Thread: Plate tear of the Labrum & Hills Sachs fracture?

Early last month while I was traveling at a pretty high rate of speed, my downhill ski popped off and when I landed all of that force and my weight landed on my downhill outstretched arm. My arm was blown out of the socket. After re-dislocating it 10 more times, I finally got in to see a top rated sports doc. here who's specialty is shoulders and knees. He said that I have a pan tear to the labrum, which he told me means that it goes all of the way around. I've searched this forum but didn't see anything on plate tears. I'm wondering if this is the same thing as a slap tear? He also said that I have a Hills Sachs fracture to the humeral head and that my glenoid capsule will need to be tightened. He said I may possibly need the Laterjet procedure that Dr. Mark from here highly recommends but based on the MRI he couldn't tell how much bone loss there was. He'll make that decision when he gets in there.

If anyone here has had this type of injury or knows about it, I'd really appreciate your input. The doc said there was about a 6 month recovery period for this! I'm a little nervous about losing my range of motion.

Thanks in advance for any advice.

a slap tear is basically a labrum tear on the top of the joint. it sounds like the plate is just a tear of the entire thing. i think i might be closest to you in terms of labrum tears, i go 3 to 9 but some other people have bad ones too. there are a bnch of us who are at various stages of the shoulder surgery path. i have mine in 2 days.

it seems like the latarjet is used when there is bone loss/deformation and the entire joint needs restructuring.

i have no idea what i am getting done, but the mri sounded like it would be more complicated than a typcial bankhart repair. plan is go in arthroscopically but it could resort to open if the damage is too bad. i do have a lot of frayed edges/tendons etc that will hopefully get cleaned up.

I could be wrong, but maybe a plate tear is also called a "circumferential labral tear"? I think that goes all the way around the shoulder. I was close with SLAP, bankart, and reverse bankart lesions. My tears were fixed arthroscopically with 5 anchors, and I underwent joint tightening as well.

skibumnh had a circumferential tear
[ame="http://www.tetongravity.com/Forums/showthread.php?t=112621"]Circumfrential Labral Tear - Teton Gravity Research Forums[/ame]

hope this helps. good luck. drmark might chime in too.

Thanks for your input so far crackboy and peterslovo! This is exactly what I was hoping to get. I want to be an informed patient. Hopefully others will chime in too, but I know time is tight! The top of the humerus head has a pretty significant dent in it and the doctor said he would be surprised if I didn't have bone loss on the sides.

Best of luck, Snowmiser....the one thing I wanted to add to the above is that you will be trading range of motion for stability (so expect some stiffness compared to the other side). That being said, a lot of the outcome also depends on your rehab, and you sound pretty motivated.

Thanks Orthoski!

I'm a big swimmer and really am not ready to give that up yet, so hopefully that will keep me motivated to work hard to get the motion back.

Thanks for your input!

yea, to my understanding it seems like the latarjet is more of a sacrifice for stability at the cost of your shoulder being bone blocked. but i imagine if you work hard you can probably get close to where you are at before hand.

whereas more standard surgerys like the bankhart etc you probably wouldn't lose as much unless they are reoganizing tendons/muscles

i have to be at teh hospital in 15 hours or so. starting to get nervous.

Originally Posted by crackboy

yea, to my understanding it seems like the latarjet is more of a sacrifice for stability at the cost of your shoulder being bone blocked. but i imagine if you work hard you can probably get close to where you are at before hand.

whereas more standard surgerys like the bankhart etc you probably wouldn't lose as much unless they are reoganizing tendons/muscles

i have to be at teh hospital in 15 hours or so. starting to get nervous.

g'luck dude! The surgery is the easy part, so don't sweat it too much. Work hard in PT and you'll be fine.

Positive vibes and prayers heading your way crackboy! Keep us posted plz!

Did anybody else with this type of injury have pain in the bicep area at times? Mine hurts once in a while. I forgot to mention it to my doctor. I'm wondering about maybe a small tear in the bicep tendon. I might have to call him and ask. Dr. Mark, if you have a minute, I'd really appreciate it if you could let me know what I'm in for and how long it will be to recover. My doctor said 6 months, but after reading some of these posts, it seems like it will be longer than that.

Thanks!

one of the places i would manifest pain was in teh bicep, i also had migraines and back pain from compensation. it makes sense for you to have a lot of bicep pain since the attachment of that is at teh end of the humerus which you broke and is also pretty closely tied into the rotator cuff lagature, which you tore.

Thanks crackboy! I'm trying to familiarize myself with what I have. I've found a few good sites that show a lot of details. Peterslovo sent me a link to a really good one. Thanks! I really want to go into this fully informed. Best wishes on a successful surgery! Your in our thoughts and prayers!

In response to your question about biceps pain, yes, I had some. It was due to the SLAP lesion, but my biceps tendon was in very good shape, so went unrepaired. However, as part of rehab and for some reason, my biceps tendon pain is increased, and I'm 11 months out of surgery. I've read that SLAP repairs can lead to biceps tendonitis due to irritation from anchor placement and scar tissue formation. Not sure if that's where I am, but it is important to note.

Good to know peter! Thank you!

Doctor's office called today to schedule my surgery for my pan tear of my labrum March 9th is the day! The nurse indicated that the doctor thought there was a strong possibility that I would wind up having the Laterjet procedure, but won't know until they get the scope in. The MRI report states that I have a very prominent Hill-Sachs deformity on the postero-lateral humeral head and evidence of a bony Bankart fracture along the anteroinferior glenoid. There's also a triangular-shaped structure, thought to represent a combination of osseous avulsion/cartilage/ligamentous substance near the inferior margin of the glenoid. The glenoid labrum is extensively torn as part of a SLAP tear specturm that involves the glenohumeral ligaments, the biceps-labral ancor complex and a portion of the coracohumeral ligament. The tear involves much of the labral circumference. The long-head biceps tendon is inflamed and minimally torn where it courses through the rotator cuff interval space.

Sounds bad to me! .

It's 4:30a.m. and I'm just getting ready to head out to the hospital to finally get my shoulder fixed. I put the skis away after playing for a few great hours yesterday and gave my son back his belt that is an old Lincoln seatbelt that I been using to keep my upper arm strapped to my torso to keep it from popping out! It worked out great all season, but now I have a new nickname on the hill...."Seatbelt Annie". I guess it's better than "Crash".
[IMG][/IMG]

4th day post op and doing GREAT! NO pain meds today. Sleeping fine on a recliner! I start physical therapy on Tuesday. Have been able to shower and change, etc...! Life is good! No more dislocations!

Man is this getting discouraging!!!! My rotation is soooooo limited! I'm going to pt once a week and I've been working my butt off, 2 - 3 times a day on my own trying to loosen this shoulder and arm up and it's not helping! My therapist wants me to add 2 more days but insurance is gone after 6 more visits. When I pull my arm straight up, I can go pretty far up, but when I try to rotate to the side, my arm shakes like crazy as I'm trying to stretch it, but I'm not gaining any range of motion! If any of you have some good suggestions for some exercises that I can do at home, I'd really appreciate it!

The farther you try to go to your side the harder it will get. That's how I am anyway. You're still under a month post-op, I don't know that you should expect so much ROM so soon. What procedure did you have done exactly? Was it scoped or full open, any capsule tightening?

My surgery was 12/23/09 and I feel like I've hit a brick wall with progress. It's getting better, but at a really slow pace. PT's say the doc must've really tightened the shit out of my capsule. I can just barely wash my hair with my left arm if that says anything.

Wow, mdp. Now I feel a little better I think! Maybe my therapist is expecting too much too soon and freaking me out a little! He wants me there 3 times a week now because he's afraid I'm going to wind up locked.

I had 4 anchors put in and he tightened up the shit out of my capsule too. If your 3 months post op and that stiff still, then I guess I should relax.

i am 5 weeks as of yesterday. i am doing 2x per week of PT with 2-3 times a day exercises on my own. at the pt i do 10s x 15 on the pully forward and the side. then i do 15 x 10 s with a cane forward to the side and gently working the external rotation. then i do 5 x 10s towel stretch which is behind the back. do 20ish wall crawls. then i do 30 arm lifts using my own power forward, to the side, and external rotation. i did 3 sets of 15 laying on stomach palm forward raising my arm back until its at my side. then i get stretched.

last wednesday i was at 135 degrees rotation but i didn't get measured today.

i had 6 anchors put in arthroscopically

i am not sure how long you are holding your stretches but that makes a huge difference. the only ones i don't push my limits too hard are the external rotation cane and the towel. oh at home i do shoulder shrugs. hold each shrug for 10 secs. forward back, up and down. this should help open up your scapula and deltoid

Crackboy, your PT sessions sound a lot like mine. Except that you're five weeks post-op and my surgeon wouldn't even let me out of the sling until six weeks, at which point I finally started PT. I hate doing the towel behind the back. That's a nasty stretch at this point for me. Painful and difficult.

My PT today stretched the shit out of me and would hold it in those positions. I think after hearing me say I wanted to see some more results, he decided to be a little more aggressive. Man was I happy to be done with him stretching me and get on with the electro-therapy to end my session.

Also, I think a little of what holds me back is my apprehension to moving my arm. After dealing with dislocations for 12 years, I've learned to move my body in different ways to protect it. This has made my left shoulder super weak. My PT says after I move my arm in any direction as far as I can, he can move it farther which shows that my strength is part of the issue. He says for what the doctor did and for my case specifically, I'm not doing too bad.