Management of Shoulder Labrum Repair
For shoulder labrum repair, treatment should begin with conservative management including physical therapy focused on rotator cuff and periscapular muscle strengthening, with surgical intervention reserved for cases that fail to respond to non-operative treatment. 1, 2
Diagnostic Approach
- Initial evaluation should include standard radiographs with at least three views: anteroposterior (AP) views in internal and external rotation, and an axillary or scapula-Y view 1, 2
- MR arthrography is considered the gold standard for imaging labral tears, particularly in patients under 35 years of age 1, 2
- MRI without contrast is appropriate for suspected labral tears with negative or indeterminate radiographs 1
- CT arthrography may be appropriate if MRI is contraindicated 1, 2
Non-Surgical Management
- Physical therapy should focus on strengthening of the rotator cuff, periscapular muscles, and core musculature 2
- Rehabilitation should include capsule flexibility exercises 2
- Activity modification and anti-inflammatory medications should be incorporated into the treatment plan 1
- For athletes with SLAP tears who complete a comprehensive rehabilitation program, return-to-play rates can reach 78%, with 72% returning to prior performance levels 3
- Factors associated with failure of non-surgical management include older age, participation in overhead sports (especially baseball pitchers), traumatic injury, positive compression rotation test, concomitant rotator cuff injury, and longer symptomatic period 3
Surgical Management
- Surgical intervention is indicated when conservative management fails to resolve symptoms 1, 2
- For labral tears, the specific surgical approach depends on the type and location of the tear:
- For SLAP tears (superior labrum), repair typically involves anchoring the superior labrum and biceps tendon complex to the superior glenoid tubercle 4
- For posterior labral tears due to instability, arthroscopic posterior labral repair and capsular shift has shown excellent results with 96% of patients returning to prior sports activities 5
- For anteroinferior labral tears (Bankart lesions), repair focuses on reattaching the capsulolabral complex 6
Post-Surgical Rehabilitation
- After SLAP repair, throwing athletes should avoid throwing for a minimum of 6 weeks 2
- A strengthening phase of rehabilitation should follow for an additional 6 weeks (total of at least 3 months rest from throwing) 2
- Typical rehabilitation protocols recommend sling use for 4-6 weeks (61.7% of protocols) 7
- Common exercises in rehabilitation protocols include pendulum swings (53%), submaximal isometrics (55%), and scapular strengthening (65%) 7
- Return to sports typically occurs around 24 weeks post-surgery (33% of protocols), with throwing activities beginning around 16 weeks (38.3% of protocols) 7
- Return to sports should be based on functional testing rather than arbitrary time points 2
Common Pitfalls to Avoid
- Failing to obtain adequate imaging can lead to missed diagnoses 1
- Overlooking associated injuries, particularly in traumatic cases 1
- Premature return to throwing or overhead activities before adequate healing 2
- Lack of specificity in rehabilitation protocols regarding functional progression 7
- Insufficient duration or intensity of rehabilitation, as patients who successfully completed non-operative treatment averaged 20 physical therapy sessions versus 8 sessions for those requiring surgery 3