slap repair
TRANSCRIPT
SLAP Repair
By: Katy Lutz
Anatomy
Shoulder joint involved 3 bones: scapula, clavicle & humerus
Humeral head rests in a socket on the scapula called the glenoid
A soft fibrous tissue called the labrum surrounds the glenoid to help deepen and stabilize the joint
The labrum deepens the glenoid by up to 50%
so that the head of the humerus fits betterIt also serves as an attachment site for several ligaments
Injuries
Falling on an outstretched arm
Direct blow to the shoulder
Sudden pull, such as when trying to lift a heavy object
Forceful overhead motions
Location of Tears
A SLAP lesion (superior labrum, anterior to posterior) is a tear of the labrum above the middle of the glenoid that may also involve the biceps tendon
A Bankart lesion is a tear of the labrum
below the middle of the glenoid socket that also involves the inferiorglenohumeral ligament
Signs and Symptoms
Pain, usually with overhead activities
Catching, locking, popping or grinding
Occasional night pain or pain with daily activities
A sense of instability in the shoulder
Decreased range of motion
Loss of strength
SLAP Repair Surgery Procedure
https://www.youtube.com/watch?v=1-pKLJRvJpg
Phase 1: 0-4 Weeks after Surgery
-Passive ROM Phase
Goals:
1. Protect the surgical repair
2. Ensure wound healing
3. Prevent shoulder stiffness
4. Regain ROM
5. Control pain and swelling
Use your sling most of the time for the first 2 weeks
You may use your hand on the operated arm in front of your body but DO NOT raise your arm overhead
You may shower or bath and wash the incision area
Exercise Program--ICE: 7 days a week, 4-5 times per day for 15-20 minutes
STRETCHING / PASSIVE ROM (w/ therapist help)Days per Week: 7 Times per day: 4-5
-1-2 sets of 10-20 reps of each exerciseProgram:Pendulums & wand exercises
Supine External Rotation
Supine assisted arm elevation
Behind the back internal rotation
Isometric exercises: internal and external rotation at neutral
Rhythmic stabilization and proprioceptive training drills with physical therapist
Ball squeeze
Scapular retraction
https://www.youtube.com/watch?v=dHxzx0abAGs
Phase 2: 5 to 7 weeks after Surgery
-Active ROM Phase
Goals:1. Protect the surgical repair
2. Improve ROM of the shoulder
3. Begin gentle strengthening
Your sling is no longer necessary unless your doctor instructs you to continue using it
You can now move your arm for most daily activities, but do not lift objects heavier than 1 or 2 pounds
https://www.youtube.com/watch?v=mP1hrnOamsY
STRETCHING / ACTIVE MOTION (patient performs)Days per week: 7 Times per day: 1 to 3
- Do 2-3 sets of 15-20 repsPendulum exercises
Wall walks
Thera-band internal and external rotation
Table slides
Prone row
Supine passive arm elevation
Prone horizontal abduction Ts
Seated-Standing Arm Elevation
Behind the back internal rotation
STRENGTHENING EXERCISES Days per week: 7 Times per day: 1
Prone extension
Side lying external rotation
Phase 3: 8 to 12 weeks after Surgery
-Strengthening Phase
Goals:1. Protect the surgical repair
2. Regain full ROM- passive & active
3. Use arm in all plane for daily activites
STRETCHING / RANGE OF MOTIONDays per week: 7 Times per day: 1-2
Pendulum exercises
Standing External Rotation / Doorway
Seated Row
Wall slide Stretch-- Start the 11th week after surgery
Hands-behind-head stretch-- Starting the 9Th week after surgery
Standing Forward Flexion
Behind the back internal rotation
Supine Cross-Chest Stretch
Side lying internal rotation (sleeper stretch
https://www.youtube.com/watch?v=EMAepitmJ8w
STRENGTHENING / THERA-BANDDays per week: 7 Times per day: 1, 2 sets of 15-20 reps
External Rotation w/ towel roll
Internal Rotation w/ towel roll
Standing Forward Punch - Add resistance 1 to 3 lbs.
Shoulder Shrug
Military press
Dynamic hug
Ws
Biceps curl-- Start the 9 week
STRENGTHENING / DYNAMICDays per week: 7 Times per day: 1
Side-lying External Rotation
Prone Horizontal Arm Raises Ts
Prone row
Prone scaption Ys
Prone extension
Weight Training
You should not return to training using heavy weights or on weight machines until your doctor says it is safe
Usually safe to return to heavier weight training at three months following labrum repair
You should have full range of shoulder motion and normal strength in the rotator cuff and scapular muscles
The doctor or a physical therapist will test your motion and strength before you start weight training
You can start with 3 sets of 15-20 repetitions, high repetition sets ensures that the weights that you are using arent too heavy.
***NEVER perform any weight training exercise to the point of muscle failure
WEIGHT TRAINING cont
The following weight training exercises should be avoided:1. Pull downs behind-the-neck (wide-grip)
2. Behind-the-neck shoulder press
3. Wide-grip bench press
4. Standing lateral deltoid raises
5. Triceps press overhead
Exercises Usually Problem-Free:1. Biceps Curls
2. Cable and bent-over rowing
3. Shoulder shrugs
Phase 4: 12 to 16 weeks after Surgery
-Sport Specific Phase
Goals:1. Gradual initiation of functional activities
2. Progress to normal ROM & strength
3. Progressive use of arm for daily activities
STRETCHING / RANGE OF MOTION Times per day: 1 Days per week: 5-7
-1-2 sets, 15-20 repsPendulum exercises
Standing External Rotation / Doorway
Resisted wrist flexion-extension
Wall slide Stretch
Hands-behind-head stretch
Push-ups
Side lying internal rotation (sleeper stretch)
External rotation at 90 Abduction stretch
STRENGTHENING / THERABAND Times per day: 1 Days per week: 3
Continue exercises from phase 3
External rotation at 90
Internal rotation at 90
Standing Ts
STRENGTHENING / DYNAMICTimes per day: 1 Days per week: 3 ; 2-3sets, 15-20 reps
Continue exercises from phase 3
Prone external rotation at 90 abduction Us
Biceps curls
Resisted forearm supination-pronation
PLYOMETRIC PROGRAM Times per day and days per week: as directed by PT
Rebounder throws with arm at side
Wall dribbles overhead
External rotation at 90& Internal rotation at 90,Standing Ts, Resisted forearm supination-pronation
Rebounder throws with arm at side, Prone external rotation at 90 abduction Us
Phase 5: 16 to 20 weeks after Surgery
-Return to Activity Phase
Goals:1. Progression of functional activities
2. Maintain full ROM & strength
3. Begin sport progressions with clearance
STRETCHING / RANGE OF MOTIONDays per week: 5-7 Times per day: 1
-1 set, 15-20 reps*Continue all exercises from phase 4
https://www.youtube.com/watch?v=doQOyz8cxfk
STRENGTHENING / THERABAND -2-3 sets, 15-20 repsDays per week: 3 Times per day: 1
Continue from phase 4
STRENGTHENING / DYNAMICDays per week: 3 Times per day: 1
*Continue from phase 4
PLYOMETRIC PROGRAM Days per week: 1-2
Rebounder throws with arm at side
Wall dribbles overhead
Rebounder throwing/weighted ball
Deceleration drills with weighted ball
Wall dribbles at 90
Wall dribble circles
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