Superior Labral Anterior
to Posterior (SLAP) Tears
Thomas J Kovack DO
Superior Labral Anterior
to Posterior (SLAP) Tears
Anatomy

Superior Labrum

Deepens socket
Attached to ligaments

Helps stabilize shoulder


Long Head of Biceps


Attaches to top of labrum
Pull of biceps may “peel off ” labrum
 Pitchers
 Weightlifters (overhead press)
 Golfers (club strikes ground)
Types of SLAP Tears
Type I
Type II
Type III
Type IV
SLAP with Ganglion Cyst

Labral Tear acts as one way valve
Joint fluid leaks out of joint
 Creates Ganglion Cyst
 Cyst presses on suprascapular nerve
 Weakness to Shoulder Rotation

Age Related Changes

Natural degeneration of the labrum with age
Diagnosis

Clinical Examination

MRI-Arthrogram

MRI without contrast can
miss the tear

Accuracy of 90% in
detecting labral tears
(Bencardino et al., Radioogy 2000)
Non-operative Treatment

Non-operative
Activity Modification
 NSAIDs
 Cortisone Injection
 Physical Therapy

Rotator Cuff and Periscapular Muscle Strengthening
 Improve stability of shoulder by strengthening dynamic
stabilizers

Operative Treatment

Arthroscopic Surgery
Debridement
 Labral Repair

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
Repair

Arthroscopic Surgery
Anchor the torn labrum to
the bone
 Using dissolvable plastic
anchors and heavy suture


Results of Repair
94% satisfactory results
 91% return to pre-injury level of shoulder function
 Results are less favorable in patients who participate
in overhead sports

(Kim, JBJS 2002)
Post-operative Rehab

Self-directed therapy program

Phase I (0-1 month)




Phase II (2-3 months)


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Motion as tolerated
No lifting overhead
Phase III (3-6 months)


Sling for ~1 week
ADLs immediately
1 Week: Active assisted range of motion
Progression to light strengthening
Phase IV (6+ months)


Overhead lifting at 6 months
Begin swimming, serving tennis, volleyball
Complications








Stiffness
Arthritis
Persistent Pain
Implant malposition or failure
Rotator Cuff Tear
Infection
Nerve Injury
Failure to achieve the desired result