SLAP Repair

Overview

 

SLAP (Superior Labrum Anterior to Posterior) Injury of shoulder is common in players involved in racquet sports and throwing sports. It is due to the bucket handle tear of the Biceps tendon origin in the shoulder joint. This needs a keyhole surgery to repair. 

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Diagnosis

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​A thorough physical examination of the shoulder is required to check for the rotator cuff muscles and stability. Signs checked for assessing the shoulder for SLAP tear are not very specific to the SLAP tear, however can be helpful.

X-ray. X-ray is performed and is useful to rule out any bone injuries, however, SLAP tear is not visible on the X-ray.

MRI Scan. MRI Scan with contrast is the gold standard investigation to identify the type and extent of the SLAP tear. However, a plain MRI scan is still good enough in picking up these injuries. In addition, it helps to assess the condition of the muscle tendons, rest of the labrum (lip of the socket) and the quality of the biceps tendon.  

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Treatment

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SLAP repair Surgery

 

SLAP repair surgery is a day care surgery. Through arthroscopy (Keyhole), the shoulder joint is assessed and the joint structures are evaluated. Using the probe, the extent of the tear and the quality of the biceps tendon is assessed. In patients with frail biceps tendon, biceps tenotomy (cutting and releasing of the biceps tendon) or biceps tenodesis (reattaching the biceps tendon at a more distal point) procedure may be more appropriate. However, in young patients with intact biceps tendon, the SLAP tear is repaired typically by using one or two suture anchors on the front and back of the biceps tendon attachment.

The suture anchors used are made up of different materials

• PEEK (high grade polymer)

• Biocomposite (becomes bone)

• All Sutures

• Metal (titanium)

 

SLAP Repair Rehabilitation

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Post-surgery, you can expect to be in a broad arm sling supporting your arm. Gentle passive mobilisation is started early, usually on the day 1 or 2. Abduction (moving the arm outwards and upwards is restricted upto 3 weeks). Usually within 2 weeks, active ROM exercises are started. Strengthening exercises typically start post 6 weeks. To achieve full functionality including lifting objects, you can expect it to take around 4 to 6 months.

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