SLAP Repair

What is SLAP Tear?

The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP Tear, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP Tear occurs both in the front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.

Types of SLAP Tear:

Type 1 SLAP Tear

Involves isolated fraying of the labrum, but it is still attached to the Glenoid. Generally, does not show any symptoms. It is said that most people have a Type 1 SLAP tear that they would not know of.

Type 2 SLAP Tear

Involves detachment of labrum from the Glenoid causing instability of the biceps-labral anchor. They can be further classified as anterior, posterior, or a blend of the two.

Type 3 SLAP Tear

Involves bucket-handle tear of the labrum. Biceps anchors are attached. Labrum droops into the shoulder joint. Often treated with Arthroscopy

Type 4 SLAP Tear

This is again a bucket-handle tear of the labrum however it extends up to the biceps tendon in varying degrees. It also involves instability of the biceps-labrum anchor. Depending on the extent of the biceps tendon involved, treatment options are selected.

Causes of SLAP Tear:

Injuries to the superior labrum can be caused by acute trauma or by repetitive Shoulder Motion.

The common causes of SLAP Tear are:

• A fall onto an outstretched arm
• Forceful pulling on the arm, such as when trying to catch a heavy object
• Rapid or forceful movement of the arm when it is above the level of the shoulder
• Shoulder Dislocation

People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears as a result of repeated Shoulder Motion.

Many SLAP Tears, however, are the result of a wearing down of the labrum that occurs slowly over time. In patients over 40 years of age, tearing or fraying of the superior labrum can be seen as a normal process of aging. This differs from an acute injury in a person under the age of 40.

Diagnosis

A Shoulder Specialist will evaluate the patient’s medical history which includes discussing the symptoms, current occupation, previous treatments, medications, etc. Evaluating the medical history of the patient along with physical examination plays a very important and intricate part in diagnosing the problem. In many cases, the doctor diagnoses the problem based on medical history and physical examination which is then validated using x-rays or imaging technologies.

Treatment

Conservative Treatment:

All patients should be treated non-operatively initially.

This consists of :

• Rest to allow the lesion to heal
• Physiotherapy
• Non- Steroidal Anti-inflammatory Medications

urgical Treatment:

Those patients who fail to respond to non-operative treatment are offered Arthroscopic Surgery. The arthroscopic technique involves inserting a tiny camera into the shoulder joint, and the surgeon uses this to look around the joint, removing any damaged tissue from the labrum.

The torn labrum is then repaired with sutures, or stitches, and reattached to the humerus bone, while the biceps tendon is detached from the labrum, allowing for faster recovery time.

SLAP Repair Post-operative precautions

ollowing surgery, you will be instructed to wear your sling for the first three weeks and then gradually start moving the shoulder within its joint range.

You may need physical therapy later to regain the full strength of your shoulder back to its old glory.

While taking pain medications and applying ice packs to control swelling and pain, physical therapy can help regain motion and strength after surgery.

You should avoid driving until your physician clears you to do so, which could take up to a few weeks.

After consultation with your surgeon and physical therapist, you can gradually return to sports activities.