WHAT IS A SLAP Tear?

Thanks to http://www.orthspec.com for the info below.  

What is a SLAP tear?

A SLAP tear is a cause of shoulder pain. The labrum is a

cartilage ring which surround the shoulder socket (Figure 1).

The biceps tendon, which come from the muscle on your arm,

goes through the shoulder joint and attaches to the top of the

labrum. A SLAP (Superior Labrum Anterior Posterior) tear

occurs when there is damage to the labrum where the biceps

tendon attaches  

How does a SLAP tear occur?

Many times, a SLAP tear occurs from repetitive trauma in

overhead throwers, such as baseball or volleyball players. It

can also occur from a traction injury to the arm, such as lifting a

heavy object off of the ground.

How do I know I have a SLAP tear?

Many patients with a SLAP tear have pain in the front of the

shoulder or deep inside the joint. There also may be a feeling

of catching or grinding in the joint. The examination in the

office usually confirms the presence of a SLAP tear.

Do I need x-rays, MRI’s or any other test?

A set of x-rays is usually ordered to make sure there are no

fractures (broken bone) in the shoulder. An MRI can

sometimes be helpful to confirm the tear of the labrum or

biceps tendon, and evaluate for other shoulder problems. In

some cases, a special MRI called a MRI arthrogram is

performed. This requires an injection into the shoulder joint,

and can be better to evaluate a tear of the cartilage ring, the

labrum, in the shoulder. An MRI is not necessary in all cases.

Is there other damage to the shoulder in cases of SLAP

tears?

There can be other damage to the labrum (where the shoulder

ligaments attach) seen with SLAP tears, usually in cases of

shoulder instability. The biceps tendon itself can also be frayed

or torn. Rarely, there is also a rotator cuff tear.

What are the treatment options for SLAP tears?

The treatment primarily depends on your activity level and

symptoms. Since SLAP tears can be difficult to diagnose, they

are often first treated with physical therapy. The therapy is

designed to restore range of motion and strength to the

shoulder.  In cases of persistent pain and disability, surgery is

recommended.

How are SLAP tears treated with surgery?

SLAP tears are repaired with arthroscopic techniques

(Figure 2). The arthroscope is a small fiber optic instrument

that is placed into the joint through a small incision. A camera

is attached to the arthroscope and the image is viewed on a TV

monitor. The arthroscope allows a complete evaluation the

entire shoulder joint, including the ligaments, the rotator cuff,

and the cartilage surface. Small instruments ranging from 3-5

millimeters in size are inserted through additional small

incisions so that any injury can be diagnosed, and damaged

tissue can be repaired reconstructed or removed.

In SLAP tears, the damaged labrum and biceps tendon are

identified and then repaired back to the socket. This is

usually performed by using suture anchors (a small rivet with

sutures attached) to sew the labrum back in place (Figure 3).

The anchor is usually bioabsorbable, meaning the body

absorbs the anchor over time.  Sometimes a metal anchor is

used, which does not need to be removed. Occasionally, the

biceps tendon is too damaged to repair. In this case, the tendon

is cut and reattached in the upper arm (biceps tenodesis). This

requires a small incision. If the tendon needs to be cut, there is

no loss of strength that occurs.

What are some of the possible complications?

Possible complications include stiffness of the shoulder after

surgery or continued or recurrent pain. The use of arthroscopic

techniques attempts to limit these complications. Other

complications include an infection, bleeding, nerve damage, or

problems with the anesthesia.

What kind of anesthesia is used?

A combination of general anesthesia and regional anesthesia

is used for most surgeries. Before the surgery, the

anesthesiologist will inject numbing medicine around the

nerves of the shoulder. This numbs the arm and helps to control

your pain after surgery. In addition, you go to sleep (general

anesthesia) to help keep you comfortable during surgery.

What do I need to do to prepare for surgery?

Our staff will help to set up the surgery through your

insurance company and will instruct you on any paperwork

that may be necessary.  Prior to your surgery, you may be asked to get several

medical tests, done on an outpatient basis. Some patients need

some minor blood tests and a urinalysis. If you are over age

50, you may require an EKG and chest x-ray. Some

patients may also need to see an internist or their family doctor

to obtain clearance for surgery.

The night before the surgery, a member of our staff will

contact you about what time to arrive for surgery. You may

not eat or drink anything after midnight the night before your

surgery.

How long will I be in the hospital?

Almost all patients are able to have surgery and go home the

same day. Occasionally, patients will be admitted for an

overnight stay.

What happens the day of surgery?

The day before surgery you will be told what time to report

to the hospital. You will be admitted and taken to a preoperative

holding are where you are prepared for surgery.

You will be asked several times which shoulder is being

operated on, and the surgical site will be initialed. Please

note that you are asked this question many times on

purpose.

After the operation, you will be taken to the recovery room

to be monitored. Once the effects of anesthesia have worn off

and your pain is under good control, you will be taken to

another area where you can see your family and finish

recovering. You will be given all of your post-operative

instructions and pain medication before leaving.

Please be aware that the process of getting checked in,

prepared for surgery, undergoing the operation, and recovering

from anesthesia takes the majority of the day. We would

recommend that you and your family members bring along

some reading material to make the process easier for you.

How should I care for my shoulder after surgery?

Prior to your discharge, you will be given specific instructions

on how to care for your shoulder. In general, you can expect

the following:

Diet:

Resume your regular diet as soon as tolerated. It is best to

start with clear liquids before advancing to solid food.

Medication:

You will be given a prescription for pain medication.

Bandage:

You will have a thick dressing on the shoulder. You will be

instructed on when it can be removed, usually in 3 days.

Showering:

You may shower after your dressing is removed, after 2 –3

days. You cannot take a bath until the wounds are completely

sealed, usually 2 –3 weeks after surgery.

Sling:

You will have a sling, which you will use for 4 weeks. You

can remove it for grooming and physical therapy.

Ice: You may receive an ice machine that continually surrounds

your shoulder with cold water. If not, you may apply ice over

the dressings for 30 minutes every hour for several days. Do

not use heat.

Suture removal:

Your stitches will be removed at your office visit 7-10 days

after surgery. Ocassionally, sutures are used which absorb and

do not need to be removed.

Follow-up office visit:

You will be instructed on when to follow-up in the office.

This is usually 7-10 days after surgery.

Exercise:

You will be instructed on exercises you can do immediately

after surgery. You will start physical therapy within 1 to 2

weeks after surgery.

Return to work or school:

You can return to school or work within 3 –5 days without

using the affected arm. If you need the use of the arm to return,

you may be out of work or school for a longer period of time.

What will rehabilitation involve?

The rehabilitation is based on several goals: 1) allowing the

tissue to heal; 2) regaining motion; 3) regaining strength; and

4) return to sports. The rehabilitation protocol for the physical

therapist is attached for you to review.

When can I return to sports?

In general, you will be allowed to return to sports in 6

months after surgery. You must have good motion, strength,

and control of your shoulder and arm. How quickly you return

to sports depends on several factors, including: 1) your own

rate of healing; 2) the damage found at surgery; 3) if you have

any complications; 4) how well you follow the post-operative

instructions; 5) how hard you work in rehabilitation.

What is the success rate?

Overall, the success rate for SLAP repair ranges from 85 to

95%. The goal is to achieve a shoulder with no pain for

throwing or overhead activity.