Shoulder Labrum Repair: Concerns About Titanium Screws

Inquiry about the glenoid labrum and the use of screws?

Hello, Doctor.
I have been diagnosed with a tear in the supraspinatus muscle and a labral tear.
I have been experiencing pain for a long time, and after more than a year of ineffective rehabilitation, my doctor has recommended arthroscopic surgery.
However, I have several concerns about the surgery that are making me very anxious.

(1) The procedure involves inserting two titanium alloy screws, each less than 0.5 mm, into the medullary cavity to secure the repair.
The doctor mentioned that these screws would not need to be removed and that it would not have any adverse effects.
However, I have read that screws can act as foreign bodies in the body, potentially causing tissue irritation or damage, leading to pain.
I would like to ask the doctor if these 0.5 mm screws could cause the issues I mentioned above.
Is it possible to remove them later, or would you recommend removing them? What would happen if they are not removed? Could the screws fatigue and become loose or displace? If they do displace, how would that be managed? After rehabilitation, will I still be able to engage in sports (like throwing, basketball, push-ups, and arm rotations)? Could displacement pose a danger?
(2) Another hospital suggested using self-pay sutures for fixation instead of screws, stating that they would also not be removed.
They explained that if there is any displacement, it would not cause the same damage as screws, but rather just a shift in the suture.

Doctor, these are my anxious questions.
Which option would be more beneficial for me, or what would you recommend? Thank you.

Wei, 30~39 year old female. Ask Date: 2018/03/18

Dr. Shi Guozheng reply Orthopedics

1.
Usually, the screws used to fix ligaments do not need to be removed, and if removal is necessary, it can be quite difficult.
You can still engage in physical activity later, and the chance of loosening is minimal.
You may want to consult your attending physician about this.

2.
Using sutures for fixation is also an option, and it is not likely to displace easily.
It is advisable to communicate clearly with your physician before making a decision regarding surgery.

Reply Date: 2018/03/18

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding the shoulder labrum repair and the use of titanium screws. It’s completely understandable to feel anxious about surgery and the implications of having foreign materials in your body. Let’s address your questions one by one.

1. Titanium Screws and Their Effects: Titanium is widely used in orthopedic surgeries due to its biocompatibility, strength, and resistance to corrosion. The screws you mentioned, which are approximately 0.5 cm in size, are designed to remain in the body permanently. While it is true that any foreign object can potentially cause irritation or discomfort, titanium screws are generally well-tolerated by the body. They are less likely to cause significant issues compared to other materials.
The concern about screws causing pain or tissue damage typically arises from improper placement or if the screws are too large for the bone. If the screws are placed correctly and the surrounding tissues heal properly, you should not experience significant problems. However, if you do experience persistent pain or discomfort after surgery, it’s important to communicate this with your surgeon, as they may want to evaluate the situation further.

Regarding the possibility of removing the screws, it is usually not necessary unless they cause complications. In some cases, if the screws become loose or if they are causing significant discomfort, removal may be considered. However, this is relatively rare. The risk of screw fatigue or loosening is low, especially if the screws are properly placed and the bone heals well.

2. Alternative Methods of Fixation: The use of suture anchors or other fixation methods is also a common practice in shoulder surgeries. These methods can provide a secure repair while minimizing the risk of irritation from hardware. Suture anchors are designed to hold the tendon in place and are typically absorbed by the body over time, which may reduce the risk of long-term complications associated with permanent hardware.

The choice between using titanium screws and suture anchors often depends on the specific nature of the injury, the surgeon's preference, and the expected outcomes. Both methods have their advantages and disadvantages. Suture anchors may reduce the risk of long-term irritation, but they also require careful placement to ensure they provide adequate support for the repair.

3. Post-Surgery Rehabilitation and Activity: After your surgery, rehabilitation will be crucial for your recovery. Your physical therapist will guide you through exercises to regain strength and mobility in your shoulder. It’s important to follow their recommendations closely to ensure a successful recovery.
As for returning to activities such as throwing, basketball, or other sports, this will depend on your healing progress and the advice of your surgeon and physical therapist. Generally, most patients can return to their previous level of activity after a successful recovery, but this may take several months. It’s essential to listen to your body and not rush back into activities that could jeopardize your healing.

In conclusion, while it’s natural to have concerns about surgery and the materials used, titanium screws are a reliable option for shoulder repairs. If you have ongoing concerns or experience any unusual symptoms post-surgery, don’t hesitate to reach out to your healthcare provider. They are there to help you navigate your recovery and ensure the best possible outcome.

Best wishes for your surgery and recovery!
Sincerely,
Doctor Q&A Teams

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