1 / 45

SLAP Tears

baylee
Download Presentation

SLAP Tears

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. SLAP Tears Eric L. Chehab, MD January 20, 2010

    5. SLAP Tears Snyder 1990 coined the term “SLAP” Superior labrum anterior and posterior 27 lesions in 700 shoulder arthroscopies (3.9%) MOI: Compression onto outstretched arm Symptoms: Pain, overhead pain, catching/popping Divided into 4 types (most common classification used today)

    6. Type I

    7. Type II

    8. Type III

    9. Type IV

    11. Labrum Anatomy Fibrocartilage Blood supply Shape

    12. Labrum Anatomy

    13. Labrum Anatomy

    14. Labrum Anatomy

    16. Labrum Anatomy

    17. Labrum Anatomy Like the meniscus, the blood supply to the labrum dictates treatment High variability in the normal anatomy can make pathologic conditions in the labrum more difficult to identify

    18. Labrum Function

    19. Labrum Function

    20. Labrum Function

    21. Labrum Function

    22. Labrum Function Increases concavity and compression Stabilizes shoulder anterior-posteriorly and superiorly/inferiorly Improves rigidity of the shoulder in the cocked, throwing position (ie loads the gun)

    23. Mechanism of Injury Baseball, javelin, football, tennis, softball Tremendous force with late cocking, deceleration phase of throwing Repetitive micro trauma Fall with direct compression on forward flexed arm

    24. Mechanism of Injury Predisposing factors Peel – back Capsular contracture (essential lesion) Internal impingement Increased glenoid retroversion

    25. Schematic and graphical representations of the humeral shift from neutral to maximum external rotation, showing the superior shift of the humeral head following the simulated posterior capsular contracture.Schematic and graphical representations of the humeral shift from neutral to maximum external rotation, showing the superior shift of the humeral head following the simulated posterior capsular contracture.

    26. Mechanism of Injury Native shoulder – head shifts posteroinferiorly in late cocking phase With posterior contracture & anterior laxity from repetitive throwing, head shifts posterosuperiorly. This loads the labrum while under excess tension with increased ER. Labrum peels back and separates from glenoid rim attritionally.

    27. Clinical Presentation Difficult Pain universal – but variable in type History of injury – traction injury w. unexpected shift of heavy objects; fall from a height; repetitive microtrauma Mechanical symptoms Dead Arm

    28. Clinical Presentation PE: Several diagnostic maneuvers suggest a SLAP, but no single exam finding is diagnostic of a SLAP tear

    29. Clinical Presentation Speed’s test Yergason’s Anterior Apprehension Relocation Test Compression-Rotation Test O’Brien’s Active Compression Test Kibler Test Whipple Test Biceps Load Test Bicepital Groove Tenderness

    37. Clinical Presentation Diagnosis based on history and physical exam A combination of exam maneuvers can increase diagnostic accuracy of SLAP lesions.

    38. MRI

    39. Treatment Nonsurgical Treatment Improve posterior capsular flexibility Cuff Strength Scapular mechanics 3 months of conservative treatment

    40. Surgical Treatment

    43. Results Suture Anchor Technique Pain relief and function reliable after SLAP repair, but return to sport is less variable Morgan et al 97% good to excellent; 84 % RTS (102 repairs) Kim et al 94% good to excellent; preinjury level of function 91%; only 22% RTS Ide et al. 90 % good to excellent, 75% RTS

    44. Results AOSSM Meeting Keystone 2009 23 Elite Pitchers (collegiate/pro) underwent Type II SLAP repair At 38 months postop; 13 playing pain free (57%); 6 playing with pain (26%); 4 not playing (17%) Good to excellent results in 96%

    45. Results Operative treatment of SLAP results in between 57% to 84% RTS at preinjury level of function. However, good to excellent results can be expected with most non-overhead activity

    46. Thank You

More Related