Superior Labral Anterior to Posterior (SLAP) Tears Thomas J Kovack DO

Superior Labral Anterior to Posterior (SLAP) Tears

Anatomy Superior Labrum Long Head of Biceps Deepens socket Attached to ligaments Helps stabilize shoulder Long Head of Biceps Attaches to top of labrum Pull of biceps may “peel off” labrum Pitchers Weightlifters (overhead press) Golfers (club strikes ground)

Types of SLAP Tears Type I Type II Type III Type IV

SLAP with Ganglion Cyst Labral Tear acts as one way valve Joint fluid leaks out of joint Creates Ganglion Cyst Cyst presses on suprascapular nerve Weakness to Shoulder Rotation

Age Related Changes Natural degeneration of the labrum with age

Diagnosis Clinical Examination MRI-Arthrogram MRI without contrast can miss the tear Accuracy of 90% in detecting labral tears (Bencardino et al., Radioogy 2000)

Non-operative Treatment Activity Modification NSAIDs Cortisone Injection Physical Therapy Rotator Cuff and Periscapular Muscle Strengthening Improve stability of shoulder by strengthening dynamic stabilizers

Operative Treatment Arthroscopic Surgery Debridement Labral Repair

Debridement Results At 1-year -- 78% of the patients had excellent pain relief At 2-year -- this number decreased to 63%. 45% of these patients returned to their preinjury level of athletic activity. Cordasco et al, AJSM 1993

Repair Arthroscopic Surgery Anchor the torn labrum to the bone Using dissolvable plastic anchors and heavy suture

Results of Repair 94% satisfactory results 91% return to pre-injury level of shoulder function Results are less favorable in patients who participate in overhead sports (Kim, JBJS 2002)

Post-operative Rehab Self-directed therapy program Phase I (0-1 month) Sling for ~1 week ADLs immediately 1 Week: Active assisted range of motion Phase II (2-3 months) Motion as tolerated No lifting overhead Phase III (3-6 months) Progression to light strengthening Phase IV (6+ months) Overhead lifting at 6 months Begin swimming, serving tennis, volleyball

Complications Stiffness Arthritis Persistent Pain Implant malposition or failure Rotator Cuff Tear Infection Nerve Injury Failure to achieve the desired result