The labrum is a fibrocartilage rim which is attached around the margin of the glenoid cavity (the shoulder socket). The shoulder socket is very shallow, which allows a healthy shoulder to move through a wide range of motion. The labrum deepens the shallow socket and helps maintain shoulder joint stability. When the labrum sustains a significant tear, the shoulder becomes unstable and can dislocate or sublux repeatedly. Subluxation refers to a partial dislocation - when the ball comes partway out of the socket and then back in. A labral tear can be caused by repetitive activities and get progressively worse over time or can happen suddenly by falling on an outstretched arm or sustaining a dislocation injury. In some cases, only the front portion of the labrum is torn. This type of injury is referred to as a Bankart lesion. A tear involving only the back portion of the labrum is called a reverse Bankart lesion. A SLAP lesion (Superior Labrum Anterior to Posterior) refers to a tear in the labrum that runs across the top of the labrum from front to back. Shoulder instability and recurrent subluxation are not always related to injury or repetitive use. They can also be caused by general ligament laxity (looseness), in which case it can be referred to as multidirectional instability.
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When you come to see the doctor with shoulder instability, the doctor will examine the shoulder and assess your ligaments for signs of laxity. An MRI may be ordered to assess the shoulder for tears of the muscles, ligaments, or labrum. An MRI with arthrogram which involves the injection of contrast dye into the shoulder joint to allow the radiologist to better visualize the labrum.
An unstable shoulder is typically treated conservatively initially. Non-surgical treatment options include physical or occupational therapy, activity modification (avoiding activities that aggravate your symptoms), and use of anti-inflammatory medication. Physical/occupational therapy for shoulder instability focuses on strengthening and stabilization exercises for the muscles around the shoulder and shoulder blade. If conservative treatment fails to stabilize the shoulder joint and improve symptoms, surgery may be recommended.
In the case of a Bankart or reverse Bankart lesion with shoulder instability, the surgical repair is referred to as a Bankart repair (or reverse Bankart repair) with capsular plication. The surgical repair involves reattaching the torn labrum to the bone. Plication is the process of overlapping part of the joint capsule onto itself and using sutures to tighten the capsule and improve stability.
If a SLAP lesion is present, the surgical repair is referred to as a SLAP lesion repair and involves use of sutures to reattach the torn labrum to the bone of the shoulder socket. In exchange for significant improvement in joint stability, it is common to lose a bit of rotational range of motion.
In the case of Bankart repair, the doctor will require use of a sling when in public for 2 weeks. You will begin home exercises for range of motion immediately following surgery, but will not start formal physical or occupational therapy until 4 weeks after surgery. Return to work time frame depends on the type of work to which you will be returning, and can range from 12 to 16 weeks after surgery.
After SLAP lesion repair, a sling is used for 4-6 weeks after surgery. Rehab begins shortly after surgery and progresses from passive to active motion and eventually to strengthening and stabilization exercises based on the doctor’s protocol. Return to work after this type of surgery will depend on the type of work to which you will be returning and can range from 12 to 16 weeks after surgery.
