Return to activity requires both time and clinical evaluation. To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Functional evaluation including strength and range of motion testing is one method of evaluating a patient’s readiness to return to activity. Return to intense activities following a SLAP repair requires both a strenuous strengthening and range of motion program along with a period of time to allow for tissue healing. Symptoms such as pain, swelling, or instability should be closely monitored by the patient.
What is the rehabilitation process for SLAP lesions?
SLAP lesion (Superior Labral Anterior to Posterior tear). These injuries can also occur from trauma, such as falling on your arm, bracing your arm in an accident, arm tackling in football or any large sudden force applied to the arm. There are four basic types of SLAP tears.3 A Type II SLAP tear is the most common type of SLAP tear requiring surgical
What are the indications for surgery for a SLAP lesion?
evaluating a patient’s readiness to return to activity. Return to intense activities following a SLAP repair requires both a strenuous strengthening and range of motion program along with a period of time to allow for tissue healing. Symptoms such as pain, swelling, or instability should be closely monitored by the patient.
What is the treatment for a SLAP tear?
Sling for 4 weeks during day and at night NO active ER, extension or elevation NO isolated activation of biceps NO jogging, running, jumping NO long head bicep tension for 6 weeks to protect repaired tissues- avoid long lever arm with shoulder flexion NO resisted supination or resisted elbow flexion NO early pendulums
What are the treatment options for SLAP lesions on the shoulder?
Feb 01, 2009 · A comprehensive approach involving a thorough history and physical examination, adequate imaging, and ultimately diagnostic arthroscopy is often necessary to recognize and appropriately treat SLAP lesions.
How do you rehab a SLAP tear?
A tear in the upper portion of the labrum where the biceps tendon attaches is known as a SLAP tear. SLAP stands for superior, labral, anterior to, posterior....Physical Therapy for a SLAP Tear.TimePhysical Therapy and RecoveryConservative treatment· RICE (rest, ice, compress, and elevate) your knee · Physical therapy – strengthening & flexibility4 more rows•Jan 19, 2021
What can you not do after a SLAP repair?
Do not attempt to actively move your arm at the shoulder joint for any reason until your doctor allows you. You may remove your sling several times a day and gently move your hand, wrist and elbow and perform shoulder pendulum exercises. Your surgeon will prescribe pain medicine for you after the operation.
What exercises can I do with a SLAP tear?
0:192:11Workouts for a Shoulder With a Labral Tear : Exercise & Workout TipsYouTubeStart of suggested clipEnd of suggested clipAnd it's just working without resistance just your body weight and doing circles letting that ballMoreAnd it's just working without resistance just your body weight and doing circles letting that ball and socket really get back to the range of motion teaching the shoulder how to function again.
When do you start rehab after labrum surgery?
Your physical therapy will begin 3-4 days after surgery. The physical therapist will guide you in your shoulder rehabilitation program. It is very important for you to start therapy when recommended.
Which exercise is contraindicated 6 weeks post SLAP repair?
Active Assisted ROM and Isometrics initiated at 4 weeks. Active ROM initiated at 6 weeks, per physician. Strengthening initiated at 10 weeks (except with Type IV- biceps involved), per physician. Aggressive strengthening of the biceps (elbow flexion or supination) is avoided for 12 weeks.
When can you run after SLAP repair?
Athletes can usually begin doing sports-specific exercises after twelve weeks, although it will be about six months before the shoulder is fully healed.
Can you rehab a torn shoulder labrum?
A labral tear can occur from a fall or from repetitive work activities or sports that require you to use your arms raised above your head. Some labral tears can be managed with physical therapy; in severe cases, surgery may be required to repair the torn labrum.Dec 1, 2016
How do you rehab a slap tear 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.Sep 10, 2020
Can I lift weights with a labrum tear?
It is generally safe to return to heavier weight training at three months following shoulder labral repair. Before embarking on a weight training program, you should have a full range of shoulder motion and normal strength in the rotator cuff and scapular muscles. Dr.
Can you bench press with a SLAP tear?
The typical symptoms are pain at the top of the shoulder, clicking and pain with overhead activities. These may be confused with AC Joint problems , but athletes with SLAP tears have pain with eccentric biceps loading (such as going down in a bench press).Jan 19, 2022
What can you not do after shoulder labrum surgery?
You may not soak in a bathtub or go swimming until your sutures have been removed and your incisions are well healed. You should remove your sling/immobilizer to shower, but if you had a repair, you must keep your arm at your side. It may be helpful to sleep in a recliner initially after your surgery.
How long is physical therapy after shoulder labrum surgery?
Although the amount of time required for recovery varies, you may need Physical Therapy treatments for about four to six weeks. Most patients are able to get back to their activities with full use of their arm within this amount of time.
How long can you use biceps for a biceps anchor?
No resisted biceps activity (elbow flexion and forearm supination) is allowed for the first 2 months to protect the healing of the biceps anchor. After 4 months, a sport-directed throwing program is initiated in overhead athletes, and contact sports are generally allowed after 6 months.
What are the mechanisms of injury?
The most commonly cited mechanisms of injury include traction and compression of the shoulder; although, in many instances, no antecedent trauma is remembered. Overhead athletes may complain of pain during a specific phase of throwing, most notably the late cocking phase.
Why is the forearm pronated?
The forearm is kept in a fully pronated position to increase tension on the biceps tendon , and the patient is instructed to perform an isometric biceps contraction to simulate the peel-back mechanism ( FIGURE 5 ). The authors have found this maneuver to cause pain and discomfort in patients with SLAP lesions.
Is labral involvement a negative test?
The authors also point out that a test is considered negative when the pain is localized to the acromioclavicular (AC) joint.
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.
What is a SLAP tear?
SLAP stands for "superior labrum from anterior to posterior." This type of shoulder labral tear occurs at the top (“superior”) of the glenoid labrum where it connects to the biceps tendon, and it extends in a curve from the chest (“anterior”) to the back (“posterior”).
What causes a SLAP tear?
SLAP tears can be caused by falling onto an outstretched hand, quickly lifting a heavy object or from a forceful, overhead arm motion during sports or work activity. More often, however, they result from repetitive stress on the shoulder which, over time, wears down the shoulder labrum.
What are the symptoms of SLAP tear?
SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. Common symptoms of a SLAP tear include:
How is SLAP tear diagnosed?
Diagnosing a SLAP tear is challenging, especially since they often occur in conjunction with other injuries to soft tissues of the shoulder and upper arm. A sports medicine physician will review your medical history, symptoms and the circumstances under which your injury occurred.
How is a SLAP tear treated?
SLAP tears may be treated nonsurgically or surgically, depending on the patient’s individual condition. Conservative, nonsurgical treatments including rest and physical therapy are usually tried first, except in severe cases.
How successful is SLAP tear surgery?
SLAP repair in athletes who perform frequent overarm movements have shown mixed results. This surgery is more successful in patients under age 40, but remains the treatment of choice for high-level overhead athletes. Older patients are more likely to have better outcomes from biceps tenodesis or tenotomy.
What is the recovery time for SLAP tear surgery?
While the surgery is typically done arthroscopically as an outpatient (meaning patients go home the same day), the recovery is the hard part. Most patients are in a sling for six weeks then get more aggressive in physical therapy to work on stretching and strengthening.
How to repair a SLAP lesion?
The basic SLAP lesion repair is as follows: First, the glenoid and labrum are roughened to increase the contact surface region and produce a blood clot which will benefit re-growth. Next, the locations of bone-anchors are chosen according to the size of the labral/SLAP lesions.
How to heal a slap injury?
The individual should be cautious and perform only low weight and low velocity movements, excluding swimming and throwing movements. The injured athlete can begin to push and regain full active flexion, abduction and rotation movements to improve their range of motion by carefully mobilizing the shoulder into full internal rotation hand behind back positions. Additionally, active posterior cuff stretches, such as the sleeper stretch and the hand behind back stretches can also help improve the range of motion within the shoulder. It’s important to avoid excessive pressure when performing the following stretches to prevent further injury. Rotator cuff, scapular and gym strengthening exercises are frequently used at this stage to rehabilitate SLAP lesions after surgery has taken place. Rotator cuff strengthening workouts should involve flexion and abduction positions while using external rotations sparingly as to not tighten the posterior cuff further and restrict mobility in the shoulder. For scapular strengthening, a variety of push-ups may be practiced: standing against the wall push-ups; against the wall push-ups with forward body lean; knees on floor push-ups; and full push-up position. Serratus anterior slide drills may follow as long as these are within the limits of shoulder pain. The closed kinetic chain with hands on the wall exercise is often used in both scapular retraction and scapular protraction positions together with the Thera band around the clock drill to also add scapular strength. Once the athlete begins to use gym strengthening exercises to rehabilitate from their post-surgery SLAP lesions, these should first, only include light horizontal pulling movements, such as the wide row, prone fly and seated row, together with controlled triceps extensions. The following weeks, exercises should include, light horizontal push movements, such as floor dumbbell press, with light dumbbell bicep curls, then, the individual should begin practicing light vertical pulling, such as pulldowns and close grip pulldowns while avoiding chin ups, and finally, the individual should progress to vertical push movements, such as front and side raises and hammer press drills, to ultimately achieve a proper rehabilitation of SLAP lesions at this phase. At stage 4 of the rehabilitation process for SLAP lesions, the individual can begin running while avoiding aggressive arm actions, they can practice aerobic interval running, or they can participate on cycling and rowing training with no limits. Swimming and boxing should be ultimately avoided at this stage.
What is the first step in a sling rehabilitation?
Stage 1 rehabilitation may include active elbow extension movements, passive elbow flexions with no biceps contractions, passive flexions and external/internal rotations within the above limits. During the first 3 weeks, there should be no direct exercises but walking and biking with the sling on are allowed.
How to do thera tubing?
The athlete can perform this exercise by placing some Thera tubing around the wrist, following by placing the hands on the wall in front of the chest. Protract the scapula and then move and touch the right hand into the 1-3-5 o’clock positions, then place the left hand into the 11-9-7 o’clock positions. Now retract the scapula and repeat the sequence.
What type of surgery is needed for a slap?
Types of Surgery for SLAP Lesions. Minor type-1 SLAP lesions may only require a simple debridement without disrupting the biceps anchor, whereas type-2 SLAP lesions are the most commonly seen type by many healthcare providers, involving a detachment of the biceps anchor from the labrum.
How to perform throwers release drill?
To perform this specific exercise, the individual should first place a square of foam or Dura disc on the wall at about shoulder height, then place the elbow against the wall and rotate the body around so that the arm and scapula are in line.
How many stages of shoulder peel back?
Keeping the above guidelines in mind, the general rehabilitation plan can be completed over six stages.
Why does a slap lesion take so long to heal?
As with other similar soft-tissue injuries, it can take a long time to heal because the blood supply to the superior portion of the labrum is poor compared to other tissues. The SLAP lesion often presents with a sudden onset injury accompanied by a popping or snapping sensation.
What does SLAP mean in medical terms?
The term SLAP is an acronym for Superior Labrum Anterior Posterior, indicat ing a tear in the superior portion of the labrum that goes in an anterior to posterior direction (Figure 2).
What is the function of the labrum?
The primary function of the labrum is too deepen the socket for the glenohumeral joint and therefore provide greater stability. Figure 1: The glenoid labrum and biceps tendon attachment. The labrum also has attachment to numerous soft tissues around the shoulder joint.
What is the glenoid fossa?
Anatomical Background. The glenoid fossa is a very shallow depression on the scapula. In order to increase stability at the glenohumeral joint the fossa is surrounded by a rim of cartilage called the glenoid labrum (Figure 1).
What causes a slap in the arm?
SLAP lesions often occur with sudden traction of the arm or forceful contraction of the biceps. Rotator cuff tears that disturb glenohumeral mechanics are also a likely cause. Another common cause of SLAP lesions is falling on an outstretched hand (also called a FOOSH injury).
Where does the tendon attach to the biceps?
The tendon from the long head of the biceps brachii also attaches to the superior portion of the labrum and that is the region affected in this particular condition. Most anatomy texts list the supraglenoid tubercle as the attachment site for the long head of the biceps brachii.
What is a patented version of active engagement techniques?
Active Release is a patented version of active engagement techniques which have been used in sports massage for decades. Graston is another patented version of a common soft-tissue treatment called Gua Sha, which is a traditional Chinese medicine treatment with a very long history.
