely be a combination of hands-on treatment to regain mobility and at-home and in-clinic exercises. As you pass certain timelines in your post-op protocol, your therapist will help to guide you in safe return to newly available motion and activities. Perhaps, even most importantly, these timelines in a post-op protocol are just dates but whether a person is ready, or how far they can progress is something that your therapist can help you with.
When to seek physical therapy for a SLAP tear.
Don’t let shoulder pain ruin your season! Many, many people come back from both conservative and surgical interventions and are able to perform at a high level. If you have had an injury or something feels consistently tweaked it would be a great idea to have one of the skilled physical therapists at Union take a look and get you back on the rock or direct you towards the appropriate medical provider. At Union PT we are outdoor athletes ourselves. We understand the unique challenges faced by your sport or daily life. We are trained in manual therapy and movement analysis making sure you will get the most out of each visit. Not only will we address the immediate issue but we’ll also look “upstream” to see WHY you are here with that problem.
About the author
Jon Sparks, PT, DPT, CSCS is a physical therapist at Union PT in Seattle. He is experienced in treating acute and chronic industrial injuries, postoperative rehabilitation and orthopedic injuries. He enjoys staying up-to-date with evidence-based treatments. Outside the clinic Jon is thoroughly obsessed with rock climbing. When not climbing, he enjoys traveling, exploring new restaurants and snowboarding.