1. SLAP Tears By Kale, Tanner, Logan, Adrien

2. Objectives What is a SLAP tear What causes a SLAP tear What are the surgical procedures for a SLAP Tear Rehabilitation interventions What are the contraindications and precautions for SLAP Tears Rehab techniques

3. What is a SLAP Tear The term “SLAP” stands for Superior Labrum Anterior to Posterior. A SLAP tear is when the superior part of the labrum has torn both in front (anteriorly) and behind (posteriorly) the long head biceps tendon attachment point to the labrum. The long head biceps tendon can also be injured in a SLAP lesion or tear as well.

4. Types of SLAP tears Type 1- Partial tear and degeneration to the superior labrum. Type 2- Most common. Superior labrum is completely torn off the glenoid fossa. Type 3- “bucket-handle” tear. The torn labrum hangs down into the joint and can cause dislocations and “popping and “clunking” symptoms. Type 4- The tear of the labrum extends into the long head biceps tendon.

5. What is the cause? SLAP injuries can be caused by trauma or repetitive shoulder motion. o Athletes who participate in overhead sports are prone to labrum tears. o Trauma by falling on an outstretched arm. o Heavy lifting

6. Diagnosis A MRI arthrogram is the best way to see a SLAP lesion. This is when they inject a special dye into your shoulder just before the MRI is done. Manual tests-Two most common o Speeds test o O’Briens test Problem with a test in diagnosing is a combination of impingement or instability

7. Surgical Procedures Non-surgical o Doctor will prescribe anti-inflammitory drug for inflammation and pain o Will be given ROM and shoulder strengthening exercises Surgical Treatment o For a SLAP tear an arthroscopy is more commonly used. An arthroscopy is using a small camera to see inside your shoulder so it is less invasive, and the scarring on the patient is minimized.

8. Repairing SLAPs Type I (rough labrum) o Cleaning up the small “rough” or “frayed edges of the labrum Type 2 (most common o Reattaching the labrum to the glenoid after it had been separated by injury Type 3 (Bucket-handle) o Removing the “bucket-handle” segment then reattach any other segments using sutures Type 4 (Biceps involvement) o The doctor will determine to either repair the injured long head of the biceps tendon, or they will remove it completely o https://www.youtube.com/watch?v=SQPqqTZ0RhEhttps://www.youtube.com/watch?v=SQPqqTZ0RhE

9. Rehab phase 1 Early protective phase Goals o Protect surgical procedure o Educate pt. o Regulate pain/ inflammation o Initiate ROM dynamic stabilization o Neuromuscular re-education Time o 0 -4 weeks post surgery

10. Rehab Phase 2 Intermediate phase Goals o Normalize Arthrokinematics o Gain neuromuscular control o Normalization of posterior shoulder flexibility Time o 5-8 Weeks post surgery

11. Rehab phase 3 Strengthening Postoperative phase Goals o Normal ROM o Progress strength o Normal scapulothoracic motion and strength o Over head FDL with no pain Times o 9-14 weeks post surgery

12. Rehab phase 5 Advanced strengthening phase Goals Pain free full ROM Improve muscular endurance Improve dynamic stability Time o 15-14 weeks post surgery

13. Precautions Stage 1- (4-6 weeks after surgery) Avoid biceps tension for 6 weeks to protect repaired tissues- shoulder flexion ROM-130 Degrees Limit ER to 40 degrees in neutral Extension and horizontal abduction

14. Precautions Stage 2- (usually 6-12 weeks after surgery) No PROM for abduction with ER or extension

15. Precaution Stage 3- (usually 10 weeks after or when criteria is meet in stage 2) All exercises and activities to remain non-provocative and low to medium velocity Avoid activities where there is a higher risk for falling or outside forces to be applied to the arm No overhead sports related exercises ( throwing ball or swimming

16. Precaution Stage 4- (Usually 16 weeks after surgery) Progress gradually into provocative exercises by beginning

17. Precaution Stage 5- (usually 22 weeks post surgery) Progress into functional movement patterns

18. bib http://www.sportsinjuryclinic.net/ http://www.ace-pt.org/ http://morphopedics.wikidot.com/ http://pjroxburgh.tripod.com/ http://orthoinfo.aaos.org/topic.cfm?topic=A00627 Lisa Maxey, Jim Magnusson; Rehabilitation For the Postsurgical Orthopedic Patient. Second Edition http://www.uwhealth.org/files/uwhealth/docs/pdf/SM14888 _SLAP_Repair6.pdfhttp://www.uwhealth.org/files/uwhealth/docs/pdf/SM14888 _SLAP_Repair6.pdf