SLAP

concomitant w/ RC repair is Arthroscopic Subacromial Decompression. Procedure includes

Subacromial bursectomy

Coracoacromial ligament resection

Resection of undersurface of anterior acromion

Resection of osteophytes

Arthroscopic Subacromial Decompression precautions include post surgical pain & avoid

impingement positions (horizontally adduction, arm overhead)

Common concomitant procedure w/ RC repair

Arthroscopic Subacromial Decompression recovery at ~10-14 weeks post-op goals

Restore Pain Free AROM: MT, Ther Ex

Strengthening: Scapular Stabilizers, RC, Shoulder Prime Movers

SAD vs Sham procedure: No difference

Indications for a Superior Capsular Reconstruction

Massive Irreparable RC tears >5cm

>= 2 Tendon tears

Intact GH joint (minimal joint degeneration)

Superior capsular reconstruction consists of re-enforcement via

Tensor fascia autograft

Prevents superior migration of humerus

Superior Capsular Reconstruction has mixed outcomes & limited

long-term data

May prove superior to TSA

Long Head of Biceps Tendinopathy biomechanical MOI & comorbidity

Repetitive traction

Friction

Glenohumeral rotation

Comorbid w/: RC & Labral Tears

Biomechanically the long head of biceps provides

anterior superior stability to GH Joint

Long Head of Biceps Tendinopathy sxs are anterior shoulder pain, signs are

Pain w/ resisted movements:

Speeds test

Yergason's Test

Impingement Tests

Neer’s/HK

Long head of biceps tendinopathy conservative management includes

RC & Scapular Strengthening: stabilizes & off loads biceps tendon

Tendon Loading based on irritability, eventually must do it (scapular exercises 1st, supine eccentrics into shoulder extension)

Long Head of Biceps tendinopathy surgical managements include

Resection (Tenotomy)

Tenodesis (younger patients): Often performed w/ other procedures, RC repair or Labral Repair

Biceps Brachii- Long Head Rupture common MOI

Degenerative (smokers, metabolic disease)

Max Lifting injury

Older Males: Lower tissue quality, Highly activity

Prognosis for a Biceps Brachii- Long Head Rupture

Minimal loss in biceps strength ~10%

Small ↑ in anterior instability of GH joint

Usually will not repair/heal

Bulged appearance will ↓ as those unused muscle fibers atrophy

Superior Labral Tears Anterior to Posterior (SLAP Tears) is an injury of the

superior aspect of the labrum extending A→P

Superior Labral Tears Anterior to Posterior (SLAP) MOI

Repetitive overhead motion (pitchers, swimmers, quarterbacks, volleyball)

“Peel-back Mechanism” (principle theory)– wind-up position peels labrum peeled back off of glenoid fossa (humeral head rolling posteriorly & superior labrum peeling)

Forceful eccentric biceps contraction (biceps attached to superior labrum, slowing arm down)

FOOSH

SLAP injuries are usually do not present in isolation. What other concomitant pathology may present?

25% w/ RC tears

37% Bankart lesion

Instability

OA

Symptoms/signs of a SLAP tear

Posterior shoulder pain that ↑ w/ overhead motion

Painful popping/clicking

Sense of looseness

(+) Impingement signs

Whole arm weakness due to loss of stability in GH jt (disrupts force transfer system)

SLAP special tests for diagnosis

O’Brien’s Anterior Compression

Biceps load test

Crank test

Clunk test

Speed’s test

Type 1 SLAP Lesion

Fraying or degeneration of superior labrum (no bicep involvement)

Type II SLAP Lesion

Fraying or degeneration of superior labrum

Biceps tendon detached from glenoid

Type III SLAP lesion

Bucket-handle tear of superior labrum

Biceps tendon is intact

Type IV SLAP lesion

Bucket-handle tear of superior labrum

Biceps tendon is also torn

Surgical Interventions for type I SLAP Tear

Conservative Treatment

Maybe Debridement of superior labrum

Surgical Interventions for type II SLAP Tear

Repair superior labrum

Biceps tendon tenodesis

Surgical interventions for type III SLAP tear includes a

surgical removal of bucket-handle tear

Surgical Interventions for type IV SLAP Tear

Surgical removal of bucket-handle tear

Resection of damaged biceps tendon

Reattachment of labrum

Repair of remaining biceps tendon

Precautions for SLAP Tear ROM

Limit A/PROM ER to <30° for 4-8 weeks (peel back lesions)

Rehab is specific to method of treatment of SLAP Tear. Starting w/ immobilization in a sling for

~4 weeks & w/ an abduction pillow in IR

Rehab of SLAP Tear, ROM considerations

Elbow & hand ROM immediately

NO bicep strengthening for 4-8 weeks