The shoulder is likened to a marble on a table. The marble can roll anywhere until it is stopped by something. Our shoulders have tremendous movement, and in order to keep the ball (humeral head) from rolling off the table (glenoid socket) we have ligaments, tendons, and muscles to help.
Our shoulder socket, also called the glenoid, is shaped like a pear. Around the edge of the socket is a piece of cartilage called the labrum. The labrum creates a bumper effect to help stabilize the shoulder. Depending on where the labrum is torn, can relate to either symptoms of instability, locking/catching, or just pain.
When the labrum tears off the top part of the shoulder, it is called a SLAP tear. SLAP stands for: Superior Labrum (i.e. top part of labrum) Anterior to Posterior (front to back). So the labrum is torn from the top part of the socket. If you think of the socket as a clock fact, a SLAP tear usually is from the 11 to 1 o’clock position. The other anatomic piece that is attached to the top part of the socket is the biceps tendon. The biceps tendon blends in with the superior labrum. With this in mind, many overhead athletes get SLAP tears because of the constant pull of the biceps tendon on the superior labrum. There are also many other ways to get SLAP tear, including traumatic falls and in association with rotator cuff tears.
Surgery for a SLAP repair focuses on reattaching the labrum to the glenoid. This can be done arthroscopically with a small camera and a couple of poke-hole incisions. The surgery typically is an outpatient procedure. You will receive a general anesthetic, in addition to a nerve block or pain catheter to your operative side. The nerve block is placed by the anesthesia service and allows you to wake up relatively pain-free. When the block or catheter wears off, you can start easing into your pain medication.
You are positioned into a “beach chair” position, with all of your extremities carefully padded. Your head is also supported in a padded head holder. After performing a “time out”, where we verify the operative site, your arm is cleaned and sterilely draped. Through a couple of small poke-hole incisions, we are able to visualize the inside of the shoulder. We look at all of the ligaments, cartilage, and tendons in the shoulder to make sure there are no other issues to be addressed.
The top part of the glenoid is cleaned of scar tissue and we prepare the bone for reattachment of the labrum. We attach the labrum with small bone anchors. The anchors are not metal, but have suture attached to them that is sewn around the labrum with small arthroscopic needles. The anchors serve as a site of fixation to the bone. Then using proper arthroscopic knot tying techniques, the labrum is fixed to the top part of the glenoid. Depending on the size of the tear, the number of anchors can range from 1 to 4, but most commonly there are two anchors placed. Any other concomitant procedures are then also completed like repairing a rotator cuff tear or cleaning out any bursitis.
The incisions are closed with suture and a sterile dressing is applied to the shoulder. Your arm is then placed in a sling and pillow device for immobilization. It is very important that you stay in the sling and pillow and adhere to the rehabilitation protocol.
Typically we move the shoulder very quickly after the procedure, but other times we keep you in the sling for a couple of weeks prior to even moving the shoulder. This will be explained to you after the procedure and very specific instructions will be given to you and your therapist.
Once your pain is under control, you are eating and keeping food down, and you are medically stable, you can be discharged home. You will get a full set of instructions of Do’s and Don’ts. Basically make sure to keep your incision clean and dry. If you have any questions on what you should be doing or not doing to your shoulder, make sure to ask your surgeon or the nurses/residents. You will be seen in the office for a check up and to remove any staples or sutures in 5 – 10 days after surgery. You will also be given a pain medication prescription. Please take the pain medication as directed. Eat a healthy diet and get plenty of rest. Also remember that ICE is a form of pain relief and you should ice the shoulder regularly.
Typically you are in the sling for 4-6 weeks after surgery but are coming out of the sling for very prescribed movements that you will be taught. Physical therapy is an important part of the rehabilitation.
We hope this provides a bit more insight into your surgical procedure for a SLAP repair. As always, if you have any questions, please contact our office at 248-988-8085.