Arthroscopic SLAP Repair
A SLAP tear is an injury to the rim of cartilage that encircles the shoulder socket (known as the labrum). The term SLAP stands for "Superior Labrum Anterior and Posterior." A SLAP tear, therefore, occurs both in front (anterior) and back (posterior) of the labrum. This portion of the labrum is especially important as it serves as the attachment point of the biceps tendon.
What is Your Shoulder Labrum?
The labrum is a cup-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder. The shoulder joint is composed of the glenoid (the shallow shoulder "socket") and the head of the upper arm bone known as the humerus (the "ball").
The labrum is the attachment site for the shoulder ligaments and supports the ball-and-socket joint as well as the rotator cuff tendons and muscles. It contributes to shoulder stability and, when torn, can lead to partial or complete shoulder dislocation.
Symptoms of Labrum Tear
The most common symptoms of a torn shoulder labrum are: shoulder pain, instability and, in some cases, a feeling of grinding, locking or catching while moving the shoulder. These symptoms may vary depending on the type of labral tear a person has.
Types of Labral Tears
The two most common types of labral injuries are the SLAP tear tear and Bankart tear. Both types of tears are usually accompanied by aching pain and difficulty performing normal shoulder movements.
SLAP tears
SLAP stands for "superior labrum from anterior to posterior." This type of tear occurs at the front of the upper arm where the biceps tendon connects to the shoulder. Superior Labrum, Anterior to Posterior tears (SLAP tears), also known as labrum tears, represent 4% to 8% of all shoulder injuries.
The L in SLAP refers to your glenoid labrum. Your labrum plays two important roles in keeping your shoulder functioning and pain free. First, your labrum is a cushion for the top part of your upper arm bone. This cushion helps your upper arm bone stay where it belongs – cradled in your shoulder socket. Second, your labrum is a connection point between your shoulder blade socket and one of your bicep tendons.
The S in SLAP refers to the top of your labrum. When this part of your labrum tears, your upper arm bone loses its cushion and your bicep tendon loses its connection to your shoulder blade socket. As a result, your shoulder hurts and feels unstable.
There are several ways to tear your labrum. SLAP tears are common injuries for people who play sports. Your labrum can be torn by an injury or simply over time as you age.
Bankart tears
Bankart tears typically occur in younger patients during a shoulder dislocation. When the shoulder joint ball slips out of the socket, the joint capsule (fibrous tissues that surround and protect the joint) can pull on the lower portion of the labrum and tear it. This in turn creates instability because the breached labrum makes it easier for the shoulder to dislocate again. A dislocation where the head of the humerus shifts toward the front of the body, it leads to what is called "anterior instability." When the ball slips toward the back of the body, it leads to "posterior instability."
With Bankart tears, patients may feel apprehension that the shoulder may slip out of place or dislocate in certain positions.
Treatment Options
Treatment for a shoulder labrum tear depends upon which kind of tear there is in the labrum. Tears that are due to instability of the shoulder, either subluxation or dislocations, require that the labrum be reattached to the rim of the socket. This can be done with an incision on the front of the shoulder, or it can be done with arthroscopic techniques through smaller incisions. There are advantages and disadvantages of each approach. At this institution we favor an open operation with an incision until arthroscopic techniques become more perfected.
If the labrum is frayed, may not require treatment if the patient does not experience symptoms. However, if there is a large tear of the labrum, the torn part should either be cut out and trimmed, or it should be repaired. Which treatment is used depends on the location and size of the tear.
Tears of the labrum near the biceps tendon attachment (SLAP lesions) may be trimmed or possibly need reattachment to the top of the socket. The best way to achieve this result is with arthroscopic surgery since this area is difficult to reach with an open operation through a large incision. Utilizing the arthroscope and small incisions for other instruments, the labrum can be reattached to the rim of the socket using either sutures or tacks.
Description of Surgery
At Aptiva Health, a SLAP repairs are performed arthroscopically. Arthroscopic surgery is utilized because it is minimally invasive and effective in restoring the labrum back to its position at the rim of the shoulder socket. The torn superior labrum is mobilised from scar tissue. The exposed upper glenoid bone is prepared to optimize healing using a rasp or a burr and your superior labrum is reattached to bone using suture anchors. If the damage extends into the biceps tendon, additional surgery may be needed.
Recovery
Following surgery, you will wear a shoulder immobilizer sling for six weeks. Typically, you can remove bulky padded dressings the day after surgery, but keep your wound dry and covered with your waterproof dressings for 12 days. Typically, you can shower after four days with waterproof dressings on.
Active participation in post-operative rehabilitation with your Aptiva Health physical therapy team is crucial to having a successful outcome from your rotator cuff repair. According to Dr. Eads, “physical therapy is likely the biggest part of postoperative SLAP repairs.” Your physical therapy team will start by introducing passive motion to the shoulder. They will carefully move your arm for you to ensure the recovering muscles and tendons are not under excessive strain. When you are ready, your physical therapy team will slowly progress to active motion, which means your therapy team will instruct you how to move your arm. Finally, you will begin to work on strengthening the shoulder with resistance exercises. While you will have regularly scheduled physical therapy appointments, your therapy team will likely give you daily at-home exercises to complete to ensure optimal recovery. Rotator cuff tear rehabilitation will usually last four to six months following surgery.
Patients vary in their symptoms after surgery, but in general you can expect to return to:
Office work after two weeks or so (in a sling)
Light physical work after twelve weeks
Heavier labor may take 5-6 months
Contact or overhead sport usually takes six months
Driving is allowed once you are confident and competent to control a car both for routine and emergency maneuvers. It typically takes about eight weeks for you to be ready for driving following surgery.