SHOULDER LABRUM REPAIR SURGERY
So you are considering shoulder labrum repair surgery including possible SLAP repair and possible biceps tenodesis! We hope that this page will answer as many of your questions as possible regarding this type of surgery. Please read through this entire page and watch all the videos. On this page, you will find:
What is labrum repair surgery? What is biceps tenodesis? How do we do it and why?
What to do before surgery.
What to do the day of surgery.
What to do after surgery.
Commonly asked questions and answers
The physical therapy protocol can be found here.
The shoulder joint is ball and socket joint. On the socket side of the joint (glenoid), there is a ring of soft tissue that sits on the perimeter of the bone which we call the glenoid labrum. At the top of the socket (12:00 position), the labrum also serves as the attachment point for the long head of the biceps tendon. This area is often thought of as the biceps anchor complex. If it is torn, repair is difficult as the biceps tendon is in the way of the typical shoulder labrum repair. Shoulder labrum repair surgery continues to evolve but the principle has always been the same. Attached the torn labrum back to where it started. This can be accomplished if we remove the biceps tendon attachment from the labrum allowing us access to the labrum. The biceps is not ignored as we typically plan to re-attach the tendon lower down its course which is called a biceps tenodesis. Newer techniques allow us to do this less invasively.
For more complete details on shoulder SLAP tears, please click here.
BEFORE SURGERY: There are many tasks that can help your surgery process go smoothly. They include the following:
Medical clearance: some patients have medical issues that may impact the safety and risk of the surgery. If you have any issues that we are concerned about, we will request that you obtain a “medical clearance” from the appropriate physician’s office. This may be a primary care physician, cardiologist, pulmonologist, neurologist, etc. We will not proceed with surgery unless these clearances are in place…even if they are well controlled on medication.
Prescriptions: you will be prescribed several medications for AFTER surgery but you need to pick them up ahead of time. We will prescribe these to your listed pharmacy approximately 1 week before surgery. Pharmacy and insurance companies have become much harder to work with and we strongly recommend getting these in advance of surgery as there will be times when the medications are difficult to get or require more paperwork than is usually necessary.
Pain medication (typically oxycodone or alternative). This is a narcotic and addictive. Please use as little as possible. You should use it ONLY as needed follow the dosing as prescribed.
Stool softener (colace). This helps prevent constipation while you are on the pain medication. Please take it routinely as long as you are on the pain medication.
Blood thinner (Aspirin). We typically recommend aspirin 325mg daily starting on day 1 after surgery until you are off of crutches. If you have stomach issues or intolerance to this medication, please let us know ahead of time.
Nausea medication (Ondansetron). This helps if you are having nausea from the anesthesia or pain medication. Use it as needed.
Muscle relaxant (cyclobenzaprine). This helps if you are having muscle spasms after surgery or during physical therapy. This can cause you to be sleepy and can help at night if you are having trouble sleeping. Use it as needed
Arrange physical therapy. We would like physical therapy to start about 1 week after surgery. This can be done near your home. We have physical therapy in our office two locations for you, if convenient. The referral will be placed but it is still up to you to schedule. Please arrange prior to surgery.
Obtain sling: you will be required to use a sling for 4-6 weeks depending on the size of the tear.
Get waterproof dressings ahead of time. If you wish to purchase either one of these waterproof dressings seen our video below, click on the picture and it will take you to Amazon.
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Post-operative T-shirt: many patients have found that a T-shirt with easy shoulder opening can make life much simpler in the first couple weeks after surgery. Patients have recommended the following brand:
Food prep: Because your mobility will be less after surgery, we recommend preparing some meals ahead of time and freezing them so that you can simply warm them up when you are recovering. Preparing 1-5 days of meals should get you through the early phase and your mobility will be improved after that time.
Expect a call from the surgery center pre-op nurse who will be reviewing your medical history and medications for your stay. This is part of the pre-anesthesia plan. They will have recommendations regarding any medications that you typically take daily.
Expect a separate call the business day before your surgery from the surgery to communicate your check-in time. This is typically 1-2 hours before the actual surgery time.
For the evening before surgery, have a nice dinner and drink a big glass of water before you go to bed because NOTHING to EAT or DRINK after midnight. If you violate this, the surgery will be cancelled.
DAY OF SURGERY: This is the big day, but relax…all you need to do is show up. The rest is up to us. Please bring the following with you as you will most likely be spending the night recovering.
Insurance card for the surgery center
The surgery will typically be performed at Orthopaedic and Spine Center of Southern Colorado: 4110 Briargate Parkway, Suite 200. This is the second floor of the same building you have been to see me.
Wear loose clothing and bring your sling!
Family and friends are welcome to come and go as they please and I will update the family as soon as the surgical procedure is finished.
AFTER SURGERY: Congratulations! You have an improved shoulder. You will want to review the following as it pertains to your shoulder surgery.
Sling usage
You will be using a sling for 4-6 weeks. Your sling should have been fitted to you prior to surgery. Here is a video on one of our sling models if you need a reminder on how to put it.
Surgery Dressing
This video will show you what to do on the first day after surgery to get the dressings removed:
It is common to see bruising surrounding the incision and the bruising and swelling often will spread down the outer thigh. Do not be concerned as this is expected.
Keep up with your fluids and nutrition.
Start your home physical therapy exercises according to this video and then get in with physical therapy in about 1 week from surgery. Click here for the physical therapy protocol if you need it.
FREQUENTLY ASKED QUESTIONS:
Will I need a sling after surgery?
Yes. Videos above show sling usage.
Can I take my sling off?
Yes. You can remove it when you are sitting down. Please attempt to keep the arm in a similar position
Please remove your sling to perform your home stretching exercises as soon as your nerve block wears off.
Please wear the sling at night for sleeping.
Sleeping is difficult…is this common?
Yes, this is common. Many patients find comfort sleeping in a recliner (Lay-Z-Boy) or propped up in bed.
How often should I ice my shoulder?
If using ice packs or bags, we recommend putting ice on for about 20 minutes and then removing the ice pack/bag for 20 minutes and then repeating.
If you have a cold compression device, it can be left on for 30-60 minutes
Audubon Orthotics & Prosthetics has a rental unit that provides both cold therapy and compression. Many patients find this to be very helpful after surgery. Please let us know if you would like to see or rent one and we will connect you with them.
I have the sequential compression devices for my legs (calf squeezers). When and how do I use them?
These devices are designed to help circulate your blood when you are less mobile. Please utilize them when you are sitting for more than an hour and at night if possible when you are sleeping
These devices have a battery, but it does not last long. We typically recommend keeping them plugged in.
When you are up and moving around, they are not needed.
Can you explain my medications again?
We give you a variety of medications to try to make the recovery go smoothly. Remember that most of these medications are AS NEEDED. So, if you do not need them, do not use them.
Pain medication (usually oxycodone or alternative). This is the narcotic. It is to take the edge off of surgical pain. It will not eliminate the pain. These are addictive so please use sparingly.
Stool softener (Colace). While taking the narcotic, please take a stool softener to counteract the constipation caused by the pain medication.
Anti-nausea (ondansetron or phenergan). This is provided if you have nausea after surgery.
Muscle relaxant (cyclobenzaprine or other). This is provided to help with muscle spasms that can occur after surgery. This can be taken with the pain medication or all by itself. Please be aware that it makes most patients sleepy.
Blood thinner (Aspirin). All surgical patients are at risk for blood clots. Based on your personal risk, we will prescribe one. Duration is based on the complexity of the surgery and the duration of risk.
When can I drive?
You cannot drive while taking pain medications (narcotics)
Driving after surgery is a judgement call. If you can get in and out of the vehicle and feel that you can control the steering wheel, then you can start driving.
Typically, patients are able to drive around 10-14 days after surgery.
When can I return to work?
Return to work is based on the type of work you do and the requirements that are necessary for your occupation.
Please discuss return to work with Dr. Huang and his staff as soon as possible. If you have any specific work related paperwork, please provide it as soon as possible.