Arthroscopic Labral Surgery Presentation Designed For Patient Education Updated 2/11.

Arthroscopic Arthroscopic Labral SurgeryLabral Surgery

Presentation Designed For Patient Presentation Designed For Patient EducationEducation

Updated 2/11

University Orthopaedics & University Orthopaedics & Sports MedicineSports Medicine

OfficesOffices

Clifton (Medical Clifton (Medical Arts Building)Arts Building)

WestchesterWestchester www.ucortho.comwww.ucortho.com 513-475-8690513-475-8690

University Orthopaedics & University Orthopaedics & Sports MedicineSports Medicine

SurgerySurgery

Holmes Hospital (Clifton)Holmes Hospital (Clifton) Outpatient Surgery CenterOutpatient Surgery Center

Mercy FairfieldMercy Fairfield MainMain Outpatient Surgery CenterOutpatient Surgery Center

Westchester Medical CenterWestchester Medical Center University Pointe Ambulatory Surgical Hospital University Pointe Ambulatory Surgical Hospital

(ASH)(ASH) University HospitalUniversity Hospital

What does the labrum What does the labrum do?do?

Cartilage that Cartilage that surrounds the glenoid surrounds the glenoid (shoulder socket)(shoulder socket)

Link between the Link between the socket and the socket and the capsule (tissue that capsule (tissue that holds the ball inside holds the ball inside the socket)the socket)

Deepens the socket Deepens the socket and is provides and is provides stability to the stability to the shouldershoulder

How is the labrum How is the labrum injured?injured?

Direct trauma to Direct trauma to the shoulderthe shoulder Motor vehicle Motor vehicle

accidentaccident SportsSports FallFall

Shoulder Shoulder dislocationdislocation

Pulling or pushing Pulling or pushing of the armof the arm

Repeated overhead Repeated overhead activityactivity AthletesAthletes Repetitive labor Repetitive labor

workwork

Labral TearsLabral Tears The labrum completely The labrum completely

surrounds the socketsurrounds the socket The tears are described The tears are described

based on their locationbased on their location Tears in different Tears in different

locations often give locations often give different symptomsdifferent symptoms

Superior labral anterior Superior labral anterior to posterior (SLAP) tearto posterior (SLAP) tear Top of labrum frequently Top of labrum frequently

involving the biceps tendoninvolving the biceps tendon Bankart tearBankart tear

Front, lower labrumFront, lower labrum Posterior labral tearPosterior labral tear

Back of labrumBack of labrum

What are the symptoms of What are the symptoms of labral injury?labral injury?

PainPain Feeling of instabilityFeeling of instability

““my shoulder is loose”my shoulder is loose” LockingLocking Clicking Clicking CatchingCatching

Labral Tears-DiagnosisLabral Tears-Diagnosis HistoryHistory Physical ExaminationPhysical Examination X-raysX-rays

Often normalOften normal MRI arthrogramMRI arthrogram

Radiologist injects dye Radiologist injects dye into the shoulderinto the shoulder

MRI scan obtainedMRI scan obtained Best imaging test for Best imaging test for

labral tearslabral tears MRI is not perfect—MRI is not perfect—

some labral tears are some labral tears are not well seen on MRI not well seen on MRI

Labral Tear

↓

Labral Tears-Non operative Labral Tears-Non operative treatmenttreatment

Anti-inflammatory medications-decreasing Anti-inflammatory medications-decreasing inflammation causes decreased paininflammation causes decreased pain

Selective cortisone shots-steroids are very Selective cortisone shots-steroids are very potent anti-inflammatory medications and potent anti-inflammatory medications and go directly to the source with little go directly to the source with little systemic absorptionsystemic absorption

Physical Therapy-strengthening the rotator Physical Therapy-strengthening the rotator cuff stabilizes the shoulder and may make cuff stabilizes the shoulder and may make the shoulder feel betterthe shoulder feel better

These options are best for older patients These options are best for older patients with degenerative type tearswith degenerative type tears

Labral Tears-SurgeryLabral Tears-Surgery

The most predictable option for The most predictable option for treatment of tears in a younger, treatment of tears in a younger, active patientactive patient

Small frayed tears are best treated Small frayed tears are best treated with arthroscopic debridementwith arthroscopic debridement

Large, unstable tears are best Large, unstable tears are best treated with arthroscopic repairtreated with arthroscopic repair

AnesthesiaAnesthesia Anesthesiologist Anesthesiologist

administers nerve block administers nerve block in pre-op holding area in pre-op holding area after giving some IV after giving some IV medicationsmedications Typically lasts about 18 Typically lasts about 18

hourshours General anesthesiaGeneral anesthesia

Patient then placed under Patient then placed under general anesthesiageneral anesthesia

Patient is positioned such Patient is positioned such that full access to the that full access to the shoulder can be obtainedshoulder can be obtained

Skin cleaned with Skin cleaned with sterilizing prepsterilizing prep

Athroscopic SurgeryAthroscopic Surgery

ArthroscopicArthroscopic Arthro = jointArthro = joint Scope = cameraScope = camera ““Look around joint Look around joint

with camera”with camera”

Arthroscopic SurgeryArthroscopic Surgery

Normal Arthroscopic Normal Arthroscopic AnatomyAnatomy

The labrum The labrum surrounds the surrounds the socket and is socket and is attached to the boneattached to the bone

The biceps tendon The biceps tendon attaches to the attaches to the labrum at the top of labrum at the top of the socketthe socket

Labrum attaching to the bone

↓

↓Biceps Tendon

Labral TearsLabral Tears The instrument is in the The instrument is in the

tear and the labrum has tear and the labrum has torn off the bonetorn off the bone

If the labrum is torn at If the labrum is torn at the top of the socket the top of the socket then the biceps can then the biceps can become unstable become unstable causing pain and causing pain and poppingpopping Instrument is under the Instrument is under the

labral tearlabral tear Yellow arrow points to Yellow arrow points to

the biceps tendon the biceps tendon attached to the torn attached to the torn labrumlabrum

↓

Labral RepairLabral Repair The labrum is sewn The labrum is sewn

back down to the back down to the bone using implants bone using implants called suture called suture anchors (special anchors (special screws with attached screws with attached sutures)sutures)

The anchor goes into The anchor goes into the bone and the the bone and the labrum is sewn down labrum is sewn down with the sutureswith the sutures

The suture holds the The suture holds the labrum to the socket labrum to the socket until it healsuntil it heals

Labral RepairLabral Repair

Suture anchor with Suture anchor with attached suturesattached sutures

Torn labrumTorn labrum

Repaired labrumRepaired labrum

Post opPost op Wake up in a sling and cryocuff (ice pack)Wake up in a sling and cryocuff (ice pack) If pre-op block was successful then you If pre-op block was successful then you

should be pretty comfortable with a numb should be pretty comfortable with a numb armarm

Go home same dayGo home same day Start taking your pain medications as soon Start taking your pain medications as soon

as you get home prior to your block as you get home prior to your block wearing off. wearing off.

It can be very difficult to “catch up” if you It can be very difficult to “catch up” if you have no pain medication in your system have no pain medication in your system when your block wears off.when your block wears off.

Post-op-MedicationsPost-op-Medications

Pain medicationsPain medications Take these as neededTake these as needed Not well tolerated on an empty stomach Not well tolerated on an empty stomach

so make sure you eat something first so make sure you eat something first even if just crackerseven if just crackers

Nausea medicationsNausea medications Sometimes patients are nauseated after Sometimes patients are nauseated after

surgery from the anesthesiasurgery from the anesthesia Usually wears off in 24 hoursUsually wears off in 24 hours Can take medication if neededCan take medication if needed

Post opPost op Leave dressing intact for first 72 hours after surgery. Leave dressing intact for first 72 hours after surgery.

Reinforce if neededReinforce if needed May remove and shower at 72 hours post opMay remove and shower at 72 hours post op Do not scrub your woundsDo not scrub your wounds Simply wash your neck with soap and water and let the Simply wash your neck with soap and water and let the

soap and water run offsoap and water run off Do not soak your wounds until permitted to do so by Do not soak your wounds until permitted to do so by

your physician. NO BATH, SWIMMING OR HOT TUBS.your physician. NO BATH, SWIMMING OR HOT TUBS. If your wounds are dry, may leave open to the airIf your wounds are dry, may leave open to the air If oozing then put on a clean dry dressing and call your If oozing then put on a clean dry dressing and call your

doctordoctor Do not put any ointments on your wounds. This Do not put any ointments on your wounds. This

includes antibiotic ointments (Neosporin, Polysporin, includes antibiotic ointments (Neosporin, Polysporin, etc)etc)

It is easiest to wear a button shirtIt is easiest to wear a button shirt Wear your sling all the time except to showerWear your sling all the time except to shower

Post opPost op

Your first follow-up appointment Your first follow-up appointment should be 5-7 days post opshould be 5-7 days post op

Please make an appointment to go to Please make an appointment to go to physical therapy immediately following physical therapy immediately following your first post op appointment.your first post op appointment. In some cases your surgeon may delay the In some cases your surgeon may delay the

start of therapy for several weeks start of therapy for several weeks depending on the type of teardepending on the type of tear

The expected start date for therapy will be The expected start date for therapy will be discussed post-operativelydiscussed post-operatively

Post-Op RehabPost-Op Rehab Start range of Start range of

motion exercises at motion exercises at 1 week1 week

Sling for 4-6 weeksSling for 4-6 weeks

Start strengthening Start strengthening at 8-12 weeksat 8-12 weeks

No sports, lifting for No sports, lifting for 4-6 months4-6 months

Post-op RehabPost-op Rehab

IT IS ABSOLUTELY ESSENTIAL TO IT IS ABSOLUTELY ESSENTIAL TO PERFORM EXERCISES AT HOME PERFORM EXERCISES AT HOME AS WELL AS IN THERAPYAS WELL AS IN THERAPY

SOMETIMES IT IS NECESSARY TO SOMETIMES IT IS NECESSARY TO DO YOUR EXERCISES SEVERAL DO YOUR EXERCISES SEVERAL TIMES DAILYTIMES DAILY

Frequently Asked Frequently Asked QuestionsQuestions

Will I have therapy post op?Will I have therapy post op? Yes. Initially 2-3 times per week then less often. Yes. Initially 2-3 times per week then less often.

Exercises must be done at home too! Exercises must be done at home too! How long do I have to wear the sling?How long do I have to wear the sling?

4-6 weeks. Longer when in an uncontrolled 4-6 weeks. Longer when in an uncontrolled environmentenvironment

When can I go back to work?When can I go back to work? This is highly variable depending on what you doThis is highly variable depending on what you do For desk jobs it could be as early as a couple For desk jobs it could be as early as a couple

daysdays Labor jobs with lifting, 4-6 monthsLabor jobs with lifting, 4-6 months

QuestionsQuestions

Any further questions should be Any further questions should be directed to your therapist or surgeondirected to your therapist or surgeon

Please call the office with questions Please call the office with questions or concernsor concerns

513-475-8690513-475-8690 www.ucortho.comwww.ucortho.com

Thank YouThank You