Labral/SLAP/Bankart Surgery Overview
Orthopaedic Specialists 502-212-2663
Stacie Grossfeld, M.D. / Bess Fley, PA-C
Labral repair, SLAP repair, and Bankart reconstruction surgery is performed as an outpatient procedure.
Upon arrival at the surgicenter you will first meet with the registration person to check you in. You will then be brought back to the pre-op area and meet with your nursing team.
The next person you will meet is the anesthesia doctor. At this time the anesthesiologist will discuss the process and address any questions or concerns you have about the anesthesia. The anesthesiologist will place a nerve block to numb up your shoulder and arm. The numbing medicine will last for 18 hours. This is a great way to reduce post operative pain. Even after the nerve block wears off, your pain level is reduced because of the anti-pain effect from the nerve block.
After the nerve block is placed, you will go to the operating room where the Labral repair, SLAP repair, and Bankart reconstruction surgery is performed. The anesthesiologist will then administer a general anesthesia, so you are completely asleep for the procedure. You may be intubated or not. There are multiple factors that determine type of anesthesia. Your anesthesiologist will discuss that with you in detail. Because it is a general anesthesia you will not hear or see anything going on in the operating room
Dr. Grossfeld will then perform the labral / SLAP / Bankart repair arthroscopically. This procedure takes between 45-60 minutes. Keep in mind after you head back to the operating room it takes about 40-50 minutes to go to sleep and get positioned on the operating room bed, so your family may not see you for 2.5 hours depending on how extensive the surgical procedure is and what needs to be fixed.
Dr. Grossfeld will make three to four small incisions, which are less than a centimeter in length around the shoulder joint. She will place a small high-definition camera, about the size of a pencil, into the shoulder joint. After the camera is inserted, inspection of the whole shoulder joint is completed. Each compartment of the shoulder is viewed. She will identify where the labral / SLAP / Bankart tear is located. The repair of the labral / SLAP/ Bankart is done by placing two or more suture anchors.
The suture anchors are made out of a synthetic-type bone material, so the anchors will actually incorporate into your own bone. Attached to the head of the suture anchor are the stitches that are used to repair the torn labrum. The suture anchors are placed into the bone which then “anchors the suture” and the sutures are then sewn around the torn labrum. Knots are tied pulling the torn labrum back down to the bone where it was attached before the tear occurred.
If there are any bone spurs, they will be removed with a small tool that is similar to a Dremel tool. If bone spurs are removed, the procedure is called a subacromial decompression, and/or an AC joint excision.
At the end of the surgery the incision site/portal sites are closed with a blue colored suture called Prolene. The sutures will be removed when you are seen in the office at 10 to 14 days post-surgery. Do not let the sutures or the incision site get wet. You can clean the incision sites with peroxide. You received detailed post operative instructions the day of the surgery that will explain post operative wound care.
Upon leaving the operating room, you will have 4 x 4 gauze placed over the incision sites followed by ABD pads, which are a larger fluffy dressing, followed by surgical tape. Your specialized shoulder sling will be placed on in the operating room.
You will get a detailed set of instructions on wound care upon discharge from the surgery center.
Night of Surgery
It is very important that you stay on top of the pain. Ice is key. It is very important to use ice as MUCH as possible. Dr. Grossfeld recommends continuous use of ice around the clock. The rule is you cannot use too much ice. Whether it is a Polar Care unit, ice pack or a bag of frozen peas or corn: use it continuously for 6-7 days after surgery.
We do have a Polar Care unit that can be purchased through our office. It is basically a motorized ice machine that has a neoprene wrap that gets placed over the operative shoulder. It is a cooler that is filled with ice and water. We suggest freezing 8 water bottles filled with water. Put four of the frozen bottles in the machine then pour water around the frozen bottles. When the bottles thaw out swap them out for the other four frozen water bottles that are in your freezer.
The Polar Care unit has a hose that connects to a neoprene wrap that goes around the shoulder, and will push ice water through the neoprene wrap for up to nine hours. We actually recommend you use ice around the clock. It is the best source of pain control and helps to reduce swelling.
She recommends that you set your alarm clock and take your pain medication every 4 to 6 hours for the first 24 hours to stay on top of your pain. Adding 800 mg Motrin every 6 hours or Meloxicam 15 mg every 24 hours can help to control pain. Do not use either Motrin or Meloxicam if you are on blood thinners or have a history of stomach ulcers or kidney disease.
It may be more comfortable to sleep in a semi-upright position. Sleeping in a recliner or using lots of pillows to support your shoulder will be more comfortable. Some people will sleep in a recliner for up to 4 weeks after labral repair / SLAP repair / and Bankart reconstruction surgery. When lying flat in bed, it allows your shoulder to roll back and tugs on the repair, which can cause pain.
You will wake up in the recovery room with your sling in place. You may take the sling off as long as you place your arm against your belly. Dr. Grossfeld recommends that you sleep in the sling because it will prevent your arm from moving around during the night.
At the end of the surgery, Dr. Grossfeld, will put on a dressing. The dressing is a bunch of 4×4 gauze pads, an abd pad and then a special surgical tape goes on top of the dressing. Please refer to your post operative orders that you will receive day of surgery for dressing change details.
Dressings to purchase before your surgery day are: ten to 15: 4×4 gauze pads, paper medical tape, water proof band aids and peroxide.
First Post-Operative Visit
Your first post operative visit will be 10-14 days post-surgery. You will be seen in the office at that time and have your sutures remove. Dr. Grossfeld or Bess Fley, PA-C will go over your surgical photos and answer any questions. At this visit most likely physical therapy will be ordered. Typically, physical therapy is only once or twice a week for the first six weeks. PT will vary from person to person based on the size of the tear and repair quality.
You will be given exercises to do post op. There is a link on your post operative instructions/orders that you will get the day of your labral repair, SLAP repair, and Bankart reconstruction surgery. The link will show you how to do some gentle post operative exercises. On the first post operative visit you will also need to purchase a set of pulleys (can purchase from our office for $20) to allow you to work on passive range of motion exercises at home.
PT is divided into two to three 6-week blocks depending on how extensive the repair.
The first 6 weeks you will attend once or twice a week to work on gentle passive ROM exercises.
The second six weeks, the therapy involves active range of motion of the shoulder with some gentle strengthening. You will attend 1-3 times a week, depending on your repair and other factors.
The third six weeks of physical therapy involves increasing range of motion and further strengthening.
This is about a four to five month recovery before you are back to your normal activities involving the operative shoulder.
Most people will start driving once they are off all pain medication. Once driving is started your sling needs to be taken off while driving. It is recommended that you place your hand on the operative side at the bottom of the steering wheel and your non-surgical hand at the top of the steering wheel to do most of the work.
Return to Work
If you work a labor type job, you will most likely not return back to that job until you are released 100%. If your employer has light duty options, you will most likely be released anywhere between two to four weeks back to light duty. Typically, light duty will not require the use of the surgical side/the side your labral repair, SLAP repair, and Bankart reconstruction surgery is performed on, except for simple tasks such as using a computer or answering a phone. Keep in mind if you are still taking pain medication you cannot drive a vehicle.
If you have an office type job, you can most likely get back to work between two to four weeks. Return to work also depended on pain level. Some people have a lot of pain after labral repair, SLAP repair, and Bankart reconstruction surgery, some people have very little. Pain is very personal, and we will supply you with pain medication to cover your pain as needed. Pain medication will be given for an appropriate amount of time.
FMLA and Disability Paperwork
Our office offers the service of completing paperwork for FMLA and/or disability for a fee of $40, per set of paperwork, and is completed in the order that it is received, typically takes 7-10 business days. All requests must originate with your employer, as your eligibility for FMLA and/or disability is based on your benefits with your employer. While each patient is unique, we do our best to estimate the time of recovery and often times over-estimate the amount of time to prevent a lapse in benefits and/or require additional paperwork. Often times disability companies require updates after each appointment. It is the patient’s responsibility to communicate this request with the office. Updates are not automatically completed. Any questions regarding this can be directed to Dorothy.