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Superior Labral Anterior to Posterior (SLAP) Tears

Superior Labral Anterior to Posterior (SLAP) Tears. Thomas J Kovack DO. Superior Labral Anterior to Posterior (SLAP) Tears. Anatomy. Superior Labrum Deepens socket Attached to ligaments Helps stabilize shoulder Long Head of Biceps Attaches to top of labrum

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Superior Labral Anterior to Posterior (SLAP) Tears

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

  2. Superior Labral Anterior to Posterior (SLAP) Tears

  3. Anatomy • Superior Labrum • 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 • Non-operative • 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

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