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SLAP LESIONS

What is a SLAP Lesion?

The "socket" of the shoulder joint is called the glenoid. It is very shallow and small compared to the "ball' or humeral head. In fact you can imagine it to be like a golf ball sitting on a golf tee. I.e. it is inherently unstable. The glenoid has a rim called the labrum that deepens the socket and makes the shoulder more stable. It also serves as the attachment point of one of the tendons of the biceps muscle (called the long head of the biceps), This attaches to the rim or labrum of the socket at its upper portion. When this area of the rim or labrum is damaged, this is called a SLAP lesion.

How does it occur?

It is generally seen in younger, active patients. There can be a single injury such as a fall or a partial dislocation while playing rugby or other sports. In other patients it is seen without a history of a single injury, but following repeated stress to the affected shoulder for example a javelin thrower or tennis player.

What are the symptoms?

The patient may feel or hear a "pop" in their shoulder after a fall or single injury. This is followed by pain that fails to resolve. Others may simply feel pain and a "click" or "catch" when throwing or serving at tennis.

How is it diagnosed?

A SLAP lesion is notoriously difficult to diagnose. In fact, it wasn't until the advent of keyhole surgery that doctors knew of its existence! A provisional diagnosis is made on the basis of the history and clinical examination. A special type of MRI scan called a MR Arthrogram is often ordered if there is clinical suspicion. However, even the scan can fail to detect a SLAP lesion. Sometimes the diagnosis is only confirmed on introducing a camera into the shoulder at the time of keyhole surgery.

How is it treated?

If the patient has a symptomatic SLAP lesion affecting quality of life, work and hobbies etc, then surgery is generally advised. The surgery is done arthroscopically (key-hole surgery) as a day case usually under a general anaesthetic.

What is the post-operative rehabilitation and recovery time?

Rehabilitation depends on the type of damage found at the time of keyhole surgery. If the labrum is found to be only frayed (Type I SLAP Lesion) and simply needs “tidying up” then the shoulder will be mobilized as soon as the post-operative pain has settled within days. If there is a torn portion of labrum that has dislocated into the shoulder joint between ball and socket (Type II SLAP lesion), this is excised and rehabilitation is also quick. If however the tear requires a keyhole repair (Type II and Type IV SLAP lesions), then the rehabilitation will start in approximately 4-6 weeks. A shoulder sling is worn for this period of time. The reason for this is that the labrum or biceps must begin to heal sufficiently so that the stress of rehabilitation does not re-injure it.

What about return to work and sports?

For sedentary jobs, return to work is usually within days. Return to driving is at least 4-6 weeks. Return to sports differs with different sports for example, breaststroke swimming can be allowed at 6 weeks but rugby and other contact sports is discouraged for about 6 months.

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