What is a Posterior Shoulder Labral Repair?
A posterior shoulder labral repair is a surgical procedure performed to address damage or injury to the posterior (back) labrum of the shoulder. The labrum is a cartilage ring that surrounds the shoulder socket (glenoid) and helps stabilize the joint. Injuries to the labrum can occur due to trauma, repetitive use, or degenerative changes.
The posterior labrum is the part of the labrum located towards the back of the shoulder joint. Tears or damage to this area can result from activities that involve overhead motion or forceful rotation of the shoulder. Athletes, especially those in sports like baseball or swimming, may be prone to such injuries.
Indications for Posterior Shoulder Labral Repair
Your physician may recommend posterior shoulder labral repair if your shoulder labrum tear is severe and conservative treatment such as anti-inflammatory medication, injections, and physical therapy have been ineffective in alleviating your symptoms from the labrum tear such as pain, decreased range of motion, and joint instability. In addition, if you are an athlete and looking to get back on the field, your ideal option will be surgery. Surgery is the ideal way to ensure that your labrum heals correctly. The goal of the surgery is to restore stability to the shoulder joint and alleviate pain or other symptoms associated with the labral injury.
Preparation for Posterior Shoulder Labral Repair
Preoperative preparation for posterior shoulder labral repair may involve the following steps:
- A comprehensive medical evaluation, routine blood tests, and imaging studies to assess the extent of the labral injury
- Informing your doctor of any allergies to medications, anesthesia, or latex
- Providing your physician with a list of medications or supplements you are taking
- You may need to adjust or temporarily stop taking certain medications - especially those that can affect blood clotting
- Disclosing any recent illnesses or other medical conditions you may have
- Stopping smoking, as it can impact the healing process and increase the risk of complications
- Abstaining from food or drink for at least 8 hours prior to the surgery
- Arranging for someone to drive you home after the surgery
- Signing an informed consent form after potential risks, benefits, and expected outcomes of the surgery have been discussed
Procedure for Posterior Shoulder Labral Repair
The procedure for posterior shoulder labral repair is typically performed arthroscopically, which involves using small incisions and specialized instruments to access and repair the damaged labrum. In general, the procedure involves the following steps:
- The surgery is typically performed under general anesthesia, meaning you will be asleep and pain-free during the procedure.
- You will be positioned on the operating table, usually in a lateral decubitus position. This means lying on the unaffected side with the affected shoulder facing upward.
- The surgical site, including the shoulder and surrounding areas, is cleaned and prepared in a sterile fashion to minimize the risk of infection.
- Your surgeon will make 3 to 4 small incisions (arthroscopic portals), about a half-inch in length, around the shoulder joint to introduce the arthroscope and specialized instruments through these incisions.
- An arthroscope, a slender tubular device attached with a light and a small video camera at the end is inserted through one of the incisions into your shoulder joint.
- The video camera transmits the image of the inside of your shoulder joint onto a monitor, allowing the surgeon to examine the labrum to identify the extent and location of the tear or damage.
- Using specialized instruments, the surgeon mobilizes the torn or damaged labrum. Sutures, anchors, or other fixation devices are then used to reattach and repair the labrum to its anatomical position.
- After completing the repair, the surgeon closes the incisions with sutures or staples. Sterile dressings are applied.
Postoperative Care and Recovery
In general, postoperative care and recovery after posterior shoulder labral repair may involve the following steps:
- Your arm is typically placed in a shoulder sling to support and protect the shoulder during the initial stages of healing.
- You may experience pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed to address these.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You may also apply ice packs on the shoulder area to help reduce swelling and pain.
- Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
- Avoid strenuous activities and gradually increase daily activities as tolerated.
- A physical therapy regimen will be designed to help gradually regain shoulder strength, range of motion, and stability.
- You should be able to resume your normal daily activities in 3 to 4 weeks, but with certain activity restrictions. Return to sports may take 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Risks and complications associated with posterior shoulder labral repair include:
- Infection
- Bleeding
- Shoulder stiffness
- Blood clots or deep vein thrombosis (DVT)
- Pain, postoperative and/or persistent
- Injury to adjacent nerves or blood vessels
- Failure of the repair/recurrent instability
