Arthroscopic Posterior Labrum Repair
How do the findings differ between tears of the anterior and the posterior labrum?
There are differences in the symptoms caused by anterior (front) and posterior (back) labrum tears. While far more common, anterior labrum tears generally cause functional problems with dislocations, instability, and apprehension, while posterior labrum tears generally cause pain. The reason for these differences relates to the anatomy and the mechanism of injury.
Anterior labrum tears usually occur with the arm out to the side and overhead where the humeral head dislocates out the front of the socket. Conversely, posterior labrum tears occur with the arm at the side or in front and do not always require a formal dislocation event. Sometimes a simple jarring event with the arm flexed in front is all it takes to generate a posterior labrum tear. Because there are so many activities that rely on positioning the arm in front of the body, living with a posterior labrum tear can become increasingly disabling.
Posterior labrum tear is confirmed with physical examination and MRI. MRI findings of the posterior labrum tear can sometimes be more subtle than those of the anterior labrum, in large part because the shoulder never formally dislocated to cause the tear in the first place. Having an experienced examiner confirm the diagnosis is helpful.
Repair of a posterior labrum tear is performed arthroscopically with minimally invasive knotless suture anchors that permit anatomical reattachment of the torn labrum back to the glenoid socket. Once the tissue is repaired and heals, not only is the pain from the tear alleviated, but the capsule (ligaments) are naturally tensioned so the humeral head is not at risk of shifting into the posterior labrum, which can also improve symptoms of posterior instability.
Although nonsurgical treatment in the form of physical therapy and exercises is often attempted for posterior labrum tears, it sometimes is not as successful as when used for tears in the anterior labrum. While optimizing the stabilizing effect of the rotator cuff can improve the function of a loose shoulder coming out anteriorly, the pain generated with activities from the posterior labrum tear is not as predictably improved with rehabilitation.
Posterior labrum tears that are painful share a similar pathophysiology (disease process) as shoulder arthritis. In both scenarios, the shoulder tends to shift out of the socket posteriorly. Shoulder arthritis, however, generally affects patients that are older (greater than the age of 50) and does not have a history of an injury or event that caused the tear. Conversely, ideal patients for posterior labrum repair are younger, have pain with specific activities, and have a history of a traumatic event that caused the tear.
X-rays and specifically MRI are useful to characterize the status of the cartilage lining of the shoulder to predict your individual response to posterior labrum repair. Patients that have intact cartilage, have an otherwise normal shoulder joint, are younger, and have a history of a traumatic injury are excellent candidates for arthroscopic posterior labrum repair.
Repair of posterior labrum tears is performed arthroscopically, through tiny incisions. A light general anesthetic and numbing block are administered. The procedure is performed in less than one hour and is performed with the patient lying on the side so access can be made to the posterior labrum tissues. A sling and brace is worn for six weeks to let the tissues heal, and activities are advanced to full between 6 and 12 weeks. Full return to sports is recommended between 4 and 6 months, pending progress with rehabilitation.
Schedule a shoulder consultation
Are you or a loved one suffering from shoulder labrum tear? Call or make an appointment online with shoulder surgeon Dr. Thomas Obermeyer. Dr. Obermeyer is widely regarded as one of the best shoulder specialists in Illinois. Dr. Obermeyer has orthopedic offices in Schaumburg, Bartlett, and Elk Grove Village, Illinois. Dr. Obermeyer regularly sees patients from throughout Illinois including Hoffman Estates, Palatine, Elgin, Streamwood, Arlington Heights, and Roselle communities.
At a Glance
Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
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