Over the last 20 years, there has been a major increase in sports participation that may distress the shoulder. Paired with the increased competitiveness within organized sports throughout childhood and adolescence, there is a greater need for surgical procedures on the shoulder joint, such as rotator cuff and labral repairs.
Rotator Cuff Repairs
The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint and is responsible for keeping the arm in its socket and allowing the joint to move. For sports that require numerous shoulder exercise repetitions, such as baseball, tennis or volleyball, a rotator cuff can be torn from overuse or from a sudden acute tear.
Surgery is often recommended for this injury when:
- Your symptoms have lasted over six months
- Your tear is larger than three centimeters
- You have significant weakness and loss of function in your shoulder
- Your tear was caused by a recent, acute injury
- You are a competitive athlete in a sport that requires overhead motions
Types of Rotator Cuff Surgeries
Rotator cuff surgeries include suturing or reattaching one or more of the shoulder joint tendons to the bone. There are three common surgical techniques used to repair a rotator cuff tear:
- Open Repair: During this technique, an incision is made over the shoulder, and the surgeon detaches the deltoid, one of the shoulder muscles, to gain access to the torn tendon. This repair is often utilized if the tear is large or complex.
- All-Arthroscopic Repair: In an all-arthroscopic repair, your surgeon uses an arthroscope, which is a specialized kind of endoscope that is used to examine the interior of hollow structures. An arthroscope is attached to a fiber-optic video camera that is transmitted to a high-definition video monitor, which your surgeon can use to guide his or her surgical instruments. This procedure is minimally invasive and only requires three small incisions.
- Mini-Open Repair: With this technique, the surgeon uses newer technology and instruments to remove any bone spurs with an arthroscope, which avoids the need to detach the deltoid muscle. For tendon repair, the surgeon views the shoulder structures directly, which differs from an all-arthroscopic approach, where the surgeon sees the shoulder join through a video monitor.
Rotator Cuff Repair Recovery
Following your rotator cuff surgery, you will be required to wear a sling for about four to six weeks after surgery. Your recovery will entail pain management, wound care, and rehabilitation exercises, which will greatly impact your ability to return to full function. Full recovery can take four to six months, depending on the size of the tear, and the kind of surgery you received.
The labrum is a ring of cartilage that lines and reinforces the shoulder joint, which is composed of a ball, the head of the humerus, and the socket, also known as the glenoid. The labrum supports the shoulder joint, and the rotator cuff’s tendons and muscles, while also contributing to shoulder stability.
When injured, a torn labrum can result in partial or complete shoulder dislocation, and cause a tremendous amount of pain. Labrum tears often happen due to a sports injury, typically in athletes who participate in baseball, tennis, volleyball, and golf. Labral tears can also occur from a traumatic acute injury or due to the aging process.
Labral Repair Surgical Treatment
There are two common types of labrum tears, meaning there are two forms of surgical treatments that are used to repair the two kinds of torn labrums.
SLAP Repair: A superior labrum from anterior to posterior, known as SLAP, is a kind of tear that runs from the front to back, occurring where the bicep muscle tendon connects to the labrum in the shoulder socket. A SLAP repair is performed utilizing an arthroscope, a specialized kind of endoscope that is used to examine the interior of hollow structures. The arthroscope is able to identify the labral tear, and the surgeon can then remove any excess tissue and drill a small hole in the bone where the labrum has torn. To reattach the cartilage, the surgeon sutures the labrum to the bone.
Bankart Repair: A bankart tear occurs when the shoulder joint ball slips out of the socket, causing the joint to pull on the lower portion of the labrum and tear it. This leads to shoulder instability because the partially torn labrum makes it easier for the shoulder to dislocate again. In a bankart repair, the surgeon reattaches the lower part of the labrum to the shoulder socket.
Labrum repair surgeries eliminate pain and restore normal function and mobility in the shoulder joint, while limiting scar tissue formation. Regardless of which type of surgery is performed, all patients are advised to wear a sling for the first four weeks after surgery to protect the shoulder as it heals.
Along with wearing a sling, patients will need medications to manage their pain, to follow their doctor’s instructions on incision-site care, and to complete rehabilitative exercises. Athletes may require six months to one year for full recovery, with overhead throwing athletes taking the longest.