Superior Labral Superior Labral Anterior to Anterior to

Posterior (SLAP) Posterior (SLAP) TearsTears

Thomas J Kovack DOThomas J Kovack DO

Superior Labral Superior Labral Anterior to Anterior to

Posterior (SLAP) Posterior (SLAP) TearsTears

AnatomyAnatomy

Superior LabrumSuperior Labrum Deepens socketDeepens socket Attached to ligamentsAttached to ligaments

Helps stabilize shoulderHelps stabilize shoulder

Long Head of BicepsLong Head of Biceps Attaches to top of labrumAttaches to top of labrum Pull of biceps may “peel off” Pull of biceps may “peel off”

labrumlabrum PitchersPitchers Weightlifters (overhead press)Weightlifters (overhead press) Golfers (club strikes ground)Golfers (club strikes ground)

Types of SLAP TearsTypes of SLAP Tears

Type I Type II Type III Type IV

SLAP with Ganglion CystSLAP with Ganglion Cyst

Labral Tear acts as one way valveLabral Tear acts as one way valve Joint fluid leaks out of jointJoint fluid leaks out of joint Creates Ganglion CystCreates Ganglion Cyst Cyst presses on suprascapular nerveCyst presses on suprascapular nerve Weakness to Shoulder RotationWeakness to Shoulder Rotation

Age Related ChangesAge Related Changes

Natural degeneration of the labrum with Natural degeneration of the labrum with ageage

DiagnosisDiagnosis Clinical Clinical

ExaminationExamination

MRI-ArthrogramMRI-Arthrogram MRI without contrast MRI without contrast

can miss the tearcan miss the tear Accuracy of 90% in Accuracy of 90% in

detecting labral detecting labral tearstears(Bencardino et al., Radioogy (Bencardino et al., Radioogy 2000) 2000)

Non-operative TreatmentNon-operative Treatment

Non-operativeNon-operative Activity ModificationActivity Modification NSAIDsNSAIDs Cortisone InjectionCortisone Injection Physical TherapyPhysical Therapy

Rotator Cuff and Periscapular Muscle Rotator Cuff and Periscapular Muscle StrengtheningStrengthening

Improve stability of shoulder by Improve stability of shoulder by strengthening dynamic stabilizersstrengthening dynamic stabilizers

Operative TreatmentOperative Treatment

Arthroscopic SurgeryArthroscopic Surgery DebridementDebridement Labral RepairLabral Repair

DebridementDebridement

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

RepairRepair Arthroscopic Arthroscopic

SurgerySurgery Anchor the torn Anchor the torn

labrum to the bonelabrum to the bone Using dissolvable Using dissolvable

plastic anchors and plastic anchors and heavy sutureheavy suture

Results of RepairResults of Repair 94% satisfactory results94% satisfactory results 91% return to pre-injury level of 91% return to pre-injury level of

shoulder functionshoulder function Results are less favorable in patients Results are less favorable in patients

who participate in overhead sportswho participate in overhead sports(Kim, JBJS (Kim, JBJS

2002)2002)

Post-operative RehabPost-operative Rehab Self-directedSelf-directed therapy program therapy program Phase I (0-1 month)Phase I (0-1 month)

Sling for ~1 weekSling for ~1 week ADLs immediatelyADLs immediately 1 Week: Active assisted range of 1 Week: Active assisted range of

motionmotion Phase II (2-3 months)Phase II (2-3 months)

Motion as toleratedMotion as tolerated No lifting overheadNo lifting overhead

Phase III (3-6 months)Phase III (3-6 months) Progression to light strengtheningProgression to light strengthening

Phase IV (6+ months)Phase IV (6+ months) Overhead lifting at 6 monthsOverhead lifting at 6 months Begin swimming, serving tennis, Begin swimming, serving tennis,

volleyballvolleyball

ComplicationsComplications

StiffnessStiffness ArthritisArthritis Persistent PainPersistent Pain Implant malposition or failure Implant malposition or failure Rotator Cuff TearRotator Cuff Tear InfectionInfection Nerve InjuryNerve Injury Failure to achieve the desired resultFailure to achieve the desired result