SLAP tear

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A torn SLAP or SLAP lesion is an injury to the glenoid labrum (fibrocartilaginous edge attached around the edge of the glenoid cavity). SLAP is an acronym for " superior magnetic rupture from anterior to posterior ".

Video SLAP tear

Symptoms

Some common but non-specific symptoms:

• Dull, throbbing, joint pain that can be caused by very heavy exertion or simple housework.
• Difficulty sleeping due to shoulder discomfort. SLAP lesions reduce joint stability when combined with bed lying, causing the shoulder to fall.
• For an athlete involved in a throwing sport like baseball, exciting pain and feelings are common. Throwing athletes can also complain of loss of power or significant speed drop in throws.
• Any force applied above the head or pushing directly to the shoulder can cause a collision and capture sensation.

Maps SLAP tear

Mechanism of anatomy

The shoulder joint is a "ball and socket" joint. However, the 'sockets' (small glacial fossa scapula), cover at most only one-third of the 'ball' (the humeral head). This is deepened by the periphery of fibrocartilage, glenoidal labrum. Previously there was a debate as to whether the fibrocartilaginous labrum as opposed to the hyaline cartilage found in the rest of the glenoid fossa. Previously, it was regarded as a redundant evolutionary remnant, but is now considered an integral part of shoulder stability. Most agree that the proximal tendon of the long head of biceps brachii muscle becomes fibrocartilaginous before it is attached to the superior aspect of glenoid. The long heads of the brachii trisep insert the inferior, same. Together, all these cartilage extensions are called 'glenoid labrum'.

A tear or SLAP lesion occurs when there is damage to the superior (uppermost) labrum area. These lesions have become public awareness because of their frequency in athletes involved in overhead activities and throws in turn related to relatively new descriptions of the labral injuries in throwing athletes, and the initial definition of the 4 (major) SLAP sub-types, all occurring since 1990 -an. The identification and treatment of this injury continues to grow.

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Diagnosis

Subtype

Although ten varieties of SLAP lesions have been described in MRI or MR arthrography the seven clinical types are generally described.

• Type I. A degenerative fight from the superior part of the labrum, with remaining labrum firmly attached to the glenoid edge
• Type II. Separation of the superior parts of glenoid labrum and biceps brachii biceps tendon from the glenoid edge
• Type III. Bucket-handle tears from the superior parts of the labrum without brecciation breccii (long head) breccia breccias)
• Type IV. Bucket-handle tears from the superior parts of the labrum extends into the biceps tendon
• Type V. An anteroinferior Bankart lesion extends upward to include biceps tendon splitting
• Type VI. The unstable radial tear flap is related to the separation of biceps anchor
• Type VII. Anterior extension of the SLAP lesion below the central glenohumeral ligament

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Treatment

There is evidence in the literature to support both surgical and non-surgical treatments. In some, physical therapy can strengthen the supporting muscles in the shoulder joint to the point of rebuilding stability.

The surgical treatment of SLAP tear surgery has become more common in recent years. Success rates for improving isolated SLAP tears are reported between 74-94%. While surgery may be performed as a traditional open procedure, current arthroscopy techniques are preferred to be less intrusive with the possibility of low iatrogenic infections.

Related findings in shoulder joints vary, may be unpredictable and include:

• SLAP lesions - separation of the labrum/glenoid on the biceps tendon
• Bankart lesions - labrum/glenoid separation in inferior glenohumeral ligaments
• Biceps Tendons - exception of pulley injuries
• Bone - glenoid, humerus - an injury or degenerative change involving the joint surface
• Anatomical variant - sublabral foramen, Buford Complex

Although good results with improved SLAP over age 40 are reported, both age over 40 and Worker Compensation status have been noted as independent predictors of surgical complications. This is especially true if there is a rotator cuff related injury. In such circumstances, it is suggested that both the labral debridement and the biceps of tenotomy are preferred.

SLAP (Labral Superior Tears, Anterior to Posterior)

• Type 1
• Fraying of Superior Labrum
• Biceps Anchor Whole
• Type 2
• Labrum Superior is separate
• Biceps Bus Detachment
• Type 3
• Buckets Handle the Labrum Superior tear type
• Biceps Anchor INTACT
• Type 4
• Bucket Handles Torn Labrum Superior
• Tear Extension in Tendon Biceps
• The part of the Anchor Biceps is still INTACT

Procedures

After examination and determination of injury level, the basic labrum improvements are as follows.

• Glenoids and labrums are rough to increase the contact surface area and promote regrowth.
• The location for bone anchors is chosen based on the number and severity of the tear. A severe tear involving SLAP and Bankart lesions may require seven anchors. A simple tear may only require one.
• Glenoid was drilled for anchor implantation.
• Anchors are inserted into the glenoid.
• The stitching component of the implant is fastened through the labrum and secured in such a way that the labrum is in close contact with the glenoid surface.

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Surgical rehabilitation

Surgical rehabilitation is very important, progressive and supervised. The first phase focuses on early movements and typically occupies post-surgical weeks of one to three. Passive range of motion is restored on the shoulders, elbows, forearms, and joints of the wrist. However, while manual resistance training for scapular protraction, elbow extension, and pronation and supination are encouraged, elbow flexion resistance is avoided because of the biceps contractions it produces and the need to protect the labral repair for at least six weeks. A sling can be worn, as needed, for comfort. Stage 2, occupying weeks 4 to 6, involves the development of force and range of motion, trying to achieve progressive abduction and external rotation in the shoulder joint. Phase 3, usually weeks 6 to 10, allows flexion elbow resistive exercises, now allowing the biceps to come into play with the assumption that the labrum will heal enough to avoid injury. Thereafter, the isokinetic exercise can be started from weeks 10 to 12 to 16, for continued reinforcement leading to a full return based on postoperative evaluation, strength, and functional range of motion. The isokinetic period through the final clearance is sometimes referred to as phases four and five.

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References

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External links

Source of the article : Wikipedia