The shoulder is a highly mobile joint, susceptible to injury. Understanding specific injuries and their treatments is important for those experiencing shoulder pain. A common shoulder ailment involves the labrum, a specialized cartilage. This article explores a particular type of shoulder injury, a SLAP tear, and its surgical repair.
Deciphering SLAP
SLAP is an acronym for Superior Labrum Anterior to Posterior. This describes a tear in the upper part of the shoulder’s labrum, extending from the front to the back. The shoulder is a ball-and-socket joint, where the upper arm bone (humerus) fits into a shallow socket on the shoulder blade (scapula). This shallow socket is deepened by the labrum, a rim of tough, flexible fibrocartilage that encircles the glenoid, providing stability and cushioning for the joint. The labrum also serves as an attachment point for the biceps tendon.
A SLAP tear affects the superior labrum, often involving the attachment site of the long head of the biceps tendon. These tears can vary in severity, ranging from minor fraying to a complete detachment from the shoulder socket. Common causes of SLAP tears include acute trauma, such as falling onto an outstretched hand, a direct blow to the shoulder, or a sudden, forceful lifting motion. Repetitive overhead activities, common in athletes like baseball players, swimmers, or weightlifters, can also lead to these injuries due to chronic stress.
Individuals with a SLAP tear often experience symptoms. A persistent dull ache or sharp pain deep within the shoulder is common, particularly when lifting the arm overhead or stretching it behind the head. Other indicators include a painful clicking, popping, or grinding sensation during shoulder movement. Patients might also report a feeling of instability, weakness, or a decreased range of motion in the affected shoulder.
The Surgical Intervention
When non-surgical treatments like rest, anti-inflammatory medications, and physical therapy do not adequately resolve symptoms, a SLAP repair may be considered. This surgical procedure reattaches the torn labrum to the bone, aiming to restore the shoulder’s stability and function. The procedure is typically performed arthroscopically, a minimally invasive approach. This involves small incisions, usually two to four, through which a surgeon inserts an arthroscope (a thin camera) and miniature surgical instruments into the shoulder joint.
During arthroscopic SLAP repair, the surgeon evaluates the labral damage. The torn labrum is prepared for reattachment, sometimes involving the removal of damaged tissue or scar tissue. Small holes are then drilled into the shoulder socket bone near the tear.
Suture anchors, often absorbable, are placed into these drilled holes, and strong sutures are passed through the torn labrum. The labrum is then tied to the bone using these sutures. The number of anchors used, typically two to three, depends on the tear’s specific characteristics.
Post-Surgical Journey
Following a SLAP repair, patients typically go home the same day, though assistance is needed for the initial 24 hours. The immediate post-operative period involves managing pain and discomfort with medication and ice packs. The arm is usually placed in a sling or immobilizer for four to six weeks to protect the healing repair and restrict movement. Sling use and movement restrictions are specific to each patient.
Physical therapy and rehabilitation are crucial for recovery, often beginning within one to two weeks after surgery. The rehabilitation program is structured in phases, with initial goals focusing on protecting the repair, controlling pain and swelling, and gradually restoring passive range of motion. As healing progresses, active range of motion exercises are introduced, followed by strengthening exercises for shoulder muscles and the rotator cuff, usually around 6 to 10 weeks post-surgery.
Overall recovery time varies significantly, influenced by tear severity, adherence to rehabilitation, and patient activity level. While functional movement may be achieved within 8 to 10 weeks, and many return to daily activities within 3 to 4 months, a full return to recreational activities or sports can take 6 to 12 months. Consistent participation in rehabilitation is important for optimal outcomes.