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SLAP Tear Notes

SLAP Lesion

What is the labrum? Fibrous ring attached to the rim of the glenoid
Labrum Functions Expands size & depth of glenoid Increases sup/inf diameter 75% & ant/post diameter 50% Primary attachment of capsule & GH ligs Sup. aspect attachment site for LHB (where tear typically occurs)
LHB Tendon Blends with superior labrum Inserts into supraglenoid tubercle of scapula
Labrum Attachment Meniscoid & has free edge extending over rim of glenoid onto articular surface May naturally be loose LHB tendon important for anterior stability Some biceps loading is good for joint stability
Bankart Lesion Dislocation anterior-inferior & tear anterior-inferior labrum
Causes of SLAP Biceps contracting eccentrically to decelerate extending elbow during follow-thru of throw Disruption of sup labrum-LHB complex involving tearing/separating sup labrum starting post to biceps tendon & extending anteriorly
Classic description of labral tear patient Shoulder pain with throwing activities & palpable clicking Labral tears rarely seen w/o presence of instability
SLAP MOI Forceful abd, ext, & ER Post. damage with force applied to humerus in direction of longitudinal axis with shoulder in 90 deg fwd flex Superior labrum with biceps tendon/traction or fall on outstretched, abd & fwd flexed arm
SLAP S/sx Pain- greater with OH activity; "catching & popping" Strength > RTC injury but painful with resistance Pt. population of SLAP younger than RTC, OH athlete
SLAP Tests- what should you put together? Combine 2 sensitive tests with 1 specific test 70% sensitive & 95% specific
What are 3 sensitive tests for SLAP? O'Brien Apprehension Compression Rotation
What are 3 specific tests for SLAP? Speed's Yergason's Biceps load II
Type I SLAP Lesion SLAP degenerated Marked fraying with degenerative appearance Periphery attached Biceps firmly attached
Type 2 SLAP Lesion Degenerated & fraying Sup. labrum & biceps tendon stripped off glenoid Labral-biceps anchor unstable & pulled off glenoid Most common SLAP tear Posterior 3x more common in throwers Anterior 3x more common in traumatic injuries
Type 3 SLAP Lesion Bucket Handle tear Central (Superior) portion displaced into joint while periphery firmly attached to glenoid
Type 4 SLAP Lesion Bucket handle tear with extension into biceps Labral flap tends to displace into joint
What is seen as a result of tight posterior-inferior shoulder capsule? Hyper ER Hyper horizontal abd Dropped elbow Premature trunk rotation *All classic derangements of pitching mechanics*
SLAP Lesions in Throwers Anterosuperior type 2 Posterosuperior type 2 COmbined anterior & posterior type 2 SLAP lesion Posteiror & combined type 2 SLAP are frequently observed in OH athlete & have unique dx & tx challenges separating them from anterosuperior type 2
Peel-Back Mechanism When a torsional force "peels back" the biceps & posterior labrum as the shoulder goes into extreme abd & ER during cocking phase of throwing LHB force shifts vertically & posteriorly (abd/ER) If initiated, peel back will repeat each time
Peel-Back Mechanism Once it occurs, it causes progressive failure over time, with gradual enlargement of lesion Arm brought into abd/ER, LHB assumes vertical/posterior angle Angle produces twist at base of biceps, transmits torsional force to post/sup labrum
Clinical Implications of Peel-Back Mechanism Has to be neutralized to surgically repair posterior SLAP lesion Requires at least 1 suture anchor stabilizing labrum posterior to biceps to effectively counter torsion Avoid PROM past 0 Wait 3 wks before allowing ER >0
Treatment of Type 1 Tear Torn & frayed debrided back to intact labrum Careful preservation of attachment of labrum & biceps tendon to glenoid More common than type 3 or 4
Treatment of Type 2 Tear Attention to torn labrum/LHP but also re-attachment of biceps anchro to superior glenoid neck Superor glenoid neck abraded to promote healing of detached labrum Creates a bleeding bond surface
Treatment of Type 3 Tear Excision of bucket handle
Treatment of Type 4 Tear Excision of bucket-handle, with resection continuing into the split portion of the biceps tendon Sometimes the split in the biceps tendon & the labrum can be repaired with sutures
Type 1 Post-Op Treatment ROM as tolerated, no restrictions Protect biceps 7-10 days Return to sport in 2-4 wks
Type 2 Post-Op Treatment Sling x4 weeks Full ROM by 6 wks Avoid biceps resistance x10-12 wks, no ER past neutral x4 wks, 40 deg x6 wks Interval throwing @4 months Throw from mound @6 months Full-velocity from mound @7 months Be sure to stretch post. capsule!
GIRD Loss of GH IR of dominant shoulder compared to non-dominant Those with GIRD >20 deg or >10% total rotation in non-dominant shoulder may be at risk for SLAP lesions
Posterior Capsule Contracture in posteroinferior quadrant of capsule in zone of posterior band of IGHL complex Stretch capsulotomy pt more aggressively so capsule doesn't scar back down
Moseley Core Scapular Exercises Press-Ups from seated Rows Scapular Protraction/Push Up (+) Elevation in Scapular Plane
Type 3 Post-Op Treatment ROM similar to type 1 but a couple weeks slower Protection same as type 1 Return to activity 2-4 wks
Type 4 Post-Op Treatment Sling x3 wks, full ROM at 6 weeks Avoid biceps resistance x6 weeks if tenodesis or 10 wks if repaired Return to sport at 8-10 wks with excision & tenodesis Return to throwing at 3-4 months
Created by: 1190550002