The human shoulder is a ball-and-socket type of joint. To provide more stable shoulder, the shoulder socket is surrounded by a ring of firm tissues. This ring of tissues is known as labrum. Labrum provides support to the arm bone in the socket. The injury to the labrum is termed as SLAP(Superior Labrum Anterior and Posterior) lesion or SLAP tear. The SLAP tear involves injury to the upper region of the labrum. At this region, the biceps tendon connects to the labrum. A SLAP injury is seen both at the front and back end of this connection.
Repeated shoulder injury and acute trauma are the common causes of labrum injury. Other causes include:
- Vehicle accident
- Heavy object lifting
- Fall from a great height
- Rapid movement of arm
- Shoulder injury or dislocation
The typical symptoms of SLAP lesion include:
- Catching or popping sensation in the shoulder
- Severe pain during arm movement
- Less shoulder strength
- Limited range of motion
- A pop out of joint feeling of shoulder
Prior to treatment procedure, a variety of tests such as x-ray or MRI scan is done. These tests help to decide the appropriate treatment technique for the patient. The past medical history of person is also analyzed to detect the actual cause of discomfort. Every patient reacts in a different manner to each of the treatment procedure. Based on the doctor-patient preference, the treatment is decided. Typically, both non-surgical and surgical methods are used in treating SLAP lesion.
- Non-surgical Treatment
The commonly used non-operative methods are:
- Non-steroidal ant-inflammatory medication(NSAIDs):
NSAIDs are preferred to lower the pain and swelling in the shoulder. Commonly used NSAIDs are ibuprofen, aspirin, and naproxen.
- Physical Therapy:
Simple exercises are usually advised by physical therapist to regain lost movement. These exercises are helpful to provide strength to the shoulder. Stretching exercises enhance the flexibility and range of motion of shoulder joint. They aim to prevent further injury to arm. The duration for this program is 3 to 6 months.
- Surgical Treatment:
If pain and other symptoms of SLAP lesion continues then surgery is chosen as treatment measure. An arthroscopic key-hole surgery is the method employed. During surgery, a small cut is made on the shoulder joint. A small camera, called arthroscope, is inserted through the cut into the shoulder joint. This camera is used to view images on a television monitor. These images help the surgeon to decide the path for the surgical instruments. The damaged part of the labrum is then removed through these instruments. In some patients, stitches are used to re-attach the torn segment of labrum.
After surgery, a sling is provided for 2-4 weeks. This sling helps in arm movement, while the labrum heals. Rehabilitation program is started after the initial swelling and pain settles. Physical therapy is the main aspect of a rehabilitation program. Physical therapy, initially, aims to enhance the flexibility. Gentle stretching exercises are helpful to increase flexibility and range of motion. They also prevent stiffness in the shoulder. Typically after 4-6 weeks after operation, healing improves. At this point, special exercises to strengthen rotator cuff and shoulder muscles are included in the program. The overall result of surgery are generally very good. People experience less pain and more strength. The person may recover within 3 to 4 months and hence return to work.
The potential risks included in SLAP lesion surgery is:
- Shoulder stiffness and swelling
- Blood clots in repaired area
- Excessive bleeding
Damaged blood-vessels or nerves