SLAP Repair
The shoulder joint comprises the upper arm bone, shoulder blade, and collarbone, forming a ball and socket structure where the upper arm bone’s head fits into the shoulder socket, known as the glenoid cavity. Surrounding the outer edge of the glenoid is a robust fibrous tissue known as the labrum.
A superior labrum anterior and posterior tear, or SLAP tear, represents an injury to the labrum that may also involve the biceps tendon attached to its top portion. This injury often results from repetitive shoulder use during activities like throwing or from a fall onto the shoulder. Treatment for a SLAP tear typically involves an arthroscopic surgical procedure known as SLAP repair.
Indication
Indications for SLAP repair arise when conservative treatments such as NSAIDs (non-steroidal anti-inflammatory medications) and Physical Therapy fail to alleviate SLAP tear symptoms.
Procedure
SLAP repair is a minimally invasive surgery employing an arthroscope, a tube equipped with a light and camera projecting images onto a monitor for the surgeon’s visualization inside the joint. The specific SLAP repair method depends on the tear type and is determined during the surgical procedure under general anesthesia and nerve block.
During the procedure, small incisions are made to introduce the arthroscope and thin surgical instruments into the shoulder joint. The surgeon identifies the SLAP tear type and removes the damaged labrum tissue. Subsequently, a small hole is drilled near the labral tear, into which the surgeon places an anchor along with a sturdy suture. Additional anchors may be inserted as needed to secure the torn labrum to the shoulder socket bone, ultimately tying the labrum to the bone with sutures.
Post-Operative Care
Following the procedure, the arm is immobilized in a sling for three weeks to stabilize the shoulder joint, with restricted shoulder motion advised for approximately six weeks. Pain medications and ice packs are recommended to manage swelling and discomfort. The plaster strips covering the wounds must remain dry until healing occurs. Physical therapy aids in gradually restoring motion and strengthening the shoulder, with resumption of sports activities subject to consultation with the physical therapist and surgeon. Driving should be avoided for a few weeks post-surgery.
Advantages
Advantages of SLAP repair include restoring the labrum to its normal anatomical position, thereby reinstating shoulder anatomy and function.
Risks and complications
Potential risks and complications of SLAP repair, like any surgical procedure, include infection, excessive bleeding, blood clots, shoulder stiffness, and injury to nerves or blood vessels.
Labral Repair
The shoulder joint functions as a “ball and socket” joint, facilitating smooth arm movements. However, its inherent instability stems from the shallow socket. To deepen the socket and enhance stability, a soft rim of cartilage known as the labrum lines it, aiding in accommodating the head of the upper arm bone.
Injuries resulting from trauma or shoulder overuse activities like throwing or weightlifting can lead to labral tears. Additionally, the aging process may weaken the labrum, making it susceptible to injury. Symptoms of a shoulder labral tear may include pain, sensations of catching or locking, reduced range of motion, and joint instability.
Initially, conservative approaches are typically employed by doctors, such as prescribing anti-inflammatory medications and recommending rest to alleviate symptoms until diagnostic scans are performed. Rehabilitation exercises aimed at strengthening rotator cuff muscles may also be advised. If symptoms persist despite these measures, arthroscopic surgery may be recommended.
During arthroscopic surgery, the surgeon assesses the labrum and the biceps tendon. If the damage is limited to the labrum without involving the tendon, the torn labral flap is excised. In cases where the tendon is affected or if detachment is observed, absorbable wires or sutures are utilized to repair and reattach the tendon. Following surgery, a shoulder sling is provided for 3-4 weeks to support the shoulder. Motion and flexibility exercises are then recommended once the sling is removed, aiming to enhance shoulder joint range of motion and flexibility.