{"id":318,"date":"2009-08-10T08:25:37","date_gmt":"2009-08-10T15:25:37","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=318"},"modified":"2009-08-10T08:32:00","modified_gmt":"2009-08-10T15:32:00","slug":"slap-tears-revisited","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=318","title":{"rendered":"Slap Tears Revisited"},"content":{"rendered":"

Over the past few weeks I have had numerous questions and comments on the blog about SLAP tears.\u00a0 So, I thought I would add another post with more in depth information on classification of tears, typical treatment and outcomes.\u00a0 This is a relatively common injury that many know so little about.\u00a0 To see a diagram, click here<\/a>.<\/p>\n

Different types of SLAP tears<\/strong><\/p>\n

    \n
  1. Type I – Fraying of the edge fo the superior labrum<\/em><\/li>\n
  2. Type II – detachment of the biceps anchor from the glenoid labrum (most common)<\/em><\/li>\n
  3. Type III – Bucket handle tear\u00a0of the superior labrum with otherwise normal biceps anchor<\/em><\/li>\n
  4. Type IV – Bucket handle tear of the superior labrum extending into biceps tendon causing detachment of the biceps anchor<\/em><\/li>\n<\/ol>\n

    Other surgeons have expanded on these classifications as well, but i will not go into that depth here.\u00a0 You should know that some sub classify type II tears into anterior, posterior and combined anterior and posterior lesions.\u00a0 In effect a SLAP tear can cause a microinstability thereby leading to articular sided rotator cuff tears.\u00a0 In plain terms, a posterior labral tear could create a posterior partial thickness rotator cuff tear and an anterior labral tear could create an anterior cuff tear.<\/p>\n

    The shoulder exam itself often reveals pain with passive external rotation at 90 degrees of abduction (picture the cocking phase of throwing here).\u00a0 Weakness and instability may also be present depending on the type of tear and if there is already a cuff injury present as well.\u00a0 There are a number of diagnostic clinical tests done including the O’Brien test, Speed’s test, crank test and biceps load test to name a few.\u00a0 Many have been successful at confirming labral pathology.\u00a0 In the end, the MRI is the gold standard in confirming an injury.<\/p>\n

    Non-operative treatment is often unsuccessful in most cases.\u00a0 Patients with Type I tears may do better than most (JOSPT February 2009).<\/em>\u00a0 Therapeutically, we often see GIRD.\u00a0\u00a0 GIRD stands for glenohumeral internal rotation deficit, meaning the affected shoulder has significant posterior capsule tightness and decreased internal rotation (common among overhead athletes and throwers).\u00a0 Restoring this motion may prevent injury that often occurs between the supraspinatus tendon and the posterior superior labrum.\u00a0 Research is unclear if GIRD increases risk for a labral tear.<\/p>\n

    In addition to this stretching the posterior capsule, it is critical to strengthen the scapular muscles and rotator cuff to restore optimal mechanics and motion between the humerus and scapula.\u00a0 Due to poor posture, flexibility issues and muscular imbalances, the average person may have an altered scapulo-humeral rhythm.\u00a0 If non-operative treatment fails, one typically opts for surgery.<\/p>\n

    Arthroscopic surgery is the standard procedure today with\u00a0debridement of the labrum and reattachment\u00a0via sutures.\u00a0\u00a0 In many cases, surgeons debride rotator cuff tears with less than 50% torn, while opting for primary repair if greater than a 50% tear.\u00a0 According to a leading surgeon, David Altchek, he will\u00a0excise a longitudinal\u00a0biceps tear that\u00a0is less than 1\/3 of the diameter of the tendon, while optiong\u00a0to repair one that is greater in size back to the major portion of the tendon.<\/p>\n

    Common\u00a0rehab timetable<\/strong>\u00a0<\/p>\n

      \n
    • Max protection for 0-3 weeks in sling with limited external rotation and overhead activity<\/li>\n
    • No biceps strengthening for 2 months<\/li>\n
    • Focus on motion restoration in weeks 3-8<\/li>\n
    • More aggressive strengthening begins at week 8<\/li>\n
    • Return to throwing begins at month 4 in most cases<\/li>\n<\/ul>\n

      These are some rough guidelines and progressions vary\u00a0based on each case and the type of tear and associated damage as well as desired activity level.\u00a0 About 90% of patients experience good to excellent results with Type II repairs in the short to mid term follow-up, but there is not extensive long term data out there.\u00a0 It should also be noted that throwers and overhead athletes tend to exhibit lower satisfaction with repsect to return to pre-injury levels after surgery.\u00a0 Recent studies also seem to indicate throwers with an overuse related injury do not do as well as those with a specific traumatic injury resulting in a type II tear.<\/p>\n

      I hope this post is helpful for those suffering from labral tears or who suspect they may have one.\u00a0 It is an intricate injury but quite disabling to function with long term implications for the health and function of the shoulder.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Over the past few weeks I have had numerous questions and comments on the blog about SLAP tears.\u00a0 So, I thought I would add another post with more in depth information on classification of tears, typical treatment and outcomes.\u00a0 This is a relatively common injury that many know so little about.\u00a0 To see a diagram, […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,8,36,11],"tags":[],"class_list":["post-318","post","type-post","status-publish","format-standard","hentry","category-health","category-rehab","category-shoulder","category-shoulder-injuries"],"yoast_head":"\nSlap Tears Revisited - Brian Schiff's Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.brianschiff.com\/?p=318\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Slap Tears Revisited - 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