The posterior branch of the axillary nerve travels within 1mm of the inferior capsule of the glenohumeral joint and can be injured with suture passing devices during posterior-inferior labral repairs. The superior-lateral brachial cutaneous nerve and the nerve to the teres minor always arise from the posterior branch. Injury can lead to teres minor weakness on external rotation and sensory symptoms in the lateral arm in the region marked by yellow in Figure B.
Figure A shows an axial image of the shoulder with a posterior-inferior labral tear off of the glenoid with a small fragment of bone.
Ball et al traced the course of the axillary nerve in cadaveric shoulders and noted that the posterior branch of the axillary nerve has an intimate association with the inferior aspects of the glenoid and shoulder joint capsule, which may place it at particular risk during capsular plication or thermal shrinkage procedures.
Esmail et al used intraoperative nerve monitoring to identify axillary nerve position, capsule thickness, and provide real-time identification of impending nerve injury and function during shoulder thermal capsulorrhaphy. The use of intraoperative nerve monitoring altered the heat application technique in 4 of 11 patients and may have prevented nerve injury.
Illustration A shows the sensory distribution of the axillary nerve. Illustration B shows an arthroscopic image (viewing from anterior while in the lateral decubitus position) following repair of this posterior-inferior labral tear.
I wish I'd read this earlier, I found that there wasn't a lot of advice post surgery as to do what when, to my demise!
7 months ago I had labral tear repair, osteochondroplasty and a cam shave. Was given crutches for 4 weeks and told to start hydrotherapy immediately, I even had my first session in the hospital the day after the surgery. All went well to begin with and 2 weeks in, I was much improved. At this point I decided to freestyle my rehabilitation and do a "light" session in the gym doing some unweighted squats, dynamic bridges and leg extensions. Major mistake! Pain was excruciating and got worse for a 2 days. I ended up being on crutches for 6 weeks and then back to work. The hip was painful every day with recovery at a snails pace. I thought that I might have retorn it but an MRI scan suggested not. 3 Months later, the pain still really bad, tried injections but they didn't last long at all.
Eventually the surgeon decided that It might be torn again and I agreed to another arthroscope. This was 4 weeks ago. The surgeon reported that the original stitches had held but a new part of the labrum had torn, so he repaired that too. This time 2 weeks on crutches and all was progressing really well. Every so often a slight flare up if over doing the bike (on no resistance) or too long in the pool but nothing severe. Then 2 days ago I stupidly attempted to lift up my bed whilst kneeling, big flare up! Not in the same league as before but a fair step backwards, just icing and hoping for the best now! You literally can't get away with anything post surgery...
I think the best advice on this site is to take your time and don't rush recovery! I'd recommend getting a week by week advice plan from your physio and don't stray from it...
Surgical treatment is done arthroscopically on an outpatient basis. Surgical options are frequently dependent on the age of the patient and the quality of the tissue at the time of surgery and include SLAP repair, bicep tenodesis or bicep tenotomy. The bicep tendon serves a compressive function and may aid in shoulder stability during the throwing motion so unless the patient is a throwing athlete, functional or strength deficits caused by releasing the bicep tendon are typically nominal. In fact, both Brett Favre and John Elway played professional football after release and rupture, respectively, in each of their throwing shoulders without limitations. Historically, with the advent of suture anchor devices, the majority of SLAP tears (Type 2) have been treated with in-situ repair of the native tissue. The published outcomes however have noted varying degrees of success thru such treatment with "excellent" outcomes only reported in 15-30% of patients. 1 , 2, 3 In younger active patients, anything short of excellent can be met with frustration and disappointment. A trend, therefore, has been made to advise bicep tenodesis as an alternative in patients physiologically older than the age of 40. 4 Several recent publications have demonstrated improved outcomes as compared to SLAP repairs with higher satisfaction ratings and higher return to sports. 5 , 6 In my practice, I generally advise tenodesis in patients older than the age of 35. In younger patients, SLAP repair is generally recommended. Repair of SLAP tears in throwing athletes remains a very sensitive area with 64% of overhead athletes able to return to preinjury level of play and so surgery is often the last resort in this group of patients. 7