Surgical Explanations
Rehabilitation Protocols
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SLAP (Labrum) Tears
A SLAP tear is an injury to a part of the shoulder joint called the labrum. The shoulder joint is a shallow joint, and thus inherently unstable. A cuff of cartilage, called a labrum, forms a cup on the glenoid (shoulder joint) where the end of the arm bone (humerus) forms a joint. This cup of tissue (labrum) stabilizes the bone within the joint and also allows free movement of the arm.
SLAP tears occur at the site where the tendon of the biceps muscle inserts onto the labrum at the glenoid (shoulder joint). This particular area of the labrum where the tear occurs is susceptible to injury because it is an area of poor blood supply. Tears can occur elsewhere on the labrum but because of better blood supply, they heal more easily.
SLAP tears are repaired through an outpatient arthroscopic procedure. Arthroscopy is a surgical procedure used to visualize, diagnose, and treat problems within a joint. During an arthroscopic examination, Dr. Bryan makes a very small incision in the skin and then inserts a pencil-sized probe that has a camera and light at the end. The camera and light enlarge and illuminate the structures inside the joint and allow Dr. Bryan to view the interior of your joint on a monitor in the operating room.
Once Dr. Bryan has assessed the labrum tear, he proceeds forward to fixate the torn labrum back onto the glenoid with specialized anchors. The labrum is captured with a loop of suture. The suture is secured through a puchlock anchor and the anchor is then fixated into the bone of the glenoid. The labrum is now re-approximated onto the edge of the glenoid in its normal position. The close proximity of the labrum to the glenoid will allow the body to once again attach the labrum to the bone. This reattachment takes many weeks and movement of the arm will be restricted during this time to facilitate healing.
The shoulder will be extremely painful for several days to weeks following the surgery. You may find that remaining in a semi-sittting position, even while sleeping, is the best option. You will be in a large sling upon waking from surgery. This sling is for comfort. You may take your arm out of the sling and straighten your elbow and move your wrist. You may even move your arm in small circles or pendulum type exercises. You will find that sleeping with the sling is most comfortable for 1-2 weeks following surgery. You will also want to wear your sling whenever you are out in public to protect the shoulder. You will do only very basic exercises for 1 month following surgery. Physical therapy will begin approximately 4-6 weeks following surgery. Recovery from a SLAP repair is intense and time consuming and can take upwards to 9 months. The length of recovery depends on many factors, including the size of the tear, date of injury to the shoulder, and patient motivation for rehabilitation. |
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