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

2. Superior Labral Anterior to Posterior (SLAP) Tears

3. 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)

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

5. 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

6. Age Related Changes
Natural degeneration of the labrum with age

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

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

9. Operative Treatment
Arthroscopic Surgery
Debridement
Labral Repair

10. 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

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

12. 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)

13. 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

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