PT7711- SLAP Tears

Long head of biceps brachii

SLAP lesions may involve the ______________________ or not.

High

If there is RC traumatic injury, then the likelihood of labrum involvement is ___________________.

Throwing

SLAP lesions are often associated with repetitive ____________________ motions.

Non-surgical

SLAP lesions are ______________________ as long as patient is non-throwing athlete.

Bicipital groove; posterior shoulder

Pain around the anterior part of the shoulder (___________________), but if the labrum is involved, pain could also be in the _____________________.

Overhead

Difficulty with _____________________ movements (reduced strength with throwing).

Dead arm

Patients can report a "____________________".

Traction

_______________________ injury leads to neural component (c/o arm feeling heavy, hard to use).

Instability

Often, patients do not c/o ___________________ as much with SLAP tears, but some may be possible.

Normal superior and inferior glenoid labra without sub-labral leak of contrast material.

What does image A show?

Superior labrum (curved arrow) shows normal relationship to biceps tendon (straight arrows).

What does image B show?

Biceps tendon

A SLAP tear occurs where the _____________________ anchors to the labrum.

SLAP tear

What does the image show?

Worn tissue of biceps tendon and labrum

What does the image show?

Biceps tendon and labrum becoming detached

What does the image show?

Tissue flap-bucket handle tear of labrum and stable labrum/biceps complex on the glenoid

What does the image show?

Tissue flap-bucket handle tear of labrum, tear extended into biceps tendon, stable or unstable labrum/biceps complex on the glenoid

What does the image show?

Loose body

_____________________ in joint that is getting caught would make the case surgical.

- Active compression test (O'Brien's)

- Labral crank

- Biceps load II

- Resisted supination external rotation test (RSERT)

What are the provocative tests for SLAP tears?

- Overhead throwing (peel-back)

- Traction injury

- Direct compression (FOOSH) arm in front

What are the common MOI for SLAP tears?

Conservative treatment

Clinical Case:

- 25 y/o male

- High velocity, wide grip, pull-up 4 weeks ago

- c/o deep pain, popping, clicking, and locking

- Positive O'Brien's and bicep load test

_____________________ initially recommended

Phase I

Pain management, restoring ROM

Phase II

AROM and low intensity strengthening

Phase III

RC and scapular strengthening, emphasize dynamic stability.

Phase IV

Return to sport power and higher speed activities.

Mobility; strengthening; tear; surgery

Generally, immobilization is followed by progressive ______________________ and then ______________________.

Factors:

- Type of __________________

- Type of ___________________

- Surgeon preference

ER; none; scapular; dynamic stabilization

Additional thing to consider with SLAP repair:

- _________________ motion restriction is still very controversial.

- ____________________ for 4 weeks.

- Progress with up to 10° after the first week if the arm is ABD < 45°.

- _____________________ isometrics and begin early on as well as controlled _______________________.

0-4; passive; ER; elbow flexion; supination

Phase I:

- __________________ weeks

- ROM is ____________________ only with staged goals

- __________________ should be avoided initially then can progress to 20

- Strengthening: No active ___________________ or _____________________. Wrist and scapular strength is fine, submax isometrics for GH joint.

4-6; AAROM; 160; 45; 6th

Phase II:

- ___________________ weeks

- No sling

- ROM: Progress to ____________________

- ~___________________° of elevation, ___________________° of ER

- Can begin AROM by the end of ___________________ week

6-12; AROM; isotonic

Phase III:

- _____________________ weeks

- Full ___________________

- _________________ rotator cuff strengthening and scapular strengthening

- Encourage kinetic chain exercise

12-16 (or 18); throwing; sport-specific

Phase IV:

- _____________________ weeks

- Begin progressive ______________________ program, other _____________________ drills

Bicipital tenodesis

Portion of the biceps tendon is removed and the tendon still intact is fixed is a different location.

Diseased

Bicipital tenodesis is performed when the bicep is involved in the SLAP tear or __________________ (causing pain).

Windup

Red in image.

Early cocking

Orange in image.

Late cocking

Yellow in image.

Acceleration

Green in image.

Deceleration

Blue in image.

Follow through

Purple in image.

1. PNF D2 diagonal

2. ER/IR at 0° (or 90°)

3. Abduction to 90°

4. Scaption with ER

5. Prone horizontal abduction (at 120-135°)

6. Press up

7. Prone rowing

8. Push up

9. Elbow flexion/extension

10. Wrist flexion/extension, forearm supination/pronation

What are the Thrower's Ten?

Diagonal pattern flexion

What does the image show?

Diagonal pattern extension

What does the image show?

ER at waist

What does the image show?

IR at waist

What does the image show?

ER at 90° abduction

What does the image show?

Shoulder abduction to 90°

What does the image show?

Scaption with ER

What does the image show?

Sidelying ER

What does the image show?

Prone horizontal abduction to neutral

What does the image show?

Prone horizontal abduction with full ER, 100° abduction

What does the image show?

Prone rowing

What does the image show?

Prone rowing into ER

What does the image show?

Press ups

What does the image show?

Push ups

What does the image show?

Elbow flexion (bicep curl)

What does the image show?

Elbow extension (tricep press)

What does the image show?

Wrist extension/flexion

What does the image show?

Wrist supination/pronation

What does the image show?

1. Active elbow flexion

2. Active shoulder flexion

3. Passive extension

4. Passive ER

What movements would be limited (contraindicated during maximal protection phase) for SLAP tears?