Shoulder Slap Repair

A “SLAP” tear, which stands for Superior Labrum Anterior and Posterior tear, is a specific type of labrum tear in the shoulder joint. It occurs at the top (superior) portion of the labrum, where the long head of the biceps tendon attaches to the labrum. SLAP tears are commonly associated with repetitive overhead activities, sudden trauma, or degenerative changes in the shoulder joint. 

Symptoms: SLAP tears can cause various symptoms, including shoulder pain, popping or clicking sensations, shoulder weakness, decreased range of motion, and instability. The pain may be felt deep within the shoulder joint and can worsen by overhead movements or lifting objects.

Diagnosis: Diagnosing a SLAP tear involves a combination of patient history, physical examination, and x rays.

Physical tests such as the O’Brien test, Crank test, or Speed’s test may be performed to reproduce symptoms associated with a SLAP tear. Imaging studies such as MRI or magnetic resonance arthrography (MRA) may be used to confirm the diagnosis and assess the severity of the tear.

Treatment: Treatment options for SLAP tears depend on factors such as the severity of symptoms, the patient’s age and activity level, and the specific characteristics of the tear. Non-surgical treatments may include rest, activity modification, physical therapy, anti-inflammatory medications, and corticosteroid injections. However, if these measures fail to relieve symptoms or if the tear is severe, surgical intervention may be needed. Surgical options for SLAP tears include arthroscopic repair, debridement, or biceps tenodesis (relocation or removal of the biceps tendon).

Rehabilitation: Plays an important role in the recovery process following treatment for a SLAP tear. Physical therapy exercises are prescribed to strengthen the shoulder muscles, improve range of motion, and restore shoulder function. The specific rehabilitation program may vary depending on the type of treatment received and the individual patient’s needs.

Prognosis: With appropriate treatment, most patients with SLAP tears can experience significant improvement in symptoms and return to their previous level of function. However, the recovery process may be prolonged, particularly for surgical repair patients.

SLAP tears cause of shoulder pain and mobility issues, particularly in those patients who play sports with repetitive overhead movement that involve throwing or swinging motions.

SLAP repair or reconstruction is a surgical procedure to correct the Superior Labrum Anterior and Posterior (SLAP) tear or lesion in the shoulder. SLAP tears involve the superior portion of the labrum, where the long head of the biceps tendon attaches to the labrum. This type of injury can cause shoulder pain, instability, and functional impairment.

 SLAP repair or reconstruction:

Preoperative Evaluation: Before surgery, the patient undergoes a thorough preoperative evaluation, a physical examination, imaging studies (such as MRI or magnetic resonance arthrography), and a medical history review. Our medical team will assess the severity and extent of the SLAP tear and determine the most appropriate surgical approach.

Anesthesia: SLAP repair or reconstruction is typically performed under general anesthesia, although regional anesthesia (such as a nerve block) may also be used. The anesthesia team monitors the patient’s vital signs throughout the procedure to ensure safety and comfort.

Surgical Approach: Dr. Pournaras will make small incisions around the shoulder to access the torn labrum and surrounding structures. The specific location and number of incisions depend on factors such as the characteristics of the SLAP tear and the surgical technique used.

Labral Repair or Reconstruction: Depending on the severity and characteristics of the SLAP tear, he may perform either a repair or reconstruction of the labrum:

SLAP Repair: In cases where the torn labrum is amenable to repair, Dr. Pournaras will reattach the labrum to the rim of the glenoid using sutures, anchors, or other fixation devices. This restores the integrity and stability of the labrum and helps alleviate symptoms.

SLAP Reconstruction: In severe or irreparable SLAP tears or recurrent tears, Dr. Pournaras may reconstruct the labrum using tissue grafts or synthetic materials. This involves creating a new attachment point for the long head of the biceps tendon and restoring stability to the shoulder joint.

Biceps Tenodesis: In some cases, mainly if the long head of the biceps tendon is involved in the SLAP tear or if there is evidence of biceps tendon pathology, the surgeon may perform a biceps tenodesis. This involves relocating or removing the biceps tendon from its original attachment point and anchoring it to another location on the humerus (upper arm bone).

Closure: After the labral repair or reconstruction is completed, the incisions are closed with sutures or surgical tape, and sterile dressings are applied to the surgical site.

Recovery and Rehabilitation: Following surgery, the patient undergoes a period of postoperative rehabilitation to facilitate healing, restore shoulder function, and optimize outcomes. Physical therapy exercises are prescribed to strengthen the shoulder muscles, improve range of motion, and promote a safe return to activity.

SLAP repair or reconstruction can be effective to restoring stability and function to your shoulder.

Surgical options for treating a SLAP (Superior Labrum Anterior and Posterior) tear involve repairing or reconstructing the damaged labrum in the shoulder joint. The choice of surgical technique depends on factors such as the severity and location of the tear, the patient’s age and activity level, and the presence of any associated injuries. 

Arthroscopic SLAP Repair: Arthroscopic SLAP repair is the most common surgical technique for treating SLAP tears. It is a minimally invasive procedure performed using a tiny camera called an arthroscope and specialized instruments inserted through tiny incisions around the shoulder joint. During the procedure, the torn labrum is reattached to the rim of the glenoid (shoulder socket) using sutures, anchors, or other fixation devices. Arthroscopic SLAP repair offers advantages such as smaller incisions, less tissue trauma, reduced postoperative pain, and faster recovery compared to open surgery.

SLAP Reconstruction: In cases where the SLAP tear is severe, irreparable, or involves significant tissue loss, SLAP reconstruction may be performed. This involves creating a new attachment point for the long head of the biceps tendon and reconstructing the labrum using tissue grafts or synthetic materials. SLAP reconstruction may be necessary when the torn labrum cannot be adequately repaired using traditional techniques or when there is a need to restore stability to the shoulder joint.

Biceps Tenodesis: Biceps tenodesis is a surgical procedure that involves relocating or removing the long head of the biceps tendon from its original attachment point on the labrum. This procedure may be performed in conjunction with SLAP repair or reconstruction, particularly if the biceps tendon is involved in the tear or if there is evidence of biceps tendon pathology. Biceps tenodesis can help alleviate pain and prevent recurrence of SLAP tears by eliminating tension on the biceps tendon and stabilizing the shoulder joint.

Capsular Plication: In some cases, Dr. Pournaras may also perform a capsular plication procedure to tighten or plicate the loose or stretched capsule (the fibrous tissue that surrounds the shoulder joint) to further stabilize the joint and prevent recurrent instability. Capsular plication may be performed in conjunction with SLAP repair or reconstruction to optimize outcomes and reduce the risk of re-injury.