Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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Baseball pitchers who fail nonoperative care for SLAP injuries will undergo a repair if they wish to continue throwing. The injury may occur at ball release as the biceps contracts to resist glenohumeral joint distraction and decelerate elbow extension. The other thought is that injury occurs in late cocking as the result of a “peel back” mechanism when the abducted shoulder externally rotates. Previous research by Shepard et al. published in American Journal of Sports Medicine (AJSM) measured in vitro strength of the biceps-labral complex during the peel back and distal force and concluded that repetitive force in both scenarios likely causes SLAP lesions.
“Baseball pitching motion 2004“. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
One of the concerns for pitchers after surgery is regaining full shoulder external rotation and horizontal abduction. If too much tension is placed on the glenohumeral ligaments during surgery, regaining motion can be tough. Ironically, external rotation is limited in the early phase of rehab to protect the labral repair which may impair throwing mechanics later on. Appropriate rehab and progression is paramount for long term success.
Laughlin et al. at the ASMI sought out to explore in a labaratory if there are differences in pitchers who underwent a SLAP repair compared to those in age controlled groups without injury. In a paper published in the Dec. 2014 AJSM, the researchers hypothesized that the SLAP group would exhibit compromised shoulder range of motion and internal range of motion torque during pitching. Of 634 pitchers (collegiate and professional) tested at ASMI from 2000 – 2014, 13 in this group were included in the SLAP group as they had undergone a SLAP repair at least 1 year before their biomechanical testing.
By far the most comments on my blog and emails that flood my inbox these days have to do with SLAP tears. I must admit that outside of ACL tears and rotator cuff issues, I find myself increasingly drawn to studying and researching this issue. It definitely is a source of great pain for many and an issue that medical professionals are challenged by today.
In my personal clinical experience, I see good, bad and in between outcomes. Through email and my blog I tend to read more on the not so good side from people who are seeking my expertise in how to resolve their issues. When I speak to surgeons, I find they are often hesitant to commit to a set algorithm of treatment, and they are not 100% sure what the right answer is in addressing these injuries as a whole.
If you read the literature, the success in terms of patient satisfaction and return to premorbid activity levels is not going to make you rush down to the operating room and opt for an arthroscopic repair if you are an overhead athlete (especially baseball players). However, other studies have presented more favorable data ranging from 63%-75% good-excellent satisfaction in other overhead athletes who have had the procedure done.
If you are unfamiliar with SLAP tears, I suggest reading my original post on them (click here). In today’s post, I wanted to present a quick recap on Type II SLAP tears and some new published research on the results of revision procedures where the primary repair failed.
Below are two images of a type II tear (MRI and operative view from the scope)
Keep in mind a type II tear means the biceps anchor/superior labrum has pulled away from the glenoid with resulting instability of the complex. This is the most common type of tear seen among injured people. In a study from the Kerlan-Jobe Orthopaedic Clinic in LA in the latest American Journal of Sports Medicine (June 2011 – click here for the abstract), they discussed a chart review of from 2003-2009 looking at patients who had undergone revision type II SLAP repairs.
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