1. Superior Labral Anterior to Posterior (SLAP) Tears Thomas J Kovack DO

2. Superior Labral Anterior to Posterior (SLAP) Tears

3. Anatomy Superior Labrum Superior Labrum Deepens socket Deepens socket Attached to ligaments Attached to ligaments Helps stabilize shoulder Helps stabilize shoulder Long Head of Biceps Long Head of Biceps Attaches to top of labrum Attaches to top of labrum Pull of biceps may “peel off” labrum Pull of biceps may “peel off” labrum Pitchers Pitchers Weightlifters (overhead press) Weightlifters (overhead press) Golfers (club strikes ground) Golfers (club strikes ground)

4. Types of SLAP Tears Type IType II Type IIIType IV

5. SLAP with Ganglion Cyst Labral Tear acts as one way valve Labral Tear acts as one way valve Joint fluid leaks out of joint Joint fluid leaks out of joint Creates Ganglion Cyst Creates Ganglion Cyst Cyst presses on suprascapular nerve Cyst presses on suprascapular nerve Weakness to Shoulder Rotation Weakness to Shoulder Rotation

6. Age Related Changes Natural degeneration of the labrum with age Natural degeneration of the labrum with age

7. Diagnosis Clinical Examination Clinical Examination MRI-Arthrogram MRI-Arthrogram MRI without contrast can miss the tear MRI without contrast can miss the tear Accuracy of 90% in detecting labral tears Accuracy of 90% in detecting labral tears (Bencardino et al., Radioogy 2000)

8. Non-operative Treatment Non-operative Non-operative Activity Modification Activity Modification NSAIDs NSAIDs Cortisone Injection Cortisone Injection Physical Therapy Physical Therapy Rotator Cuff and Periscapular Muscle Strengthening Rotator Cuff and Periscapular Muscle Strengthening Improve stability of shoulder by strengthening dynamic stabilizers Improve stability of shoulder by strengthening dynamic stabilizers

9. Operative Treatment Arthroscopic Surgery Arthroscopic Surgery Debridement Debridement Labral Repair Labral Repair

10. Debridement Results At 1-year -- 78% of the patients had excellent pain relief At 2-year -- this number decreased to 63%. 45% of these patients returned to their preinjury level of athletic activity. Cordasco et al, AJSM 1993

11. Repair Arthroscopic Surgery Arthroscopic Surgery Anchor the torn labrum to the bone Anchor the torn labrum to the bone Using dissolvable plastic anchors and heavy suture Using dissolvable plastic anchors and heavy suture

12. Results of Repair Results of Repair 94% satisfactory results 94% satisfactory results 91% return to pre-injury level of shoulder function 91% return to pre-injury level of shoulder function Results are less favorable in patients who participate in overhead sports Results are less favorable in patients who participate in overhead sports (Kim, JBJS 2002)

13. Post-operative Rehab Self-directed therapy program Self-directed therapy program Phase I (0-1 month) Phase I (0-1 month) Sling for ~1 week Sling for ~1 week ADLs immediately ADLs immediately 1 Week: Active assisted range of motion 1 Week: Active assisted range of motion Phase II (2-3 months) Phase II (2-3 months) Motion as tolerated Motion as tolerated No lifting overhead No lifting overhead Phase III (3-6 months) Phase III (3-6 months) Progression to light strengthening Progression to light strengthening Phase IV (6+ months) Phase IV (6+ months) Overhead lifting at 6 months Overhead lifting at 6 months Begin swimming, serving tennis, volleyball Begin swimming, serving tennis, volleyball

14. Complications Stiffness Stiffness Arthritis Arthritis Persistent Pain Persistent Pain Implant malposition or failure Implant malposition or failure Rotator Cuff Tear Rotator Cuff Tear Infection Infection Nerve Injury Nerve Injury Failure to achieve the desired result Failure to achieve the desired result