Shoulder Labrum 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 which helps in stabilising the shoulder joint. The biceps tendon is attached inside the shoulder joint at the superior labrum of the joint. The biceps tendon is a long cord-like structure which attaches the biceps muscle to the shoulder and helps to stabilise the joint.

Causes

Traumatic injury to the shoulder with football is a common cause. Overuse of the shoulder by repetitive throwing, bowling or weightlifting can cause a labral tear. In addition, the ageing process may weaken the labrum leading to injury secondary to wear and tear.

Symptoms

A shoulder labral tear injury can cause symptoms such as pain, a catching or locking sensation, decreased range of motion and joint dislocation or instability.

Types of labral tears

The most common types of labral tears include:

• Bankart tear: Bankart tear is an injury to the labrum that leads to recurrent dislocations and arthritis of the shoulder
• SLAP tear: The term SLAP (superior –labrum anterior-posterior) refers to an injury of the superior labrum of the shoulder, at the attachment of the biceps tendon.
• Posterior labrum tears: This type of labrum tear is rare, but may be caused by repeated internal impingement, where the extreme extension and external rotation of the shoulder joint causes pinching of the bulged part of the arm bone against the lining of the shoulder joint cavity.

Diagnosis

A labral tear may be suspected based on your symptoms and medical history. Professor Bain will inquire about your pain and history of injury and several physical tests will be performed by Professor Bain to evaluate the range of motion and stability of your shoulder. X-rays and computed tomography (CT) scan or magnetic resonance imaging (MRI) scan, with a contrast medium, to determine the presence of tears. Diagnosis of a labral tear can also be confirmed through shoulder arthroscopy.

Conservative Treatment

A conservative approach such as prescribing anti-inflammatory medications and advise rest and modification of activities to relieve symptoms. Rehabilitation exercises may be recommended to strengthen rotator cuff muscles. If the symptoms do not resolve with these conservative measures, arthroscopic surgery may be recommended.

Surgical Treatment

During arthroscopic surgery for SLAP tears, the labrum and the biceps tendon are examined. If the damage is confined to the labrum without involving the tendon, then the torn flap of the labrum may be removed. In cases where the labrum or tendon is detached then sutures will be used to repair and reattach.

Bankart lesion is repaired by a Bankart operation. In this procedure, the Bankart tear is repaired by reattaching the labrum and the capsule to the anterior margin of the glenoid cavity. A few small incisions are made around the joint. Through one incision an arthroscope is inserted into the shoulder to visualise the inside of the shoulder joint. Other surgical instruments are inserted through the other incision to re-attach the labrum to the glenoid with the help of sutures or anchoring devices. The arthroscope and surgical instruments are removed and the incisions are closed.

Post -Operative Care

Following the surgery, your shoulder is immobilised with a sling for a few weeks. To control pain and you will be prescribed pain relieving tablets. A sling is used for 2-6 weeks. Passive range of motion exercises are also initiated in the post-operative phase. Active range of motion exercises are started about 6 weeks after the repair, to regain your shoulder movement. Athletes can return to sports in about 6-9 months.

Risks and Complications

Risks associated with a labral repair include:

• Nerve injury
• Wound infection
• Tear of the repair
• Shoulder stiffness
• Recurrence of instability or dislocation
• Failure of the repair