Wrestling After Rotator Cuff/Labrum Surgery – Can Therapy Make You 100%?
Can you return to the mat and wrestle at 100% of your ability after rotator cuff/labrum surgery? The answer is yes, but there is new medical information that shows the most effective rehabilitation method for returning to the wrestling mat at full strength.
Here you’ll find some basic information about the rotator cuff and the labrum from anatomy, to injuries, surgical repair, and rehabilitation with physical therapy.
Throwing athletes and weightlifters suffer from the lion’s share of rotator cuff and labrum injuries, but wrestlers are also susceptible due to the repetitive motion, shoulder tension and stress demands of the sport. In addition, unlike sports like football, lacrosse and hockey which use protective shoulder padding, the risk of injury from trauma is high because the shoulders are unprotected during a wrestling match.
What Is The Rotator Cuff?
The rotator cuff is a group of four tendons that attach four shoulder muscles to the upper arm. Tendons are stringy tissues that attach muscle to bone. A healthy shoulder is the most versatile joint in the human body. It has a wider "range of motion," which means it can move more freely, and in more directions, than any other joint. The shoulder's versatility enables us to perform thousands of activities.
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What Is The Labrum?
The labrum is a ring of soft fibrous tissue that surrounds the glenoid (the end of the shoulder blade) and helps stabilize the shoulder joint. The shoulder is a ball and socket joint where the arm meets the body). The arm bone (humerus) forms a ball at the shoulder which meets the socket which is part of the shoulder blade. These two bones are connected by ligaments which are tough tissues forming tethers that hold the bones in relationship to each other. The labrum deepens the socket by up to 50 percent so that the head of the upper arm bone fits better.
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What Is A Rotator Cuff Tear?
Many shoulder problems are caused by injuries to the rotator cuff - the tendons that attach the shoulder muscles to the arm. If a rotator cuff tendon becomes inflamed or is partially torn, it can cause pain and limit shoulder movement. If a tendon tears completely, the corresponding muscle can no longer affect movement of the arm. This type of injury usually causes severe limitations in shoulder movement as a result of pain and weakness.
Rotator cuff tears can also happen suddenly; for example, when a person tries to lift a heavy object above the head. Repeatedly performing a strenuous task such as throwing a baseball can also damage the rotator cuff. In such cases, the excess strain on the rotator cuff causes one or more tendons to tear.
What is a torn Labrum?
Athletes can experience labrum tears due to trauma or repetitive shoulder motion.
Tears can be located either above (superior) or below (inferior) the middle of the glenoid socket. A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the rim above the middle of the socket that may also involve the biceps tendon. A tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion. Tears of the glenoid rim often occur with other shoulder injuries, such as a dislocated shoulder (full or partial dislocation).
Signs and symptoms
- Pain, usually with overhead activities
- - Catching, locking, popping or grinding
- - Occasional night pain or pain with daily activities
- - A sense of instability in the shoulder
- - Decreased range of motion
- - Loss of strength
Diagnosis
If you are experiencing shoulder pain, your doctor will take a history of your injury. You may be able to remember a specific incident or you may note that the pain gradually increased. The doctor will do several physical tests to check range of motion, stability and pain. In addition, the doctor will request X-rays to see if there are any other reasons for your problems.
Because the rim of the shoulder socket is soft tissue, X-rays will not show damage to it. The doctor may order a computed tomography (CT) scan or magnetic resonance image (MRI). In both cases, a contrast medium may be injected to help detect tears. Ultimately, however, the diagnosis will be made with arthroscopic surgery.
Treatment
Until the final diagnosis is made, your physician may prescribe anti-inflammatory medication and rest to relieve symptoms. Rehabilitation exercises to strengthen the rotator cuff muscles may also be recommended. If these conservative measures are insufficient, your physician may recommend arthroscopic surgery.
Surgical Rotator Cuff repair
In order to repair a torn rotator cuff, the surgeon reattaches the damaged tendon (or tendons) to the upper arm (humerus). (Some rotator cuff injuries involve more than one torn tendon.)
During this operation, the surgeon also removes bone spurs and releases any ligaments that are pressing on the tendon. If a bursa is inflamed, the surgeon excises or removes it. The surgeon also may remove a small portion of the acromion to make sure the repaired rotator cuff has enough room to move. Afterwards, the patient's arm is placed in a sling. With time, healing occurs, as scar tissue connects the tendon to bone. Because tendons receive such poor blood supply, this is a slow process.
Arthroscopic Rotator Cuff Surgery
Arthroscopic surgery is a technique for performing an operation using pen-shaped instruments with a miniature video camera attached to the end. Because arthroscopic surgery requires only limited surgical access, the incision is much smaller than is necessary for open surgery, resulting in fewer risks.
The patient's recovery time is also shorter. However, because repairing a torn rotator cuff can be a complicated procedure, it is often performed as an open procedure. However, arthroscopic repairs are becoming more common, especially for small size tears.
Arthroscopic Labrum Surgery
Until the final diagnosis is made, your physician may prescribe anti-inflammatory medication and rest to relieve symptoms. Rehabilitation exercises to strengthen the rotator cuff muscles may also be recommended. If these conservative measures are insufficient, your physician may recommend arthroscopic surgery.
During the surgery, the doctor will examine the rim and the biceps tendon. If the injury is confined to the rim itself, without involving the tendon, the shoulder is still stable. The surgeon will remove the torn flap and correct any other associated problems. If the tear extends into the biceps tendon or if the tendon is detached, the result is an unstable joint. The surgeon will need to repair and reattach the tendon using absorbable tacks, wires or sutures.
Tears below the middle of the socket are also associated with shoulder instability. The surgeon will reattach the ligament and tighten the shoulder socket by folding over and "pleating" the tissues.
Rehabilitation
After surgery, you will need to keep your shoulder in a sling for three to four weeks. Your physician will also prescribe gentle, passive, pain-free range-of-motion exercises. When the sling is removed, you will need to do motion and flexibility exercises and gradually start to strengthen your biceps. Athletes can usually begin doing sports-specific exercises after six weeks, although it will be three to four months before the shoulder is fully healed.
New Study Shows Free Weight Training 90% Effective for Full Recovery After Rotator Cuff Surgery
In a recent study, Dr. Jamie Stark, director of Research and Development at the Athletic and Therapeutic Institute in Chicago, it was shown that resistance training, some of it job-specific, was successful in getting 90 percent of workers with severe rotator cuff injuries back to work, the majority (75 percent) at their previous job, after traditional physical therapy had failed to do so.
At the doctor prescribed rehabilitation interval, some form of free weight resistance training is necessary for wrestlers to return to competitive wrestling at or close to 100% of maximum ability.
By: Rick Contrata
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