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Dr. Andrea Bowers - 04/2014

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3DPT interviews Dr. Andrea Bowers about shoulder labral injuries

Dr. Andrea Bowers shoulder labral injuries

Dr. Andrea Bowers
Orthopaedic Surgeon
Burlington County Orthopaedic Specialists
204 Ark Rd Mt Laurel, NJ 08054

3DPT is proud to have Dr. Andrea Bowers of Burlington County Orthopaedic Specialists as part of its Medical Minute this month. Dr. Bowers has expertise in surgical management of shoulder labral injuries and answers some questions related to this topic below.

3DPT: What does it mean to have a "torn labrum"?

Dr. Bowers: The labrum is a cartilaginous ring that lines the glenoid, or socket, of the shoulder joint. It receives the long head of the biceps tendon as it enters the shoulder and serves as a cushion to help stabilize the ball in the socket and prevent dislocation. A tear can mean the cartilage has separated from the bony socket or a split develops within the fibers of the cartilage ring.

3DPT: Is there a certain injury or activity that you find is the cause of labral problems in the shoulder?

Dr. Bowers: The labrum can sustain a traumatic tear if the shoulder dislocates. In this situation the labrum is typically focally separated from the glenoid bone. It can also begin to fray with repetitive sport or work activities that place undue stress on the labrum. Typically this involves overhead activities like throwing a ball, playing tennis or volleyball, or lifting weights. As the labral tissue ages, the quality of the rubbery substance declines, and it can become prone to cracking. Irregularity of the labrum is often witnessed incidentally during surgeries performed for rotator cuff tears or arthritis.

3DPT: How does a patient with a labral tear typically present?

Dr. Bowers: Traumatic tears of the front or back of the labrum usually present with pain and often a sense that the shoulder is shifting out of place. This typically occurs after a traumatic hit or fall that generated enough force to dislocate or sublux the shoulder. Some patients report popping or catching in the shoulder. If the tear involves the top portion of the labrum, where the biceps attaches (SLAP tear, Superior Labrum Anterior-Posterior tear), patients may complain of weakness and loss of velocity or control with performing overhead activities. The pain or popping is often positional and activity related, with little or no symptoms at rest.

3DPT: Does a labral tear always require surgery?

Dr. Bowers: Labral tears do not always require surgery. Often the symptoms can be managed with activity modification and physical therapy targeted at capsular stretching and dynamic stabilization of the joint with rotator cuff and periscapular strengthening.

3DPT: How do you determine if surgery is necessary?

Dr. Bowers: Surgery is indicated when the patient's symptoms fail to respond to the aforementioned conservative measures. Patients who have dislocations of the shoulder should undergo repair to stabilize the joint and minimize the risk for further damage.

3DPT: If a patient requires surgery:
      a. How soon do they start physical therapy?
      b. How long is the rehabilitation process?

Dr. Bowers: Therapy after surgery varies depending on whether the labrum requires a debridement (trimming) versus a repair. If a simple debridement is performed, a sling is worn for comfort only for a week or two, and therapy can be initiated right away to restore motion and ultimately strengthen the shoulder. Return to sports usually occurs at the 3 month mark. If a repair is performed, or if the biceps anchor is involved and requires a tenodesis (reattachment of the tendon away from the labrum), a sling is worn for 4-6 weeks and therapy is delayed 2-4 weeks to allow for some healthy scar tissue to set in. Return to full sports is often delayed to 5 months after surgery.

3DPT: What are the predicted outcomes and ability for patients to return to sport?

Dr. Bowers: Most patients (~85-90%) are able to resume full sporting activities. Elite level throwers may lose some velocity on their pitching as a result of tightening of the tissues. Patients who injured their labrum with a dislocation may resume contact sports but do remain at higher risk for repeat dislocation.

3DPT: Where did you go to medical school/residency/fellowship?

Dr. Bowers:

Medical School: Vanderbilt University
Residency: Orthopaedic Surgery at the University of Pennsylvania
Fellowship: Sports Medicine and Shoulder Surgery at the Hospital for Special Surgery

3DPT: What is your favorite part of being a Sports Medicine Orthopaedic Surgeon?

Dr. Bowers: The ability to use my mind and my hands to assist people in maintaining a healthy lifestyle and lifelong participation in sports.

3DPT: What do you like to do in your spare time?

Dr. Bowers: Spending as much time as I can with my husband and children, fostering their own developing love for sports

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