Treatment of a SLAP Tear

Options For Treatment of Superior Labral Tears of the Shoulder

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Most patients with SLAP tears will respond to conservative (meaning non-surgical) treatments. Any patient with a SLAP tear will be advised to rest after the injury to allow the injured tissue to cool down. A period of rest will allow inflammation to subside and may help to alleviate symptoms.

Other treatments that are often used in cases of a SLAP tear include:

In patients who have continued symptoms despite these treatments, arthroscopic surgery of the shoulder may be recommended. There are several specific surgical procedures that may be performed, and it is important to understand that SLAP tears often occur in conjunction with other shoulder problems such as rotator cuff tears, and even shoulder arthritis. In these cases, surgical treatment will have to take into account these factors.

Surgery for a SLAP Tear

The primary surgical options for the SLAP tear are:

  • Debridement of the SLAP tear
    When a SLAP tear is debrided, the torn portion of the labrum is shaved away to leave a smooth edge. This option is only suitable for minor tears that do not involve the biceps tendon.  Recovery following an isolated debridement is faster than when surgical repair is required.
  • SLAP Repair
    A SLAP repair is an arthroscopic procedure that uses sutures to reattach the torn labrum down to the shoulder socket. A SLAP repair is best suited to patients with an otherwise healthy shoulder who want to remain athletically active.  During the surgical procedure, your surgeon will use a surgical implant to reattach the damaged labral tissue to the bone of the shoulder socket.  The most commonly used device is called a suture anchor.  The anchor is seated into the bone, and the sutures are wrapped around the labrum and tied snugly to the bone.
  • Biceps Tenodesis
    A biceps tenodesis is a procedure that cuts the biceps tendon from where it attaches to the labrum, and reinserts it in another area. The idea behind a biceps tenodesis is that by decreasing the forces that pull on the SLAP region, the symptoms will be alleviated. A biceps tenodesis is most often performed on patients over 40 years of age or patients with associated biceps tendonitis or tearing. A biceps tenodesis can either be performed arthroscopically, or through a small incision over the top of the shoulder. Determining how to best perform a biceps tenodesis depends primarily on other conditions being treated within the shoulder joint.

    Results of Surgery

    The results of different surgical procedures have been reported in a number of scientific studies.  The most commonly studied surgical procedure is the SLAP repair.  In patients having an arthroscopic SLAP repair using modern suture anchors, better than 90% of patients are found to have good results, and more than 85% of patients are able to return to competitive athletic activities.

    Risks of surgical treatment include the usual risks of arthroscopic shoulder surgery.  These may include infection, stiffness, and weakness of the shoulder.  Furthermore, in addition to having a SLAP tear, some patients are found to have other damage within the shoulder joint that may also require treatment.  These other problems can affect the recovery of the shoulder from surgery.

    Sources:

    Keener JD, Brophy RH. "Superior labral tears of the shoulder: pathogenesis, evaluation, and treatment" J Am Acad Orthop Surg. 2009 Oct;17(10):627-37.

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