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Superior Labral (or "SLAP") repair

Pre-Operation

The biceps tendon can be seen to be detached from where it should be securely attached within the shoulder joint.

Patients usually describe an acute onset of pain in their shoulder, or a chronic overuse type onset. They may also notice weakness and / or reduced performance

Most patients will find that the pain pain settled with reduced activity, but returns as they attempt to resume physical activity.

Common causes include weight lifting, cross-fit, contact sports (tackling in particular), rock-climbing, and racket sports.

Although mild cases that present early for physiotherapy, may heal without surgery, mot cases require surgical repair in order to return to full activity. This is because, when a tear has developed, the tendon is within the joint and therefore fluid within the joint (and thus within the tear itself) impedes repair.

 
In shoulders with instability, as the head of the humerus moves forwards this places a traction force on the long head of biceps tendon. Shoulder instability needs to also be corrected as part of the treatment of a SLAP lesion.

Within the sporting population, some patients have both instability of the shoulder, and a SLAP tear. The instability, usually anterograde-inferior in direction, contributes to the generation of the tear and this should be corrected as part of the treatment, otherwise the treatment will fail and the problem will become recurrent.

Operation

The operation is performed in an operating theatre with the patient under a general anaesthetic. The surgery is performed arthroscopically, i.e. "key hole" surgery.
Using "suture anchors" inserted it bone, the labrum and biceps tendon can be repaired back to bone with key-hole surgery

The operation is performed in a sterile operating theatre with the patient under a general anesthetic.

Usually three puncture holes, 1cm long, also called “portals” are required to perform the surgery. Dr. Porter will pass the camera into the joint using one of the portals, while the other two portals allow him to work within the shoulder joint using special arthroscopic instruments.

In this manner he is able to reattach the long head of biceps tendon back to bone using “suture anchors” which sit within the bone and strong suture material tied around the tissues that need to be repaired. In those cases where instability of the shoulder is a contributing factor, this is also corrected at the same time.

The portals are closed with sutures, dressings applied, and the patient placed in a sling. Most patients go home on the day of surgery with instructions.

Potential
complications

Despite our best attempts, potential complications are a risk with any injury or surgical procedure. You need to be aware of these rare potential complications.

The more common ones are listed here, but please ask the surgeon if there are any you are particularly concerned about.

1. Infection

The risk of a superficial wound infection is around 1%, and deep infection is much lower. Most of these will respond to a course of oral antibiotics, but on occasions a return to theatre to wash the shoulder out, and a course of intravenous antibiotics is required.

2. Stiffness / adhesive capsulitis

There is quite often some stiffness in the shoulder following the 6 weeks period in the sling. However this usually resolves within 3 months of the surgery. On occasions it is more severe and if a "frozen shoulder" develops, although self-limiting, can take 12 months to recover.

3. Bleeding / bruising / hematoma

There may be some bleeding form the portal sites, and bruising, but this is self limiting. There is a very small risk of an injury to one of the brachial vessels, with more severe bleeding.

4. Nerve injury

The brachial plexus lies close to the inferior capsule of the shoulder joint, and unless there is some instability in the shoulder that needs to be corrected, the site of surgery is well away from this fragile structure. The brachial plexus lies below the shoulder joint, and there is a very small risk of damage to this plexus of nerves if a stabilisation procedure is required.

5. Irreparable / recurrent SLAP tear

On occasions the damage to the tendon is too severe, and / or the quality of the tenons too poor to make repair possible. In these situations the tendon will be released from its attachment, and if possible repaired lower down the arm bone. This can often been done without altering the appearance or function of the biceps muscle. On rare occasions the tendon may fail again, and in this situation the attachment of the tendon would also be moved (usually a sub-pectoral tenodesis is performed).

Post-Operation

You will be given a hand-out on discharge from the hospital, detailing the early exercises to be performed. You will also be referred for physiotherapy to supervise your rehabilitation. Click on the link below for more details. This is a printable PDF file.

https://www.cosm.net.au/wp-content/uploads/2020/07/SLAP-repair.pdf

Patients involved in clerical type work could return to work within days, while light manual task would require 6 weeks off work, and heavy manual work at least a 4 months.

Rehab / Physio

During the first 6 weeks following the surgery, the emphasis will be on performing exercises for the elbow, forearm, wrist and hand. Movement at the shoulder is allowed, as long as there is no sharp pain.

Movement of the shoulder can be progressed in all directions as long as pain free and nothing heavier than a drink is lifted.

Use of a stationary bike is possible within days of the surgery, and running after 6 weeks. Resistance work for the shoulder is commenced at 6 weeks, starting with therabands and progressing to free weights.

Exercises with heavy weights and chin-ups are slowly introduced at 4 months post surgery.