Rehabilitation Guidelines For SLAP Lesion Repair The anatomic configuration of the shoulder joint (glenohumeral joint) isoftencomparedtoagolfballon a tee. This is because the articular surface of the round humeral head is approximately four times greater than that of the relatively flat shoulder blade face (glenoid
Glenoid cavity
The glenoid cavity or glenoid fossa of scapula is a part of the shoulder. It is a shallow, pyriform articular surface, which is located on the lateral angle of the scapula. It is directed laterally and forward and articulates with the head of the humerus; it is broader below than above and its vertical diameter is the longest.
Full Answer
What is the rehabilitation process for SLAP lesions?
rehabilitation guidelines For SLap Lesion repair 3 PHASE I (Surgery to 4-6 weeks after surgery) Appointments • Rehabilitation appointments begin within 7 days of surgery, continue 1-2 times per week Rehabilitation Goals • Protection of the post-surgical shoulder
What is a Type 3 SLAP lesion on the labrum?
Due to the complexity of shoulder pathomechanics in the overhead athlete, injuries located in the superior aspect of the glenoid, known as superior labral anterior to posterior (SLAP) lesions, are often a surgical and rehabilitation challenge. In an effort to determine surgical versus conservative care of SLAP lesions a thorough clinical examination and evaluation are necessary.
What is a SLAP lesion of the glenoid?
Oct 03, 2016 · The surgical repair of a type IV SLAP lesion with either a biceps repair, biceps resection of frayed area, or tenodesis/tenotomy follows much the same postoperative rehabilitation course as that outlined for a type II lesion, in that the ROM and exercise activities are progressed similarly.
What does slap mean in medical terms?
Most controversies concern patients with SLAP II lesions, whose therapy is either fixation of the superior labrum or tenotomy/tenodesis of the long head of the biceps tendon. For patients with SLAP III or IV lesions the most commonly accepted approach is tenotomy or tenodesis of the long head of biceps tendon.
Which tendon is most responsible for SLAP lesions of the labrum?
Type II SLAP Tear The labrum and the long head of the biceps tendon (LHBT) are torn and avulses off the glenoid cavity.Feb 12, 2022
What structure does a SLAP lesion affect?
In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.
What structures attach to the labrum?
The capsule of the glenohumeral joint attaches to the glenoid labrum....The glenoid labrum is continuous with:superiorly: tendon of the long head of biceps brachii.anteriorly:anterior band of the inferior glenohumeral ligament.middle: glenohumeral ligament (variably)
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 causes SLAP lesion?
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.
How do SLAP lesions occur?
A SLAP lesion is mainly caused by a fall on an outstretched arm where there is an important superior compression on the labrum which causes a tear of the labrum. A typical symptom is intermittent pain that also occurs in overhead movements.
Is a SLAP tear the same as a labrum tear?
Superior Labrum, Anterior to Posterior tears (SLAP tears), also known as labrum tears, represent 4% to 8% of all shoulder injuries. The L in SLAP refers to your glenoid labrum. Your labrum plays two important roles in keeping your shoulder functioning and pain free.Jan 12, 2022
What is the gold standard operative treatment for Slap 2 tears?
Despite advances in imaging techniques, the gold standard for the diagnosis of a SLAP tear is arthroscopy. of most shoulder injuries. corticosteroids can be diagnostic and occasionally therapeutic. maintaining a full range of motion and strengthening the rota- tor cuff and scapula stabilizers.Apr 9, 2010
Does a type 2 SLAP tear require surgery?
Type 2 SLAP Tear In this situation, the labrum and bicep tendon do detach from the glenoid and result in a dislocated shoulder. This can occur either to the anterior or posterior sides. In most cases, Type 2 is treated by Dr. Fuchs with arthroscopic surgery.Jan 6, 2020
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
What are the 4 types of SLAP lesions?
SLAP LesionSLAP ClassificationTypeDescriptionILabral and biceps fraying, anchor intact (11% of cases)IILabral fraying with detached biceps tendon anchor (41% of cases)IIIBucket handle tear, intact biceps tendon anchor (33% of cases) (Biceps separates from bucket handle tear)7 more rows•Jun 4, 2021
How do you rehab a torn labrum without surgery?
Surgery is often recommended to repair a torn labrum. However, exercise can also be a very effective treatment option. Non-operative management includes non-steroidal anti-inflammatory drugs and steroid injections to decrease pain and inflammation.Apr 14, 2020
What causes a slap lesion?
The following causes have been found: repetitive throwing, hyperextension, a fall on an outstretched arm, heavy lifting, direct trauma.
What is the association between a slap and a medial sheath?
According to William F.B., SLAP lesions had an association of 43% with the medial sheath lesion. the author postulates that forces that affect the biceps anchor may also damage the pulley system of the bicipital sheath and, as such, this anatomic structure should be evaluated, especially when SLAP lesions are present.
What is a slap tear?
A SLAP tear or SLAP lesion is an injury to the glenoid labrum ( fibrocartilaginous rim attached around the margin of the glenoid cavity). Tears of the superior labrum near to the origin of the long head of biceps were first described among throwing athletes by Andrews in 1985.
What age is the superior labrum less attached to the glenoid?
From the average age of 35 , the superior labrum is less firmly attached to the glenoid than in people under the age of 30. In the age category 30 to 50, there are more chances of tears/defects in the superior and anterior-superior regions of the labrum (noted in cadavers).
Why is it so difficult to detect a slap?
Clinical examination to detect SLAP lesions is an extremely challenging procedure because the condition is frequently associated with other shoulder pathologies in patients presenting this type of condition. As with most shoulder conditions, the history including the exact mechanism of injury should be documented.
How many joints are there in the shoulder?
The shoulder is made up of five joints; the Acromioclavicular Joint, the Sternoclavicular Joint, the Glenohumeral Joint, Scapulothoracic Joint and Suprahumeral Joint and four linked bone groups; the clavicula, sternum, Scapula and the humerus which are related and work together.
Which is larger, the humeral head or the fossa?
But the humeral head is larger than the fossa and so the socket covers only a quarter of the humeral head. A circumflexial rim of fibrocartilaginous tissue called labrum glenoidalis firmly attaches to the glenoid fossa thereby increasing the articular surface area and the stabilisation of the glenohumeral joint.
What is SLAP in surgery?
Background: The surgical treatment of a Superior Labrum Anterior and Posterior (SLAP) lesion becomes more and more frequent as the surgical techniques, the implants and the postoperative rehabilitation of the patient are improved and provide in most cases an excellent outcome.
Is there a standard for slap lesions?
Objective: However, a standard therapy of SLAP lesions in the shoulder surgery has not been established yet. An algorithm on how to treat SLAP lesions according to their type and data on the factors that influence the surgical outcome is essential for the everyday clinical practice.
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 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 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.
What is a slap lesion?
A SLAP lesion is an uncommon shoulder pathology, affecting primarily athletes involved in an overhead sport. Baseball pitchers seem to be the most vulnerable group due to the unique forces they place on the biceps-labral complex in the act of pitching. The purpose of part one of this Rehabilitation Masterclass on SLAP lesions was to present the relevant anatomy and pathomechanics of the shoulder in relation to SLAP lesions, and how a SLAP lesion is most often diagnosed. Part two will discuss in detail the surgical management of a SLAP lesion, and in particular how it is rehabilitated in the event of shoulder surgery to repair the biceps anchor.
How to detect a slap lesion?
Some authors believe that the only definitive way to detect a SLAP lesion is through arthroscopy and argue that imaging modalities will miss many of the subtle SLAP lesions as false negatives 43. MRI, particularly MR arthrography (MRA), is the gold standard imaging method to detect SLAP tears 44. This is because the intra-articular injected contrast medium distends the joint capsule, outlines intraarticular structures and leaks into tears 45 46. This in turn means a clearer delineation of the anatomic structures and SLAP lesions from anatomic variations like sublabral recess or sublabral foramen. A sublabral recess or superior sulcus is a normal variant that is present in more than 70% of individuals. In this variation, the base of superior labrum is not attached to the superior glenoid and in some cases, this recess can be up to 1.4 centimeters deep 47.
What degree of abduction is a load test?
Similar to the biceps load test, this test is performed with the patient in supine and the shoulder at 90 degrees of shoulder abduction, with 65-70 degrees of elbow flexion and the forearm in neutral position. The examiner resists against a maximal supination effort while passively externally rotating the shoulder.
What are the passive and active restraints of the glenohumeral joint?
The gleno-humeral joint (GHJ) relies on both passive and active restraints to create joint stability. The passive restraints consist of the capsule-ligamentous structures, the glenoid labrum and negative intra-articular pressure. Dynamic restraints include rotator cuff muscles, periscapular muscles and the long head of the biceps muscle 3, which attaches to the superior margin of the labrum and glenoid rim.
Why do I have a slap tear in my shoulder?
It has been recognised that acute SLAP tears are a relatively uncommon cause of shoulder pain and dysfunction in athletes taking part in overhead activities such as tennis players, volleyball/waterpolo players baseball pitchers 18 19 20. While injury may occur in a one-off traumatic event such as dislocated shoulder (where the humeral head impacts against the superior labrum and biceps anchor and creates a tear or a severe traction type force to the biceps muscle), the majority are caused by repetitive wear and tear.
What are the symptoms of a slap injury?
The clinical diagnosis of a SLAP lesion can be an extremely challenging endeavour to the sports clinician because there are no unique clinical findings associated with this type of pathology. Also the condition is frequently associated with other shoulder problems such as impingement, rotator cuff tears, degenerative joint disease and other soft tissue-related injuries 32. However , some common ( but non-specific) features do exist 33. These include: 1 Dull, throbbing, ache in the joint. 2 Difficulty sleeping due to shoulder discomfort. The SLAP lesion decreases the stability of the joint which (when combined with lying in bed) causes the shoulder to drop. 3 A catching feeling during throwing and pitching. Throwing athletes may also complain of a loss of strength or significant decreased velocity in throwing.
What is a type IV tear?
Type III represents a bucket-handle tear of the labrum with an intact biceps anchor. Finally, type IV represents a bucket handle tear of the labrum that extends into the biceps tendon. (From Dodson and Altchek 2009)
Definition/Description
Clinically Relevant Anatomy
- The shoulder complex is one of the most sophisticated areas of the body. The shoulder is made up of five joints; the Acromioclavicular Joint, the Sternoclavicular Joint, the Glenohumeral Joint, Scapulothoracic Joint and Suprahumeral Joint and four linked bone groups; the clavicula, sternum, Scapula and the humerus which are related and work together. The major joint is the Gl…
Epidemiology/Aetiology
- The age of the patient has an impact on the superior labrum. From the average age of 35, the superior labrum is less firmly attached to the glenoid than in people under the age of 30. In the age category 30 to 50, there are more chances of tears/defects in the superior and anterior-superior regions of the labrum (noted in cadavers). In the age category 60 years or older, circum…
Clinical Presentation
- The most common complaint in patients that present with SLAP lesions is pain. Pain is typically intermittent and often associated with overhead movements.Isolated SLAP lesions are uncommon.The majority of patients with SLAP lesions will also complain of: 1. sensations of painful clicking and/or popping with shoulder movement 2. loss of glenohumeral internal rotatio…
Differential Diagnosis
- The glenoid labrum is often involved in shoulder pathology. Sometimes morphological varieties can be confused with pathological aspects and therefore diagnosis should be established following careful analysis of the case history and a physical examination.There are two regions where anatomic variants can appear: the superior region, where it’s mostly related to age, and th…
Diagnostic Procedures
- SLAP lesions are difficult to diagnose as they are very similar to those of instability and rotator cuff disorders. At first the clinician can test the tenderness to palpation at the rotator interval which can be helpful in the diagnostic procedure. The rotator interval is an anatomic space between the Supraspinatus tendon, the Subscapularis tendon and the processus coracoideus. T…
Outcome Measures
- Rowe Score (version of 1988): 1. consists of 5 domains: 1. pain 2. stability 3. function 4. motion 5. muscle strength 1. Scoring: < or = 49 = poor 50 - 69 =fair 70 - 84 = good 85 - 100 = excellent Oxford Instability Shoulder Score (OISS): 1. 12-item questionnaire measuring: 1. daily activities 2. pain 1. The total score ranges from 12 to 60 (12 indicates the best possible function). 2. A link t…
Examination
- Clinical examination to detect SLAP lesions is an extremely challenging procedure because the condition is frequently associated with other shoulder pathologies in patients presenting this type of condition. As with most shoulder conditions, the history including the exact mechanism of injury should be documented. It is important to keep in mind that while labral pathologies are fre…
Medical Management
- The surgical intervention depends on the type of labral lesion, but an advanced arthroscopic technique is most commonly used. Studies of surgical labral repairs show that they are generally good to excellent to allow the patient to return to a pre-injury level of function. Knowing the type of SLAP lesion is important for post-operative rehabilitation. 1. Type I: are treated with debridemen…
Physical Therapy Management
- Until now only one study looked at results from physical management on SLAP lesion. The study was a one year follow-up study of with 19 patients. It compared good shoulder function with the shoulder function of patient that followed successful conservative management in the form of scapular stabilization exercises and posterior capsular stretching. However, the study acknowle…