I often receive questions from patients with a labral tear of the shoulder, or SLAP tear, wondering if I can tell by the MRI if it’s a big tear or not. More importantly, they want to know if the severity or size of a labral tear could impact the surgery and recovery. I address that concept in this week’s Ask Dr. Geier column.

Adam asks:

Does the severity of a labrum tear reduce or extend the recovery time? Or is it about the same regardless?

What is a labral tear?

That is a great question Adam. For those of you unfamiliar with labral tears, the labrum is a cartilage bumper surrounding the outside of the glenoid (the socket of the ball-and-socket shoulder joint). It can be torn with traumatic episodes, such as shoulder dislocations. It can also be damaged with overuse, such as repetitive overhead activity, or compressive loads, such as weightlifting or manual labor.

Does the size of a labral tear affect the treatment and surgery?

More than the size of a labral tear, the factor that plays the biggest role in overall recovery time is the nature of the tear. Specifically, whether or not the labrum is pulled off the glenoid and needs to be reattached or just needs to be debrided or trimmed back to stable tissue makes a huge difference. To reattach the labrum, the surgeon uses sutures and anchors placed through the labrum and into the glenoid. Every effort then has to be made to get that repair to heal. Often shoulder motion, lifting, and normal use are limited for weeks to protect the repair. Motion and then strength are gradually increased over months as the repair becomes more solid and can withstand more stress. Overall, a patient undergoing a labral repair can take four to six months to regain motion, strength, and return to sports.

Does the size of a labral tear impact the surgery?
The surgeon inserts the anchor (orange arrow) into the glenoid just in front of the biceps tendon. Another suture anchor (green arrow) has already been placed to reattach the labrum just behind the biceps.

On the other hand, if the labrum is frayed, then the surgeon can often just take a shaver and “clean up” the tissue or eliminate loose fragments and decrease pain. Since the labrum doesn’t technically have to heal, the surgeon can allow quick progression of motion, strength, and activity. It still takes time to get rid of all the swelling and pain, but athletes can return to sports much quicker.

There are many other factors that can affect recovery times, including the type of sport or exercise to which the athlete is trying to return. Fortunately, surgeons are becoming more comfortable with arthroscopic surgical procedures for treatment of labral injuries, and the technology and implants continue to improve. Athletes are likely returning to sports and exercise much more reliably than ever before.

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