When to Mobilize a Labrum Repair

[jroc86]

First post guys. Happy to be here. I'm also a new PT and will be here frequently as questions arise.

New patient 12 weeks post latar-jet repair for anterior Bankarts lesion. Patient is cleared to resume strengthening and surgeon wants the anterior capsule to begin to be stretched. As well as doing external rotation, scar tissue massage, general ROM, and manual release of the tight pec/ant delt/upper trap/biceps I was thinking of adding some anterior glides of the GH joint as well. Should I avoid this presently? The surgical protocol advises not stretching into the apprehensive position for 24 months, but there are no range restrictions and hes has resumed doing gentle strengthening.

Can I mobilize this shoulder? Or should I stick with other techniques at this time.

Thanks

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[theshoulderguy]

First post guys. Happy to be here. I'm also a new PT and will be here frequently as questions arise.

New patient 12 weeks post latar-jet repair for anterior Bankarts lesion. Patient is cleared to resume strengthening and surgeon wants the anterior capsule to begin to be stretched. As well as doing external rotation, scar tissue massage, general ROM, and manual release of the tight pec/ant delt/upper trap/biceps I was thinking of adding some anterior glides of the GH joint as well. Should I avoid this presently? The surgical protocol advises not stretching into the apprehensive position for 24 months, but there are no range restrictions and hes has resumed doing gentle strengthening.

Can I mobilize this shoulder? Or should I stick with other techniques at this time.

Thanks

Hi Jroc, as you probably are aware a Laterjet procedure is indicated when the patient's "instability severity index score" is above 6/10 or they have an unacceptable amount of glenoid bone loss on CT. The Laterjet procedure provides a bony coracoid augmentation as well as a soft tissue tenodesis effect to provide superior stability in those patients with or the potential for recurrent instability.

These patients are given the all clear usually about the 12 week mark to start more aggressive rehabilitation once the treating surgeon gets confirmation from a CT scan that the coracoid bone transfer has healed.

In my experience, you can begin to mobilise without limitation in all directions.

No mobilisation into the ABD/ER position for 24 months is absurd and no use to anyone. I would double check that protocol for sure.

You can also start muscle activation, proprioceptive drills etc etc

As for anterior mobilisations, I would challenge you to think about this a little more.

Why?

Isn't this the direction of instability?

In which direction does the HOH/shoulder girdle usually move following anterior stabilisations?

Where ideally should the HOH sit?

Great questions lead to great answers.