Arthroscopic SLAP repair for superior labral lesions
SLAP lesions — superior labral tears, front to back — are common injuries among athletes and some non-athletes. They can cause a painful shoulder and a significant loss of power when throwing a ball or in overhead motions such as a tennis serve or volley.
Reviewed February 21, 2015, by Dr. Seneviratne
Symptoms
A SLAP lesion can occur through trauma — a fall or a traction injury — or through repetitive use, as in throwing athletes such as pitchers.
Why it happens
The labrum is a soft-tissue structure that runs around the rim of the shoulder socket (the glenoid) like a rubber O-ring, deepening the socket and providing stability. The long head of the biceps tendon attaches to the upper part of the labrum, and traction on it can tear the labrum off the bone at the top of the socket. Thinking of the socket as a clock face, a SLAP lesion is a tear of the labrum from roughly 10 o'clock to 2 o'clock. The second mechanism is repetitive trauma causing the labrum to tear.
How it is diagnosed
Diagnosis begins with a detailed history and a thorough physical examination. X-rays are the most important initial study. An MRI allows the soft-tissue damage to be seen directly.
Treatment
Older patients can be treated non-operatively with a sling for a few weeks followed by physical therapy. Ongoing pain may warrant surgery.
There are several ways to treat SLAP lesions; the technique Dr. Seneviratne uses most often is arthroscopic. Arthroscopic SLAP repair is generally reserved for patients under the age of 36. Older patients are usually treated with biceps tenodesis instead, where the long head of the biceps is released from the labrum and transferred to the upper humerus through a small incision. The operation chosen is personalised to each patient.
Recovery
SLAP repair and biceps tenodesis are both outpatient ambulatory procedures. Pain afterwards is not usually severe, and most patients manage with Tylenol after a few days on narcotic pain medication. A sling is worn for about three weeks and physical therapy starts one week after surgery. Early healing occurs at six weeks; full healing takes six months to a year. Most professional athletes take a year to return to their sport, while recreational athletes can return at around six months. Return to play is guided by Dr. Seneviratne.
Common questions
What is the most common problem after SLAP repair?
Shoulder stiffness and loss of range of motion. It is more common in patients older than 36, though younger patients can develop it too. Dr. Seneviratne assesses the risk factors that predict stiffness and chooses the operation accordingly. Other issues are failure to heal and persistent pain, both uncommon where patients are selected carefully and repair technique is meticulous.
Can I get arthritis if I do not address my SLAP lesion?
The answer is not known with certainty, but it is more likely than in a patient without a SLAP lesion. SLAP lesions cause micro-instability of the shoulder, which can damage the articular cartilage and lead to arthritis later. Repairing a SLAP lesion will not necessarily prevent arthritis — repair is performed to relieve pain and restore power to a throwing arm.
What are the risks of SLAP repair or biceps tenodesis?
Infection, bleeding, damage to nerves and blood vessels, recurrent dislocation and shoulder stiffness — all uncommon.
Will I have hardware in my shoulder?
A SLAP repair uses tiny suture anchors drilled into the rim of the socket, usually suture material, which patients do not feel. Biceps tenodesis uses a small non-metallic screw or a small metallic button.
How soon after surgery can I drive?
Usually 6 weeks, though as early as 3 weeks.
How soon can I return to work?
About 1–2 days depending on the occupation, though a week off is recommended.
How soon can I shower?
In 48 hours.
How soon can I fly?
About 1 week. Arrange an aisle seat, have someone else handle your bags, and do ankle pumps every 15 minutes in flight, as DVT is a real concern; aspirin is also advised unless your own physician says otherwise.
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