Transcript Superior Labral Tears

Superior Labral Anterior
to Posterior (SLAP) Tears
Thomas J Kovack DO
Superior Labral Anterior
to Posterior (SLAP) Tears
Anatomy
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Superior Labrum
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Deepens socket
Attached to ligaments
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Helps stabilize shoulder
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Long Head of Biceps
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Attaches to top of labrum
Pull of biceps may “peel off ” labrum
 Pitchers
 Weightlifters (overhead press)
 Golfers (club strikes ground)
Types of SLAP Tears
Type I
Type II
Type III
Type IV
SLAP with Ganglion Cyst
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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
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Age Related Changes
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Natural degeneration of the labrum with age
Diagnosis
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Clinical Examination
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MRI-Arthrogram
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MRI without contrast can
miss the tear
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Accuracy of 90% in
detecting labral tears
(Bencardino et al., Radioogy 2000)
Non-operative Treatment
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Non-operative
Activity Modification
 NSAIDs
 Cortisone Injection
 Physical Therapy
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Rotator Cuff and Periscapular Muscle Strengthening
 Improve stability of shoulder by strengthening dynamic
stabilizers
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Operative Treatment
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Arthroscopic Surgery
Debridement
 Labral Repair
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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
Repair
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Arthroscopic Surgery
Anchor the torn labrum to
the bone
 Using dissolvable plastic
anchors and heavy suture
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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
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(Kim, JBJS 2002)
Post-operative Rehab
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Self-directed therapy program
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Phase I (0-1 month)
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Phase II (2-3 months)
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Motion as tolerated
No lifting overhead
Phase III (3-6 months)
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Sling for ~1 week
ADLs immediately
1 Week: Active assisted range of motion
Progression to light strengthening
Phase IV (6+ months)
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Overhead lifting at 6 months
Begin swimming, serving tennis, volleyball
Complications
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Stiffness
Arthritis
Persistent Pain
Implant malposition or failure
Rotator Cuff Tear
Infection
Nerve Injury
Failure to achieve the desired result