How is the procedure performed?
The procedure is performed under a combination of general and regional anaesthesia. An arthroscope is inserted into the joint and the inside of the joint is examined. The labrum is probed to confirm the diagnosis and the extent of the tear. The rim of the socket is freshened with the aid of an arthroscopic shaver to promote bleeding and facilitate healing. The labrum is then fixed back to bone with suture anchors (small devices with sutures that are embedded in bone). If the labrum is degenerate or not reparable, it may sometimes be necessary to perform a tenodesis of the long head of the biceps. If stiffness is present or anticipated, part of the capsule may be released. Associated pathology such as a rotator cuff tear may be treated at the same time.
Benefits
The main benefit of the procedure is to repair the damage and improve the function of the joint. More than 85% of patients achieve benefit from surgery.
Risks
Pain - The shoulder may be painful for some weeks after surgery. This is usually managed by taking appropriate pain relieving medication and activity modification.
Swelling – During the procedure, the joint is distended with saline and this may lead to the shoulder remaining swollen for a day or two after surgery.
Bleeding – A small amount of bleeding from the arthroscopy portal sites is not unusual and will usually settle after a day or two.
Stiffness – Some degree of stiffness is to be expected in the first few weeks after surgery. Prevention is the key and it is essential to follow the instructions provided by the physiotherapist and perform daily stretching within the limits imposed to maintain the range of movements. If stiffness persists over a number of months, then occasionally further treatment may be necessary.
Chondrolysis – Damage to the gristle of the joint can occur during surgery.
Hardware failure – Suture anchors may rarely work loose from the bone. This will often require further surgery to remove the loose anchors.
Infection – Infection is a possibility but is rare after arthroscopic surgery.
Recurrence of symptoms– Occasionally the labrum may fail to heal or may tear again following a further injury resulting in recurrence of symptoms. The risk of this is less than 10%. This may require further surgery.
Nerve injury – This is possible but rare.
Aftercare
- Following the procedure the arthroscopy portal sites (skin incisions) will be closed with sutures and tape and covered with shower-proof dressings. These dressings should be left undisturbed as far as possible for 5-7 days. If the dressings are removed for any reason they should be replaced with similar dressings or waterproof plasters. The shoulder may also be covered with an absorbent pad (or a nappy) that will be removed the day after surgery.
- Prior to discharge from hospital a physiotherapist will provide instructions about looking after the shoulder. You will be advised to protect the shoulder by wearing a special sling for 3 weeks and intermittently performing limited movements of the shoulder. After 3 weeks you may stop wearing the sling during the day and will be allowed to move the shoulder actively through a greater range. You may resume driving at 4 weeks. Strengthening exercises are started after 6 weeks. Outpatient physiotherapy will be arranged and may need to be continued for 6-12 months.
- For detailed instructions on rehabilitation click here.
Resuming work, driving and activities
- Office duties may be resumed as soon as pain allows.
- Manual tasks should be avoided for at least 4 months.
- You may resume driving at 4 weeks.
Follow-up
An appointment will be arranged for you to be seen at 3-4 weeks after the procedure. Follow-up is required for at least 6 months after surgery or until a satisfactory recovery is achieved.