SLAP Repair

SLAP is an acronymto Superior Lubrum Anterior Posterior, which is a type of labral tear that occurs in the shoulder at the point where the biceps muscle tendon inserts on the labrum. SLAPtear stretches from the anterior (front) to the posterior (back) of the glenoid. This injury is associated with the extreme shallowness of the shoulder joint socket which makes it inherently unstable(Field& Savoie,1993, p. 787).The tear is classified as 1, 2, 3, or 4 respective to the extent of the tear and biceps tendon involvement. It is important to note that the common type of SLAP tear is type 2 and that,although type 3 and 4 are more involved, the number defining the type does not correspond to the severity of injury.

There are several possible causes of SLAP tear but can generally be classified into chronic repetitive injuries or acute traumatic events that results to failure. An acute traumatic event may be for instance, a fall onto an outstretched arm resulting in slap lesion due to abnormal contact between the biceps anchor and the humeral head. On the other hand, one of the common chronic repetitive injuries causing SLAP tear is overhead actions(Beltran, Bencardino, &Mellado,1997, p. 1409). For instance, baseball pitchers over stresses the shoulder and consequently the biceps tendon attachment that can cause SLAP tear. With a SLAP tear, one experiences pain, popping or clicking in the shoulder, and a decreased range in shoulder motion. The condition is worst if one involves the shoulder in overhead activities like throwing. It is though difficult to point out the symptoms in cases where the biceps tendon is not involved in the tear(Resnick,1997, p. 216).

Anyone experiencing pain and disability after falling onto a shoulder should plan to see a physician soonest. Additionally, sportspeople who experience persistent shoulder disability and pain despite rest and anti-inflammatory medication should see a physician immediately. This is due to the fact that many patients do not experience the classical signs of shoulder clicking or popping but only pain in the shoulder when they have SLAP tear (Beltran, Bencardino, &Mellado,1997, p. 1410). Moreover, one is likely to have the pain when using the shoulder in particular in throwing activities. In diagnosing, a physician seeks a thorough history prior to any physical test to determine possibilities of a SLAP. The effectiveness of the various examination tests for SLAP varies from one patient to another. Physicians carryoutadvanced imaging test like MRI to help define the SLAP lesion althoughsometimes the MRI does not give any reliable information. In such cases, the physician does the diagnosis during surgery if highly suspicious of the tear.

Radiographs and X-rays occasionally taken by doctors purposes to assess the borne structure hence not useful in the diagnosis(Field& Savoie,1993, p. 785).In case these treatments fail, clinicians recommend arthroscopic surgery of the shoulder. Here, physicians keep in mind that SLAP tear may not be the only problems hence expect other shoulder pathology. Therefore, surgical procedures adopted should address all the pathologies that the clinician may encounter. Generally, there are three surgical SLAP tear options, whichinclude debridement where the torn labral tissue is shaved to leave a smooth edge.The second option is repair where anchors with sutures attached are used to secure the labrum down to the socket, and third, biceps tenodesis, which is a procedure, that detaches the biceps tendon from where it is initially attached to labrum then attaching it elsewhere.(Coleman, Cohen, &Drakos, 2007, p. 750). Repair is the best option for young people who ought to remain physically active whereasbiceps tenodesis best for on patients above 40 years of age or those with extensive biceps tendonitis/tearing

On completion of the diagnostic arthroscopy, the SLAP tear is identified and any unstable tissue shaved. The superior aspect of the glenoid is shaved to cause minor bleeding hence encourage healing. A sature anchor is positioned here whose satures firmly hold down the labrum back to its anatomic location(Resnick,1997, p. 201). This process may be repeated severally depending on extend of the tear.SLAP repair is beneficial in that it restores the original anatomy of the biceps anchor complex. Consequently, once the slap tear heals, the repaired labrum and biceps attachment function normally as it was before the tear. This method is important for young people who intend to participate in sports later in life. Simple debridement or biceps tenodesis have an advantage that postoperative recovery is fast and is not restrictive.

Rehabilitation steps after a SLAP repair are determined by type and extend of the SLAP lesion as well as other damages that were present. Most patients remain in a sling and minimum activity for up to six weeks after a SLAP repair (Coleman, Cohen, &Drakos, 2007, p. 752). To prevent shoulder stiffness, passive motion is allowed during this first rehabilitation phase. At the sixth week, a physical therapy program commerce that focuses on restoring range of motion particularly the shoulder strength. One can resume full athletics activity participation after 3 to 4 months or up to 6 months for contact and non-contact sports respectively(Resnick,1997, p. 218). In case one is suspicious of a SLAP tear, it is recommendable to seek urgent consultationfrom a local sports injuries doctor for the appropriate care and follow advice given.

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