shoulder arthroscopic labrum repair

[Carlos Daniel]

I have a friend that started lifting with me, he's doing well with steady progress on all the lifts except the OHP (I'll explain it). It seems we had a slight miscommunication, he dislocated his shoulder once skateboarding and when he told me about it I understood that he had no structural damage, just some mild edema in his MRI. We started a linear progression but on his second day of pressing he felt his shoulder almost dislocate. After a fair amount of discussion I found out he actually had a slight labrum tear in the antero-inferior labrum that explains his shoulder instability.

His goals are competitive powerlifting and he only had instability with overhead movements, he can bench with no problem at all. He's thinking of getting his shoulder repaired so that he can press overhead and so that he doesn't dislocate his shoulder again and fuck up his shoulder more.

Now, here's the question: his doctor says he can't load the shoulder significantly for 4 months after the repair. Do you have experience with this sort of repair? How long before he can resume doing say squats and deadlift? How about pressing and benching?

Thank you in advance for your time, Rip.

[Mark Rippetoe]

I have no personal or direct professional experience with a labrum tear. We'll ask the board.

[KyleMask]

I had my labrum scoped about 5 years ago. To the best of my recollection, I resumed benching with an empty barbell around 3 months post op.

Squats took a while longer simply because I had trouble getting into position. When I resumed squatting, I placed a strap around the bar and held onto the strap in front of the barbell on the injured side. I never went over 315 like this because it didn't seem especially safe. I progressed to high bar with both hands on the barbell, and finally to low bar. Deadlifts came back quickly. I started pulling 3-4 months post op and was full strength approximately 6 months post op.

Press took the longest to return. I don't remember how long, but it was a long time before I felt stable enough to press any considerable weight.

My training partner is a 450 bencher and is 2.5 months post labrum repair currently. He started benching a broomstick a couple of weeks ago but hasn't progressed to a barbell yet.

[dmworking]

Hi Carlos,

I had an anterior capsular reduction on my right shoulder by arthroscopy in June 2005. I threw too many baseballs with poor form and weak shoulder musculature. The instability in a capsular repair of my kind presents similarly to a labral tear-- I was having anterior subluxing occur regularly from normal baseball activity. Also, the repair I had (where they reduce the joint ROM by pinching the capsule tighter and stitching it closed) and a common labral repair (introducing anchors to reattach the labrum to the glenoid rim) have fairly similar failure modes (rippin' out a stitch)-- which is why I'm commenting.

I was in a sling for about three weeks. I had what you would call a "standard" PT approach of lots of stretchy bands and very light weights, and I didn't know any better to try anything else. I had a ton of atrophy and resumed dumbbell work at about 6 weeks. More than anything, I was limited by range of motion-- the movements themselves weren't painful, but anything that put my shoulder into any sort of external rotation was impossible. I was pain-free after about 4 months, for every movement except for throwing a baseball (which sucked, since I was a baseball player. I never regained the ROM in my shoulder, and I finished out my baseball career in 2008 playing LF instead of CF because I couldn't make strong throws anymore.)

In 2011, I found barbell movements. I had just a BITCH of a time getting my shoulder to let me squat low-bar. By that time though, the anchors were well-healed, and my limitation was pain tolerance. So, I kept at it. Squatted 165kg for three singles on Friday, snatched 80 kg today @ 79kg BW. It's a slow process, but given that I throw harder today than I did in 2008, I have a lot of faith in the process.

Enough about me.

Your friend's repair will have slightly different limitations than mine, because of the location of the repair (inferior, instead of anterior). What doesn't change is that stressing the repaired portion of the labrum before the anchors have "taken" will result in a failure. I've read anywhere from 2-4 months for anchors to heal, but just like any other healing process, it's HIGHLY individual. Playing around with heavy weights, especially with ballistic movements, could be dangerous in that 2-4 month range.

With that caveat out of the way, there are some movements that are safer than others. Other members are welcome to correct me, but I'm not familiar with anyone ever inferiorly dislocating their shoulder deadlifting, despite the antero-inferior direction of force (I guess the supraspinatus and infraspinatus are usually strong enough that this isn't a problem...again, others welcome to comment). The deadlift position is going to be easiest to assume after surgery, as well. The combination of these two factors means I would return to that first.

The bench press and squat I would add in as soon as the shoulder lets him-- this is a "let pain be your guide" situation. I don't think he will have as much trouble getting back to the squat as I did, since my anterior repair specifically hindered my external rotation, and I couldn't get my arm back up on top of the bar for years. For your friend, though, I don't see any reason why he shouldn't squat, as long as he can assume the correct position without blinding pain. It won't be comfortable, but it's possible. Same with bench-- it's going to take a while for him to be able to handle the ROM, but once he can, he's not putting those anchors at risk.

Overhead work, on the other hand, is putting force directly on the recovering area of the surgery. I don't think there's much to be gained by returning to overhead work before those anchors are good and healed-- I understand that barbell work helps the healing process immensely, but the positive hormonal and blood flow effects are going to be covered by the other movements without directly putting the anchors at risk. If he's not a pro athlete, and he's not training for a specific competition, and he could wait 4 months to make sure the anchors are solid...I would. Just not worth having to do it all again.

So, that's my two cents. Happy to answer any questions.

Best,

Dave

(Also, I'm not a doctor, nothing here should be construed as real medical advice, my background doesn't matter because all advice here is judged on its own merits, anything your friend does is up to him, so on and so forth.)

[Mark Rippetoe]

Other members are welcome to correct me, but I'm not familiar with anyone ever inferiorly dislocating their shoulder deadlifting, despite the antero-inferior direction of force (I guess the supraspinatus and infraspinatus are usually strong enough that this isn't a problem...again, others welcome to comment). The deadlift position is going to be easiest to assume after surgery, as well. The combination of these two factors means I would return to that first.

I agree completely. I deadlifted 315 for 5 about 3 weeks post-op from my 27mm hole-in-my-RC tendon repair. No problems at all. The delt and trap support the humerus.

[Carlos Daniel]

One of the questions I had in mind was what exercises could be done to minimize strength loss. Looks like we'll be doing a lot of deadlifts for about 4 months then. We thought about doing belt squats but I don't see an easy way to set it up in my gym.

So, so far it's: deadlift maybe a month after the surgery, bench and squat as long as it doesn't hurt and we're not dumb about it and presses for last.

I thank you all for your input. If anyone else has something to share, every bit of information is valuable.

[Mark Rippetoe]

I'd be VERY careful about the bench press. Chins are very valuable -- think about the loading and the stresses. Presses are good too, if you're very careful about shrugging the weight off the labrum with the traps.

[Carlos Daniel]

I'd be VERY careful about the bench press. Chins are very valuable -- think about the loading and the stresses. Presses are good too, if you're very careful about shrugging the weight off the labrum with the traps.

Given the location of the lesion and the fact that he benches with no problem at all nowadays, you think it might be an issue? I'll be careful then.
I'll be extra careful about the presses, given that they will load precisely the area that will have been repaired. Chins seem like a great idea, since they "unload" the glenoid. What about dips? I know dips are usually bad if your shoulders are iffy, but given his particular situation I can't think of any anatomical reason for him no to do them.

[bluebutton]

I injured my shoulder in August 2000. I had an MRI in August 2012 showing a labrum tear which had been suspected by a PT in 2005. I had arthroscopic surgery Aug 15, 2013. The repair fixed the torn labrum and tightened the posterior-inferior capsule which was overly lax.

I'm 6 weeks post op as of yesterday.

The doc and PT say that the anchors are secure now and I have no restrictions from them although obviously I need to regain range of motion and strength.

Thoughts:
Obviously, I lived with a tear for a very long time. In that time, I took up new activities such as dragon boat racing and weight training and generally enjoyed myself. Things ached, but nothing was unbearable.

I had surgery in the end because the pain got to the point where I wasn't sleeping through the night. The pain was also made chin ups impossible and eventually the heavier deadlifts and OHPs started to look gross as the shoulder got sloppier and sloppier.

I had a very conservative surgeon but he works with the local minor league baseball team, so maybe he's just used to over active patients. I was in an immobilizing sling for 6 weeks 24/7. During that time, I got the post op report, read a lot about the procedure done, read these boards, learned about shoulder anatomy.

2 weeks post-op I started light bicep curls, weighted pendulums, and wrist curls. At 5 weeks post op, I started passive ROM stretching. Yesterday, I started deadlifting. As soon as I can hold a bar, I'll learn to HBBS. Although, I'm tempted to buy a mantis and just go for it now. Mwhities used to post on the board, he has only one arm and squats very nice numbers with one arm and a mantis.

I have already reached better quality of sleep than I had before surgery which speaks to how crappy it was before.

It is possible that your friend might be able to train around the tear. If the only impact the tear had on my life was my OHP, I don't think it'd be worth it to me, the OHP is one movement. But if the tear begins to impact other things, and it's hard to imagine that it wouldn't eventually impact the bench press at heavier weights, then surgery begins to make a lot more sense.

I spent a year between my MRI and surgery trying to get the muscles to make up for the instability in the joint which happens in some cases. Obviously, it didn't work for me, but I think the wait was worth it. I've had time to learn about how shoulders work. I'm much stronger which my doc and PT tells me should make recovery quicker. (And not insignificantly, another consequence is my youngest is no longer nursing and mobile enough to get into the carseat independently -- undoubtedly, this is not part of your friend's calculus.)

Best of luck to him.

[Mark Rippetoe]

Given the location of the lesion and the fact that he benches with no problem at all nowadays, you think it might be an issue? I'll be careful then.
I'll be extra careful about the presses, given that they will load precisely the area that will have been repaired. Chins seem like a great idea, since they "unload" the glenoid. What about dips? I know dips are usually bad if your shoulders are iffy, but given his particular situation I can't think of any anatomical reason for him no to do them.

In his situation, dips are probably okay, but it's hard to unload the stress if you feel something about to move. Bench is the same way.