Shoulder rehabilitation following arthroscopic repair of a torn labrium takes approximately 3-4 months before the shoulder is fully healed. To understand what the labrium is you must first have an understanding of shoulder anatomy. The shoulder joint consists of three bones (1) scapula or shoulder blade (2) clavicle or collarbone and (3) humerus or upper arm bone. The head of the humerus fits into the socket which is part of the scapular bone called the glenoid.
The labrium is soft tissue that surrounds the socket and provides stability for the shoulder. There are two types of labral tears (1) SLAP lesion is a tear of the tissue above the middle of the socket and (2) Bankart lesion which is a tear of the tissue below the middle of the socket.
Tears to the labrium occur from acute trauma or repetitive shoulder motion. Athletes such as baseball pitchers, football players and weightlifters are vulnerable to this type of injury.
This article will describe the causes, symptoms and shoulder rehabilitation of labral tears.
Some of the acute trauma causing labral tears are (1) falling on an extended arm (2) a direct impact on the shoulder (3) sudden pulling on shoulder when lifting heavy weight and (4) trying to prevent a fall with a sudden overhead reach. The main overuse cause is common to baseball pitchers who throw with great velocity. While in a program of shoulder rehabilitation the patient becomes totally aware of the bio mechanics that cause the injury.
The symptoms of a labral tear are similiar to other shoulder injuries and are (1) pain during overhead motion (2) catching, popping or grinding within the shoulder joint (3) difficulty sleeping on shoulder (4) unstable shoulder (5) decreased range of motion and (6) decreased strength.
After the procedure the involved upper extremity is usually in a sling for 3-4 weeks during which time the physical therapist will provide gentle passive range of motion in a pain free mode. In this phase therapy will consist of controlling the discomfort with the use of ice, electrical stimulation and sports massage to ease muscle tightness and decrease tenderness. The patient is instructed to maintain the mobility of the shoulder by performing pendulum exercises at home.
The next phase of shoulder rehabilitation in approximately 6 weeks is active and active assistive motion. Here is when the patient will be started on wall climbing exercises, shoulder wheel and pulley systems.
By week 10 the strengthening of the shoulder begins. I recommend starting with light weight and start working the outer core of the shoulder and biceps muscle. The patient should start working with the light weights (2-3 pounds) in shortened ranges performing flexion to 45 degrees, abduction to 30-45 degrees and extension to 20 degrees. Included here is biceps flexion/extension not to full range. Patient is shown isometric strengthening which is contracting shoulder muscles without movement usually against a wall. Strengthening the repaired shoulder during this period should not strain the healing joint.
Once the physical therapist determines the strength of the core structure is improved then the most important part of the shoulder rehabilitation program begins. This is building back the strength of the rotator cuff musculature. The patient performs internal and external rotation exercises utilizing resistive bands. Using bands allows the patient to perform the exercises with maximum flexibility and minimal effort.
During this stage the physical therapist also must increase the endurance of the involved upper extremity. An upper body ergometer or bicycle for the arms is most often used with a steady progression of time. Proprioception and plyometrics should also be included if the patient is planning to return to a high level of sports participation.
Shoulder rehabilitation outlined above is designed to get your shoulder back to the ways you are familiar with at work or performing sports activities.