Current treatment options for Type II SLAP tears include non-operative, direct labral-bicep complex repair, and debridement with tenodesis or tenotomy.
What are the treatment options for Type II SLAP tears?
Patients with Type II SLAP tears should first be trialed with non-operative management and many patients will have a successful result with ability to return to their respective sports or activities. Surgical management should be considered if non-operative management does not provide symptomatic relief.
When should SLAP tear repair be performed?
SLAP tears can cause persistent pain and dysfunction in the shoulder and the management of Type II tears remains an evolving process with narrowing indications. Based on the existing literature, Type II tears in young (<40 years of age), athletic or high demand patients should be treated with direct SLAP repair.
What is the prognosis of a type II SLAP tear?
CONCLUSION SLAP tears can cause persistent pain and dysfunction in the shoulder and the management of Type II tears remains an evolving process with narrowing indications. Based on the existing literature, Type II tears in young (<40 years of age), athletic or high demand patients should be treated with direct SLAP repair.
What are the indications for surgery for a SLAP lesion?
Our Indications for Surgery are patients who fail conservative management, patients who have a SLAP lesion with significant rotator cuff tears (>50%), and patients with large associated labral tears who exhibit severe mechanical symptoms. Generally speaking, we debride types I and III SLAP lesions and repair types II and IV.
What is a Type 2 labrum tear?
Type 2: This is the most common SLAP tear type. In Type 2 tears, the labrum and bicep tendon are torn from the shoulder socket. Type 3: Torn labrum tissue is caught in the shoulder joint. Type 4: In this type, the tear that started in your labrum tears your bicep tendon.
What is the slap test?
Pronated Load SLAP Test This test combines the active bicipital contraction of the biceps load test with the passive external rotation in the pronated position, which elongates the biceps. A positive test is indicated by discomfort within the shoulder.
Is a SLAP tear part of the rotator cuff?
Rotator cuff tendon tear causes & symptoms Rotator cuff tears have very similar symptoms to other shoulder injuries, such as SLAP tears and are best diagnosed by an orthopedic specialist. This is a tear that occurs at the front of the upper arm where the biceps tendon connects to the shoulder in the labrum.
What is a SLAP tear?
A SLAP tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint.
How is a SLAP tear repair?
A SLAP repair is a minimally invasive arthroscopic procedure which uses a tiny camera and miniature surgical instruments to repair the damaged area. During the procedure, your surgeon will remove damaged tissue. Then, he or she will suture the torn labrum to a tiny anchor set into the bone.
How is a SLAP tear diagnosed?
What are the symptoms of SLAP tear?dull or aching pain in the shoulder, especially while lifting over the head.a painful feeling of clicking, popping or grinding in the shoulder during movement.difficulty performing normal shoulder movements.pain at the front of the shoulder near the biceps tendon.More items...
Does SLAP tear need surgery?
They often occur as a result of a jarring motion of the arm. Unfortunately, SLAP tears do not heal on their own and usually require surgery to allow them to heal properly.
Can SLAP tear get worse?
Can a SLAP tear get worse if untreated? Yes, if a SLAP tear is left untreated, some common and long-term problems could occur, including: shoulder dislocation or instability, reduced range of motion, chronic pain, and adhesive capsulitis (frozen shoulder).
Will a cortisone shot help a torn shoulder labrum?
SLAP tears are usually treated with rest, anti-inflammatory medications and, in some cases, an in-office cortisone injection. This is followed by gradual stretching of the shoulder, initially with a physical therapist, for six weeks to two months.
How do you treat a labral tear in the shoulder without surgery?
Nonsurgical options such as physical therapy are usually the first treatment method employed in repairing a torn labrum. Physical therapy focuses on strengthening the muscles in the arm while increasing mobility and range of motion in the affected shoulder.
Do shoulder labral tears need surgery?
If the labrum is frayed, usually no treatment is necessary since it doesn't usually cause 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.
How successful is SLAP tear surgery?
Results of Surgery In patients having an arthroscopic SLAP repair using modern suture anchors, more than 90% are found to have good results, and more than 85% are able to return to competitive athletic activities.
What is type 2 slap tear?
Type II SLAP tears predominantly occur in males between their third and fifth decades of life. The mechanism of injury is often repeated overheard activity but can also occur due to direct compression loads and traction injuries. The treatment options have changed over the years and include non-operative therapy, direct labral-biceps complex repair, and labral debridement with biceps tenodesis or tenotomy.
When was the review of the literature conducted on Type II SLAP tears?
A review of the existing literature through October 2017 investigating the management of Type II SLAP tears was performed. Emphasis was placed on distinguishing the outcomes based on age and activity level to provide an appropriate treatment algorithm.
What are the risk factors for a slap repair?
Risk factors for failure of SLAP repair include age, smoking, obesity, female sex, and concomitant bicep pathology [ 31, 38, 69, 70 ]. Katz et al. [ 31] found that once a patient has failed first time repair, 71% will fail conservative therapy and 32% will continue to have suboptimal outcomes after a second surgical intervention. Revision SLAP repair has limited data, but an 11 patient review of six overhead athletes and five workers compensation cases saw only improvement of ASES to 72.5 and return to work and sport of 57.8% and 42.2% respectively [ 74 ]. McCormick et al [ 61 ], however, demonstrated significant improvements in ASES, SANE, and WOSI scores in their retrospective review of bicep tenodesis of 42 patients with failed SLAP repairs, including an 81% return to sports. A smaller civilian cohort of 11 patients saw similar improvements in functional outcome scores (ASES 54.5 to 78; SANE 42.5 to 70.4) and the 3 athletes returned to their sport [ 62 ]. In the cohort published by Boileau et al [ 23] there were 4/10 patients in the repair group who were unsatisfied and underwent revision surgery to bicep tenodesis. All four patients had excellent outcomes and returned to sport. In agreement with previous studies [ 46, 60, 62 ], the senior author believes that bicep tenodesis is a reliable solution to failed SLAP repairs.
Can a superior labrum anterior to posterior tear be isolated?
Superior labrum anterior to posterior tears often do not present in isolation [ 12, 13 ], and as a result patients with concomitant pathology should not only have the additional pathology addressed [ 72 ], but receive a bicep tenodesis. Gupta et al [ 30] retrospectively studied 28 patients with the average age of 43.7 years and concomitant bicep tendonitis and SLAP tear demonstrated significant improvements in ASES, SANE, SST, VAS, and SF-12 scores with excellent satisfaction in 80% of patients. A recent randomized control trial of patients with rotator cuff tears and labral-biceps lesions were broken into three treatment arms: debridement, tenotomy, and tenodesis. There was no difference in the outcome scores across all three groups in terms of range of motion and functional scores [ 33 ]. Franceschi et al [ 27] found patients with a rotator cuff tear in the presence of a SLAP tear who received bicep tenotomy performed better in terms improvement of UCLA scores (10.1 to 32.1) compared to the patients who received SLAP repair (10.4 to 27.9). Another cohort study also demonstrated greater improvement in function in terms of ASES (88.6 versus 80.4) and UCLA scores (29.6 versus 26.0) when patients underwent biceps tenotomy instead of slap repair when the patient had large to massive cuff tears [ 73 ]. In many of these studies the patient cohorts were older than 50 years of age, which could skew outcomes against SLAP repairs, however, we still recommend patients with concomitant pathology be treated with bicep tenodesis or tenotomy unless the patient is a young athlete or high demand patient.
Is Type II SLAP a difficult pathology?
Type II SLAP tears remain a difficult pathology to manage clinically, but the treatment indications are narrowing. The age and activity algorithm described in this review provides an effective method of managing this complex clinical condition.
Can a slap tear cause pain?
SLAP tears can cause persistent pain and dysfunction in the shoulder and the management of Type II tears remains an evolving process with narrowing indications. Based on the existing literature, Type II tears in young (<40 years of age), athletic or high demand patients should be treated with direct SLAP repair. In older patients and worker’s compensation patients, Type II tears should often be treated with bicep tenodesis do to the higher rate of complications and revision/failures of repair in this population. In the cases of revision, bicep tenodesis remains an excellent solution for a difficult clinical scenario.
What is a slap tear?
● SLAP tear refers to a specific injury of the superior portion of the glenoid labrum that extends from anterior to posterior in a curved fashion. These tears are common in overhead throwing athletes and laborers involved in overhead activities. SLAP tears are caused by forceful eccentric traction exerted on the biceps tendon and in throwers by the chronic stress placed on the labrum when the shoulder is forcefully abducted and externally rotated (eg, cocking position of throwing). (See 'Epidemiology, classification, and risk factors' above and 'Anatomy and biomechanics' above.)
How does a slap tear occur?
This can occur when someone falls back onto an outstretched arm, tries to prevent him or herself from falling by grabbing hold of an object, or suddenly tries to lift a heavy object.
What causes a SLAP tear?
Other common mechanisms included traumatic glenohumeral dislocation or repetitive shoulder abduction and external rotation (eg, throwers and other overhead athletes). A direct blow to the shoulder or a fall onto an outstretched hand may also cause a SLAP tear.
What happens when the anterior labrum shows degenerative tearing?
When the biceps tendon has some degree of injury or subluxation or the anterior labrum shows any significant degenerative tearing, the anterior shear forces of the humeral head increase. In addition, constraints against posterior motion of the humeral head are diminished.
Can a slap injury occur without underlying shoulder pathology?
Such mechanisms can cause an acute SLAP injury even in patients without underlying shoulder pathology. Anatomic variations in the structure of the superior labrum and the attachment of the biceps tendon increase the likelihood of SLAP tears in a small number of patients. Many SLAP lesions occur in throwing or overhead athletes.
Can a slap tear be a dislocation?
SLAP tears are typically not associated with acute anterior shoulder dislocations, although they may be present in patients with a history of shoulder dislocation and subsequent instability. Concomitant injury — SLAP tears are frequently accompanied by other shoulder pathology.
Can a bicep tear be seen on ultrasound?
Complete or partial tears of the biceps tendon are easily identified on ultrasound as the tendon is superficial. Maneuvers commonly used to elicit pain from a SLAP tear (eg, Active compression and compression-rotation tests) typically do not cause pain in those with isolated biceps tendon pathology.
Introduction
Pathology involving the superior labrum presents a diagnostic and therapeutic challenge for the arthroscopic surgeon. First described by Andrews and colleagues in 1985, Snyder later classified lesions of the superior labrum into four types and coined the term SLAP tear (superior labral tear anterior–posterior).
Procedure
The disabled throwing shoulder, with a suspected pathologic SLAP lesion, is initially subjected to appropriate rehabilitation. Isolated lesions refractory to nonoperative measures are offered surgical treatment after extensive counseling regarding natural history and expectations.
Can a slap injury cause pain?
Untreated, SLAP lesions can be a potentially devastating injury that can lead to chronic pain, as well as a significant loss of function and performance. The purpose of this article is to review the classification, pathomechanics, clinical evaluation, and treatment of SLAP lesions.
Can a slap tear be concomitant?
Most notably, patients who have SLAP tears can also have concomitant rotator cuff tears and other labral pathology . Andrews et al 1 reported that 45% of patients (and 73% of baseball pitchers) with SLAP lesions also had partial-thickness tears of the supraspinatus portion of the rotator cuff.