SLAP Tear Repair

SLAP tears can arise from both trauma and chronic overhead activities. Common mechanisms of injury include falling onto an outstretched hand with a tensed biceps or falling directly onto the shoulder. Additionally, SLAP tears can occur after shoulder dislocations, often alongside other labral injuries. Chronic or repetitive overhead activities, such as those in sports or work, exert forceful rotational movements on the shoulder. This can lead to traction on the Long Head of Biceps (LHB) Tendon, creating stress on the biceps anchor—a region encompassing the attachment of the long head of biceps to the top of the glenoid and the surrounding upper labrum. Over time, this repetitive stress can cause the superior labrum to detach from the upper part of the glenoid, resulting in a SLAP tear. Athletes engaged in overhead sports, such as baseball pitchers and tennis players, are particularly susceptible to SLAP injuries. These tears can also be associated with shoulder instability, articular-sided rotator cuff tears, internal impingement, glenohumeral internal rotation deficit (GIRD), and scapular dyskinesia. Muscular imbalances in the shoulder joint can disturb biomechanics, placing tension on the superior labrum and predisposing it to peeling off or tearing from the top surface of the glenoid.

SLAP tears are typically diagnosed through a combination of patient history, symptoms, and clinical examination, with confirmation often achieved via MRI scan of the affected shoulder. MRI provides detailed assessment of the SLAP tear, additional labral injuries, status of the rotator cuff, long head of the biceps, and surrounding bones and joints. Patients with SLAP tears may report experiencing a popping sensation during injury or overhead activities, along with deep shoulder joint pain and difficulty with overhead or throwing motions. Pain is often exacerbated when the arm is held across the chest and rotated. During examination, clicking or popping sounds may be noted, especially in overhead positions. Additionally, patients may exhibit reduced internal rotation of the affected shoulder and muscle wasting due to suprascapular neuropathy. If lower labral injury is present in these patients, they may display signs of apprehension when the shoulder is stressed, expressing a feeling that the shoulder is on the verge of dislocating.

SLAP tears are classified based on the nature of the tear: Type I: Characterized by fraying of the labrum without true detachment. This is commonly seen as a degenerative condition in middle-aged or elderly patients. Type II: Involves traumatic detachment of the biceps anchor. Type III: Presents as a longitudinal mid-substance tear of the superior labrum, forming a bucket-handle tear. Type IV: Represents a mid-substance tear of the superior labrum that extends into the substance of the biceps tendon. Type V: Involves a mid-substance tear that extends anteriorly into a Bankart lesion (according to the Mallet classification).

Treatment options for recurrent instability vary depending on the nature of the instability. Painkillers and anti-inflammatory medications can be utilized on an as-needed basis to manage discomfort, while adjustments to activities are recommended until pain diminishes. Physiotherapy exercises are designed to enhance core strength, optimize shoulder blade positioning, and bolster rotator cuff strength, aiming to fortify shoulder stability and alleviate pain. If conservative treatments fail, surgical intervention may be necessary. Arthroscopic SLAP repair involves several techniques, such as suture anchor insertion, labrum preparation, and suture knot tying. Depending on the condition of the biceps tendon, additional procedures like Biceps Tenodesis or tenotomy may be performed to address specific issues.

Following surgery for repair of SLAP tears, patients undergo a structured recovery process. Pain management is prioritized, with patients advised to use painkillers as needed due to the potentially heightened discomfort associated with SLAP repairs. A shoulder sling is provided for 4 to 6 weeks to support the shoulder during the initial healing phase, while regular ice packing helps reduce swelling and discomfort. Wound care is meticulous to prevent complications, with portal wound sites kept dry and the armpit area maintained clean and dry to prevent blister formation. Pendulum exercises are initiated immediately after surgery and continued for 4 weeks, followed by a gradual introduction of active and active-assisted range of motion exercises to restore shoulder mobility. Activity restrictions are imposed for 6 weeks to prevent strain on healing tissues, particularly avoiding overhead activities and excessive external rotation. After this period, shoulder strengthening exercises are gradually introduced to rebuild muscle strength and stability. By the end of 3 to 4 months, most patients experience improved shoulder strength and mobility, enabling them to commence sports-specific training. Full active, unrestricted activities are typically permitted after 4 to 6 months of recovery, marking a significant milestone in the rehabilitation process.

SLAP repair surgery carries the following potential risks and complications: Wound infection Swelling around the shoulder Excessive bleeding and bruising around the shoulder Formation of blood clots Shoulder stiffness Injury to nerves or blood vessels Damage to the articular surfaces of the humeral head (ball) or the glenoid (socket) Hardware failure and pull-out of the suture anchors