Welcome

Posted on March 10, 2012 by admin

shoulder image

This site is intended to provide information about labrum tears, also known as SLAP injuries, which stands for Superior Labral tear from Anterior to Posterior. Before we go any further, please be aware that I am not a doctor or in the medical profession. My experience comes as a sufferer of a torn labrum on both shoulders. Please read the terms section of the site for all the disclaimers.

 

Using this Site

This site is constructed in ‘blog’ format, meaning that all the newest entries are at the top. So reading down the page will provide you with the most current post. This is to allow those following the progress to see the latest information without scrolling through pages.

If you wish to start at the beginning, start Here. At the bottom of each post, you will see a link on the right side to link to the next article, in the order of posting. Each article is posted in timeline fashion, taking you from diagnosis, to surgery and on to recovery. Along the way I add informational posts to collect thoughts and realities of recovery.

Adverts

The advertising on the site is intended to provide you with useful links to other resources. The money generated goes towards keeping this site operating, as there are real costs associated with domain names, web hosting and professional fees. To ensure your safety, all products are advertised listed through Amazon.com, one of the most reputable online retailers. Each of the products are useful to your recovery and everyday life.

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Rehab Level 2 Begins

Posted on May 8, 2012 by admin

Officially four weeks post-op and marking the start of week five of physical therapy, it is time to start level 2! Reaching this stage depends on your personal recovery, but in most cases you will move to level 2 about this same time. Incision points are healing nicely, still some itching at the scar points, but over all, the shoulder is stable and healed from very light motion based strength training.

Sessions begin as usual on the ball and the pulley, and adds in the exercises below. The arm positions are pretty much the same, we have just added motion with no weights.

The arm is pretty sore the day after the first round of these exercises. It made sleep pretty difficult (more than usual). A lot of time was spent with cooling packs and the TENS unit. At this point I should say that if you haven’t purchased a personal TENS unit, you should. If you rented one, you will not want to keep that up as it does not make economical sense. Good TENS units can be purchased for well under $100.

The arm is still pretty weak and the average pain level requires 1 or 2 pain pills a day. But the motion is doing well overall. The most stressful part at week 4 is the sleep. It is still nearly impossible to get a good nights sleep. Mix the overall lack of sleep with either suffering through the pain or being on pain pills, and this stage of the recovery is pretty frustrating. Best advice is to stay focused, stay busy and avoid depressing movies! 🙂

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More About TENS Units

Posted on May 4, 2012 by admin

In several of the pictures you will see these square ‘electrode’ patches. If you are wondering what those are, they are the electrodes for the TENS unit. “TENS” is the acronym for Transcutaneous Electrical Nerve Stimulation. These devices are generally portable and come in many shapes and sizes. The primary purpose is to provide pain relief.

The electrical signals produces by the TENS unit are mild, but are enough to supersede the signals that are sending pain. This has a couple of affects: 1) the muscles that are tightening and in “protective mode” can relax, since the pain signals are gone; and 2) the brain may raise the level of endorphins (natural pain killers produced by the brain). Generally TENS units are only used when pain is caused by tight muscles, and should only be used under the direction of a doctor or physical therapist. Placement of the pads is critical.

For the shoulder surgery rehab patient, the TENS unit is a critical part of the recovery in my opinion. It often provides pain relief for several hours and, for me, has reduced the amount of pain killers that I would other wise be taking.

For more information about TENS units, visit Wikipedia.org/wiki/TENS_unit

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Rehab – Physical Therapy Level 1

Posted on April 27, 2012 by admin

About the third day my rehab moved to what I referred to as Level 1. I have been on this level for about a week, my last 3 visits to the therapist. The Level 1 exercises look just like the 1/2 exercises, except they are performed with big rubber bands.

Therapy starts as usual with the circular swings with the ball just as in level 1/2. Then on to the pulley for some assisted arm stretching. The ball and pulley have become two of my favorite parts of the PT.

The following are called Isometric Walkouts.

In this set of exercises, you are not rotating your arm or shoulder. The arm holding the band is held at a 90 deg angle and you step ‘in’ and ‘out’ of the resistance zone of the band. You goal is merely to hold your arm in a stable position and let the band do the work as you step in and out.

After these exercises, more stretching by the physical therapist. Then off to the ice and stim, also a favorite part of the therapy!

Helpful Items for Home Physical Therapy



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Thera-Band Professional Latex Resistance Bands For Rehabilitation, Portable Fitness and Workout, Home Exercise, 6 Yard Roll, Red, Medium, Beginner Level 3 (Sports)

List Price: $16.50 USD
New From: $9.77 USD In Stock
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Two Week Follow Up with Surgeon

Posted on April 25, 2012 by admin

Today was the two week mark since the surgery and my first visit back to the doctor. Since my surgery, I have had 4 sessions of physical therapy, all are going well.

The visit was mainly to have my stitches removed, surgical sites inspected, get my surgery pictures and ask the doctor any questions. It is a very quick visit unless you have lots to ask.

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Rehab – Physical Therapy Level 1/2

Posted on April 20, 2012 by admin

After your initial PT (physical therapy) visit, you will be graduated to a certain “level” of exercises. These will mostly include purely isometric, isometric using bands, various machines, bars and weights.

I am calling this phase Level 1/2 because it is a very light version of where you will spend your next few weeks. Perhaps the therapist will call it something else, but my brain groups it into these semi-logical levels:

  • Level 1/2 – isometric with no standard resistance tools
  • Level 1 – isometric with resistance bands
  • Level 2 – machines + isometrics
  • Level 3 – Weights

There is no set time as to how much time you will spend in each level and your therapist will mix up what you do. So again, these levels are more of how I view the rehab process and my personal progression and not a representation of how your therapist is viewing your routine or progress.

You will graduate to the more advanced level of tools when you are ready. Trust your surgeon (who is monitoring your progress through regular reports from your therapist) and your therapist to tell you when and what to do. Therapy is the most important part of the rehab process and will dictate the usefulness of the surgery.

In Level 1/2 (for me this was one day)

Helpful Items for Home Physical Therapy



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TKO Anti Burst Fitness Stability Ball (65cm) (Sports)

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Home Ranger® Shoulder Pulley, model 240 (Health and Beauty)

List Price: $19.99 USD
New From: $7.99 USD In Stock
Used from: Out of Stock

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First Day of Shoulder Rehab

Posted on April 17, 2012 by admin

The first day of Physical Therapy is probably going to be both the easiest and the hardest day of therapy. It is easy in the sense that your therapist will not be doing a lot for you on this day besides stretch you out, take some measurements and, if you do any exercises at all, perform very mild isometric exercises.

The hard part will be that this is the first time you will be moving your shoulder beyond what is comfortable and it will hurt.

Take your pain pill!

My first day went something as follows. Day one was pretty much the same for both of my shoulder surgeries, but yours may differ slightly.

shoulder stretching at physical therapy

First Shoulder Stretch After the Labrum Surgery

The Opening Stretch – my therapist spent about 15 minutes just mildly stretching the shoulder joint and determining a baseline range of motion.

Exercises

These exercises were done at PT and then during my off days, I performed then twice a day until returning to PT to get my next set.

shoulder stretch arm swing

Shoulder Stretch Arm Swing

The Arm Swing is a self stretch that you will do every day, at least 5 times a day. This is the best pain relief exercise I have found.

The picture below is a Table Slide. Sit at a 45 degree angle to the table. Rest your hand on towel on top of the table and slide your hand back and forth. NO PAIN… if it hurts, don’t do it.

Shoulder exercise table slide

Gently slide hand across table with a towel to reduce resistance

Only perform these with the approval of your physical therapist!

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First 24 Hours After Shoulder Surgery

Posted on April 11, 2012 by admin

What should you expect in the first 24 hours after your shoulder surgery? Results may vary, but here is what I found to be the critical items to focus on in your first 24 hours.

Pain Management

If you had a nerve block (which I highly recommend), there will be no pain for the first 12 to 24 hours. My experience was 12 hours. This is important because you will be in pain, sever pain, when the block wears off.

You will start to feel a tingling in your arm at about 8 hours following your shoulder surgery. At this point you have about 4 hours until the block is no longer effective.

Follow the instructions provided by your surgeon. That said, here is what I recommend based on having had both of my shoulders repaired on two separate occasions.

Twelve (12) hours after your surgery is complete, take the maximum dose of your pain killer allowed. In my case, I was taking Hydrocodone (a generic Vicodin) 7.5 with a recommended dose of 1 – 2 tablets every 4 – 6 hours. Take 2 between hours 10 and 12.

Second Dose – you will probably want to take your second dose early… I know I did. Here is roughly how my dosing pattern went:

  • Dose 1 – @2 tablets, Surgery + 12 hours
  • Dose 2 – @2 tablets, 3 hours
  • Dose 3 – @2 tablets, 3 hours
  • Dose 4 – @2 tablets, 4 hours
  • Dose 5 – @2 tablets, 4 hours
  • Dose 6 – @1 tablet, 4 hours

From here I worked to stretch the dose pattern out from 4 to 6 hours. For the first week I required @2 tablets on occasion, but in general, I was at @1 tablet every 6 hours by day 5. By day 9 I was at @1 tablet three times daily (when I wake up, mid day, before bed).

Thermal Therapy Device

If you can, you will want to get a thermal therapy device. Use this as directed to speed healing and reduce pain.

Constipation

Sorry folks, it’s a reality. You went 18 hours without food. You had a very strong anesthetic and you are go straight on to a pain medication that has constipation as a side effect. Plan on a strong bout of constipation following your shoulder surgery.

To manage, I ate mild foods and salads, and added nuts, dried fruits and other fiber rich foods. And WATER, lots of water. I was drinking about 6 – 9 / 12 oz glasses per day. On top of that, before every meal, I drank 4 oz of Magnesium Citrate (saline laxative). And between meals I would drink a TrippleLeaf(r) Detox herbal tea.

suggestions for dealing with post surgery constipation

Suggestions for Dealing with Post Labrum Surgery Constipation

Explosive decompression was achieved about 36 – 48 hours after the surgery. After my first surgery 18 months ago, it took almost 3 days for my bowl movements to start again. Hence, I attacked it aggressively this time around.

Sling Side Affect

A combination of the sling and the nerve block brought about a strange side affect. Your bicep muscle will deform as shown below.

common shoulder sling bicep deformation

Common Shoulder Sling Bicep Deformation

Sleep

You will want to find a very comfortable recliner. The surgeon will recommend that you don’t sleep lying down for a few weeks (for a variety of reasons). Sleep will come and go, nap when you can. It helps you not focus on the pain.

your post surgery bed for the next 4 weeks

Your post surgery bed for the next 4 weeks

Entertainment

I found it difficult to read (a combination of the pain and the pain medication). Have a lot of movies on hand. Personally, I have a NetFlix account (streaming) and queued up about 100 movies and just starting watching them back to back. The bad ones helped me sleep, the good ones kept my mind off of the discomfort.

Helpful Items for Home Physical Therapy

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Post Shoulder Surgery Care Instructions

Posted on April 10, 2012 by admin

Your surgeon should provide you with a set of post-operative or patient discharge instructions. These will either be provided to you before your shoulder (labrum or rotator cuff) surgery, or just before your discharge from the hospital or surgical center.

Ensure that you ask your doctor when you will be provided with these instructions, and will they be provided in writing. Try to get them in advance so you can review before you need the information.

Patient Discharge Instructions should cover the following:

Follow-up Surgical Visit Appointment: Your shoulder surgeons surgical assistant should create your next appointment in advance. Your first visit to the surgeon will probably be about 2 weeks after the labrum surgery. The visit should include: inspection of the surgical site; removal of the surgical stitches; review of the initial physical therapy results; review of the surgery pictures (such as are shown on this site); minor motion tests by the surgeon

Appointment for first Physical Therapy session: Your shoulder surgeons surgical assistant should create your next appointment in advance. The timing for the first visit will vary. Most surgeons will try to get you into Physical Therapy within 1 week after your surgery

Instructions regarding your diet – since you have probably fasted for about 16 – 20 hours, care should be taken when returning to solid foods (no tacos!)
Instructions regarding pain medication – make sure you get your prescriptions

Wound Care – Go through these in detail. Remember, the two biggest post surgical risks for any surgery are INFECTION and BLOOD CLOTS. Proper wound care is an important step in preventing infection.

Instructions with regard to driving and returning to work

Information about the nerve block

If issued, instructions as to how and when to use a muscle stimulator – The Stim Unit is a wonderful device. Do everything in your power to get your doctor to write you a prescription for one. Then, work with your insurance company to make sure it’s covered.

Instructions for when to wear your shoulder sling

 Helpful Items at Home Post Shoulder Surgery



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Johnson & Johnson Red Cross Waterproof Pads, 2 7/8 Inch x 4 Inch, 6 Count (Health and Beauty)

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Neosporin Original Ointment First Aid Antibiotic Treatment 3 Pack Value Pack (Health and Beauty)

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Post Surgery Recovery

Posted on April 10, 2012 by admin

After the surgery, which lasted approximately 1.5 hours, there was about another 1 hour in the hospital. It takes a while for the effects of the anesthetic to wear off and the hospital will require that someone drive you home.

post labrum surgery recovery

After my labrum surgery in the post op room

You will also be fitted with a few gadgets, including a sling. Some doctors will prescribe you a cooling pack. This is a wrap that fits around your shoulder, provides liquid cooling at ~ 49 deg F. More on the cooling pack in another post.

Unfortunately, my insurance did not cover the cost of the cooling unit, but the medical supply company recommended by my surgeon rented me a package with the cooling unit and a tens stimulation unit for $299 for 4 weeks.

You should be given a post operative package when you depart the hospital with care instructions. Make sure your responsible person (the person driving you home) walks through the package and clarifies all of the surgeons instructions.

The Nerve Block

If you elected to get the nerve block (which I strongly recommend), it will keep your arm completely numb and immovable for about 12 hours. They told me 24 at the hospital, they were wrong! Please review my post on the First 24 Hours After.

 

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During the Surgery

Posted on April 10, 2012 by admin

The pictures below show what the surgeon is looking at as he performs the surgery. There are three entry points: two for instruments and one for the camera.

The First Look

In the first look inside the shoulder, the surgeon can see an extreme amount of red and irritated tissue. This was his first sign that things were far more serious than what was revealed in the MRI. Because of the labrum tear, the shoulder ball was sloppy and out of control, moving well outside of the socket. This placed extreme pressure on the surrounding tissues.

first view inside the shoulder

View inside the shoulder exposing the irritated tissue causing the pain

Further Investigation

Once inside, the surgeon moved around to the rear (anterior) of the shoulder ball. This exposed the next set of trouble. Trouble in this case that can’t be corrected during this surgery, but will have to be dealt with in 10 – 20 years through a full shoulder replacement. In the picture below, you will see the formation of Osteoarthritis ( degenerative joint disease generally resulting from trauma to the joint). The white portion of the bone (lower left pic) is the normal bone, and the pinkish area is the Osteoarthritis caused by the ball of the shoulder rolling around in the shoulder socket and wearing down the protective surface.

Exposure of Osteoarthritis on the shoulder ball

Formation of Osteoarthritis on the shoulder ball

This is the first real look at the damage that can be caused by not treating a labrum tear. Unfortunately I let mine go too long and created secondary damage that will have to be dealt with at a later date.

In addition to the arthritis on the shoulder ball, there was a great deal of scar tissue that had built up impeding the shoulder motion. My surgeon made the call to cut back the scar tissue in an effort free up the shoulder motion and speed up my recovery.

Shoulder labrum tear

Scar tissue surrounding the shoulder joint

The Shoulder Labrum Tear

Now that all of the secondary damage has been dealt with, we can focus on the actual labrum tear itself and the repair.

Shoulder labrum tear

Shoulder labrum tear causing the shoulder pain and arthritis

And finally, the repair! A total of three screws were used. In the image below you can see the sutures, but you have to look into the fluffy tissue.

shouder labrum repair

Sutures used to repair the shoulder labrum

mission complete

Mission Complete

No, that is not my bald head. This is the end of the surgery story. Next up, recovery.

 

 

 

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Animated Labral Repair

Posted on April 10, 2012 by admin

The labrum is a ring of soft fibrous tissue that surrounds the glenoid (the end of the shoulder blade) and helps stabilize the shoulder joint. Ligaments and tendons can attach to the labrum and when the labrum is torn, the shoulder becomes painful. A torn piece of labrum in the shoulder will cause much pain. This video provides insightful details as to how the procedure is carried out. It is animated, so there is no blood or real tissue.

Video courtesy of Dr. Daniel Biggs on YouTube (http://www.danielbiggs.net)

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Pre Surgery Preparations

Posted on April 10, 2012 by admin

Before the Surgery

At home, preparation is fairly minimal.

  • No medications 2 days prior to the surgery.
  • No pain relievers 5 days prior to the shoulder surgery.
  • No food or water 12 hours before the procedure. Since you are under a pretty heave anesthetic, they insert a breathing tube. An empty stomach greatly reduces the risk of food or liquid seeping back up into your lungs and causing Phenomia.
  • Shower before the surgery (up to 12 hours) with anti-bacterial soap (preferred).
  • No lotions, creams or deodorants.

At the Hospital or Surgical Center

Most surgeons that perform this arthroscopic surgery will have you in and out on the same day. This is, of course, dependent on your surgeon. In my case, I arrived 2 hours early for preparation. I was admitted to the outpatient surgery ward at a local hospital where the following items took place. You can probably expect the same:

  • Fully naked under the gown
  • Insertion of the IV. This hospital has a practice of using a local anesthetic at the IV (eye-vee or  intravenous—-into the vein) insertion point to make the experience easier. I prefer this method!
  • Installation of anti-blood clot stockings and compression bags (not shown). The two highest risks of this surgery are Infection and Blood Clots. The compression bags and stockings help eliminate the Blood Clot risk.
  • Installation of the surgical arm sling. The arm is hung vertically during the surgery.
  • A nerve block (optional). I recommend this highly!
  • 2 or 3 surgical briefings, one should be from your surgeon.
prepared for Labrum Shoulder Surgery

In the hospital ready for the operation

In the above picture, you can see the ultrasound machine. The anesthesiologist used this while performing the nerve block. Prior to the block, I was administered a “cocktail” to make me “relax”. I honestly don’t remember the nerve block at all.

 

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When Can I Return to Work After Shoulder Surgery?

Posted on April 9, 2012 by admin

Three factors that you should consider prior to returning to work are driving, type of work performed and pain medication.

Driving After Shoulder Surgery

You may not operate a motor vehicle while still taking narcotic pain medication. In general, you may resume driving as you feel comfortable to do so. Since you have had an operation on your arm, you should not drive until your doctor feels it is safe for you to do so. Operating a motor vehicle often times requires two hands (especially if you have a manual transmission). Ensure that you can safely operate your car for your safety and mine!

Pain Medication

Aside from the restrictions on driving, you should be aware that narcotic pain medications cloud your judgement. You should not return to work while on pain medication if the following apply:

  • You operate heavy machinery
  • You operate in a dangerous work environment
  • You make important decisions during your normal work day
  • You are responsible for the design, construction or inspection of safety related items
  • You review legal documents or contracts

In short, it’s hard to perform complex manual or intellectual tasks while on pain medication.

You will probably be on the pain medication for about 2 weeks minimum. Plan on taking that amount of time off of work in advance, just to be safe.

 

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What Causes a Labrum Tear?

Posted on April 1, 2012 by admin

Labrum tears come in many shapes and sizes and can happen for a variety of reasons. The following are classic reasons for a labrum tear:

  • Abrupt face-ward fall where you stop yourself with your hands forward. This type of fall is called a FOSH (Falling on OutStretched Hand) and can also be referred to as FOOSH (Falling On OutStreatched Hand). The impact is absorbed by your arms and thrusts your shoulder ball against the labral tissue resulting in a weakening or tearing of the labrum.
Fall on outstreached arm (FOSH)

the outstretched arm transmits the force into the shoulder joint

  • Baseball pitchers and American football quarterbacks often tear labrums due to the forceful extension of the arm, placing excessive strain on the labrum and tearing it while the shoulder ball pulls on the labrum.
  • The overhead military press is also a big contributor. As a physical therapist told me, “We Therapists get a lot of business from Personal Trainers, and the Military Press is a leading factor in Labral Tears.”
military press

Military Press can be bad for the shoulders

  • Tennis over extended periods can weaken the Labrum. The more powerful your game, the more wear and tear. Powerful overhead serves over extended periods.
  • General wear and tear, years of supporting your upper body weight on your elbows (desk chairs and airplane seats, etc).
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What is a Labrum?

Posted on April 1, 2012 by admin

The Glenoid Labrum is a fibrous cartilage (called fibrocartilaginous) rim that surrounds the cavity (specifically the glenoid cavity) of the shoulder blade. Even though the shoulder joint is often thought of as a ball and socket, the socket is very shallow and shaped more like a saucer belonging to a tea set. The outer rim of the saucer is the labrum. The labrum provides additional ‘cupping’ that deepens the shoulder socket and is integral to the stability of the shoulder.

As the tendons of the biceps and triceps reach the shoulder, they turn into this fibrous cartilage and attach themselves to the glenoid (the outer rim of our saucer example). In short, it is the labrum that attaches your arm muscles to your shoulder.

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VascuTherm2 Thermal Device

Posted on March 26, 2012 by admin
thermal therapy device

VascuTherm2 Thermal Therapy Device

Thermal Therapy Device provides localized thermal therapy (hot or cold) for post traumatic and post surgical conditions. These devices enhance arterial circulation (blood flow), reduce compartmental pressures, reduce edema (swelling).

lifetec shoulder wrap

LifeTec Shoulder Wrap for VascuTherm Termal Therapy Device

The same can be achieved in a less effective manner with ice packs. Since ice packs are frozen, achieving a constant optimal cooling temperature is nearly impossible. The Thermal Device can provide a constant 49 deg water temperature to the cooling wrap and eliminates the possibility of freezing the skin or the joint.

Some insurance companies will cover this for up to 4 weeks post surgery, some wont. Work with your doctor and their preferred medical supply company to get one of these. This is, in my opinion, an essential part of the recovery. It is particularly beneficial for pain management.

 

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Anatomy of the Shoulder

Posted on March 26, 2012 by admin

Anatomy of the Shoulder – Everything You Need To Know – Dr. Nabil Ebraheim

This video is posted here on youtube. Thanks to Dr. Nabil Ebramheim for making this available to the public. More videos by this author can be found here.

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Shoulder Joint Anatomy

Posted on March 26, 2012 by admin

The 3B Scientific® Anatomy Video “Shoulder Joint” vividly describes the functional and topographical anatomy of the shoulder joint. In addition to naming each of the bony structures and muscles of the rotator cuff, all the natural movements of the shoulder joint are shown in detail. The details about the labrum are near the end of the video.

Because the shoulder joint is one of the most complex joints with the largest range of motion, recovery time is very lengthy. The post surgery physical therapy is very important if you hope to return to a normal range of motion.

 

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What are the Symptoms of a Labrum Tear?

Posted on March 25, 2012 by admin

Symptoms can range from no pain at all to severe sharp pain. Of course this all depends on how bad your tear is. Common symptoms can include:

  • Shoulder ‘clicking’ or ‘catching’
  • Dull shoulder ache when driving
  • Pain when stretching or reaching for distant objects
  • Pain at the joint when flexing your biceps
  • Sharp pain when putting on jackets or button up shirts (that ‘windmill’ motion)

For more information on how to detect a labrum tear, visit the Diagnosis page

What are the Symptoms of a Labrum Tear?

Another Diagnosis Page

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SLAP Tear Diagnosis

Posted on March 25, 2012 by admin

A SLAP (Superior Labral tear from Anterior to Posterior) tear is a rip that occurs where the biceps tendon inserts into the superior labrum. SLAP tears are somewhat uncommon and can be hard to diagnose, which is what makes this video so important. If you have pain deep within the shoulder or in the back of the shoulder, you need to become educated as to what a labrum tear consists of.

Tears of this type affect baseball players (dead arm after pitching), football players (dead arm after throwing), tennis players (sore shoulder during/after serving), weight lifters (pain after biceps curls, dead lifts). There are other causes, demographics affected of course.

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SLAP Repair Diagnosis

Posted on March 25, 2012 by admin

Shoulder instability is a common cause of labral tears. Dr. Wayne Luchetti discusses how instability affects your shoulder function. You’ll learn the symptoms of labral tears as well as how your shoulder is evaluated.

Dr. Emil DiIorio reviews an MRI of an athlete with a labral tear. See what a normal shoulder MRI looks like compared to an MRI of a torn labrum.

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