Arthroscopic shoulder surgery is a procedure using a small camera device (called an arthroscope) to examine and correct any damages to the shoulder joints or tissues. This technique is less invasive as the arthroscope is inserted into a small incision rather than opening a large surface area. When used in combination with glenohumeral debridement, arthroscopic shoulder treatment for a labral injury has shown good results.
By planning before operating, the need for additional access portals to the joint is not necessary. A simple technique can be used for posterior labral repair with the use of capsular plications. This technique will allow the Phoenix sports medicine surgeon to repair the capsular laxity and posterior labral tears without any accessory portals.
The shoulder has three main bones: the humerus (upper arm bone), the clavicle (collarbone), and the scapula (shoulder blade). The head of the humerus rests in a shallowsocket called the glenoid. This socket is has a soft fibrous tissue rim called the labrum, which surrounds the socket and stabilizes the shoulder joint.
With posterior shoulder instability, the mechanism of injury can be from trauma or from repetitive overuse. Therefore, the symptoms of the study participants varied, with many complains. However, all participants were eager to return to their previous activity level and continue playing sports.
Risk Factors for Shoulder Labral Injury
Injuries to the shoulder socket and surrounding tissues often occur from repetitive shoulder activity or from acute trauma. Examples of traumatic injury are:
- A direct blow to the shoulder
- Falling onto an outstretched hand
- A sudden pull during lifting
- A violent overhead reach, such as attempting to stop a slide or fall
Symptoms of a Shoulder Socket Rim Tear
- Catching, grinding, locking, and/or popping
- Pain with overhead activities
- A sense of shoulder instability
- Loss of strength
- A decrease in range of motion
Research Study Concerning SLAP Repairs
In a literature review concerning injured elite overhead throwing athletes, multiple reports on the radiological and clinical outcomes of the type 2 superior labral, anterior posterior (SLAP) repairs were noted. The purpose of this study was to discover whether labral integrity will return and be consistent. The method involved reviewing medical records of 24 elite overhead throwing athletes who had undergone arthroscropic type 2 SLAP repairs. Out of the 18 men and 6 women, who had a mean age of 22.7, 16 out of 24 of them were baseball players.
The outcomes of this study were measured using the American Shoulder and Elbow Surgeons ASES score, visual analog scale (VAS) for the pain, as well resulting satisfaction, subjective feeling of recovery, and return to play. Labral integrity was evaluated after surgery by the use of multidetector computed tornographic arthrography. After 24 to 68 months, there was a significant improvement in the function and overall pain level.
Preoperatively, the VAS for pain was 5.7, and postoperatively it was 2.0. Preoperatively. the ASES score was 55.8, and postoperatively it was 87.1. The feeling of recovery, subjectively with a mean value overall, was 76 percent. Around 50 percent of the athletes were able to return back to play after the operation.
The other overhead throwing athletes showed a higher rate of return, which reached 75 percent compared to that of 38 percent from the baseball players. This trend, however, did not manage to reach a value of significance statistically. Two athletes could not return to play as a labral retear was noted with clinical significance. One of the two, who were observed to have osteolysis, had a retear. No statistical relation between the return to play and the integrity of the repair was found.
The researchers concluded that arthroscopic SLAP repairs can show favorable outcomes both clinically and radiologically. Elite baseball players still have a problem returning to play, though. This study also shows that in elite players, labral healing does not ensure that they will be able to return to the field.
Additionally, patients with labral applications, who had implants for the same, were having complications of a wide variety from the use implants with poly L lactic acid (PLLA). Osteolysis, chondrolysis, and glenohumeral synovitis are some examples of the complications. This report is on the larger series of such patients who had either rotator cuff pathology or labral treated with PLLA implants.
Recovery and Rehabilitation
After surgery, the patient is placed in a sling that allows 30 degrees of external rotation for six to eight weeks. After this time frame, the patient can use a standard sling. Physical therapy is recommended four weeks after the procedure. The patient should avoid specific posterior capsular stretching for three months following the procedure, but shoulder range of motion exercises are encouraged. Recovery usually takes six to eight months.
One of the top shoulder surgeons in Phoenix and Scottsdale is Dr. Sumit Dewanjee with FXRX. He is Board Certified and Fellowship Trained, with significant expertise in minimally invasive arthroscopic shoulder labral repair.
Most insurance is accepted, and Dr. Dewanjee has received the Patients Choice Award 5 Years in a Row for his skill and compassionate care. Call (480) 449-3979 for more information and scheduling today!
Resources
http://www.ncbi.nlm.nih.gov/24400175
http://www.ncbi.nlm.nih.gov/23644148
