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Slap Tears PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "SLAP Tears" by Edwin E Spencer Jr MD.

This medical PowerPoint presentation is about SLAP tears, a type of injury that affects the labrum, which is a ring of cartilage that surrounds the shoulder socket. The term SLAP stands for Superior Labrum Anterior to Posterior and refers to a tear in the upper part of the labrum, which is closest to the biceps tendon.

There are several types of SLAP tears, ranging from minor fraying to complete detachment of the labrum from the socket. These injuries can be caused by repetitive overhead motions, such as throwing a ball or lifting weights, or by a traumatic event, such as a fall or a direct blow to the shoulder.

Symptoms of a SLAP tear can include pain in the shoulder, a popping or clicking sensation, weakness, and reduced range of motion. Diagnosis typically involves a physical examination, imaging tests such as an MRI, and sometimes an arthroscopic procedure to visualize the injury directly.

Treatment for a SLAP tear can range from conservative measures such as rest, physical therapy, and anti-inflammatory medications to surgery, depending on the severity of the injury and the individual patients needs. In some cases, surgery may involve repairing the torn labrum with sutures or removing a portion of the labrum that is causing pain or limiting movement.

Tags : SLAP Tears, labrum, shoulder socket, Superior Labrum Anterior to Posterior, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 1309 | Downloads : 0

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Slide 1-

SLAP Tears Edwin E Spencer Jr MD Shoulder and Elbow Center Knoxville Orthopaedic Clinic
Slide 2-

Definition Andrews first described labral tears in 1985 Snyder coined the term SLAP (superior labral anterior posterior) tears in 1990 and classified 4 types I – Degenerative fraying II – Detachment of biceps origin III – Bucket-handle tear IV – Intrasubstance tear of the biceps with a bucket-handle tear
Slide 3-

Type II SLAP Tears The greatest controversy surrounds the treatment of Type II SLAP tears Etiology? Clinical exam? Arthroscopic findings and definition Treatment?
Slide 4-

Etiology Kim et al reviewed 544 arthroscopic cases and found the incidence of a SLAP tear to be 26%. Of these 21% were type II which is similar to other studies. They found that those over 40 years of age were associated with RCT’s and those under 40 were associated with instability Kim, TK et al. Clinical features of the different types of SLAP lesions. JBJS 2003
Slide 5-

Etiology Proposed mechanisms in the young patient with a type II tear include Biceps traction in follow through phase of throwing (Andrews) Internal impingement (Walch and Jobe) “Peel-back” secondary to biceps traction in late cocking phase of throwing –abduction and external rotation (Burkhart and Morgan) This “peel-back” has been demonstrated in cadaveric models (Kuhn)
Slide 6-

Etiology McMahon et al have demonstrated increased anterior and inferior translation of the glenohumeral joint in a cadaveric model after creating a SLAP tear. This is consistent with several clinical studies which have found that type II SLAPs are associated with instability in the young patient McMahon PJ, et al. Glenohumeral translations are increased after a type II SLAP lesion: A cadaveric study of severity of passive stabilizer injury. JSES 2004
Slide 7-

Definition Defining a type II SLAP tear intraoperatively can be difficult Differentiate from a sublabral foramen and Buford complex Labrum might have more of a meniscal appearance The labral origin might be more medial The best definition of a detached labrum is where there is exposed bone or torn tissue medial to the articular cartilage of the superior glenoid
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Treatment Snyder and Altchek have reported unsuccessful outcomes with debridement alone for type II tears. This prompted operative stabilization with various devises and with various methods including suture anchors, knotless anchors and the SureTac.
Slide 9-

Treatment Cohen et al looked at the results of SureTac fixation of 41 isolated type II SLAP tears Found that nonthrowing athletes (71% satisfaction) had better results than throwing athletes (38% satisfaction) The use of a transrotator cuff portal was associated with poor results with only 55% of the patients in this group having G/E results Only 40% able to return to preinjury sport Cohen DB et al Outcomes of isolated type II SLAP lesions treated with arthroscopic Fixation using a bioabsorbable tack. Arthroscopy 2006
Slide 10-

Treatment Rhee et al found that 76% of their athletes were able to return to preinjury sport. They evaluated 44 SLAP’s (mostly type II’s) Fixed with SureTac and suture anchor and found no difference but switched to suture anchor fixation midway through the study secondary to a case of synovittis 86% G/E results via UCLA score Rhee, YG et al. Unstable isolated SLAP lesion: Clinical presentation and outcome of arthroscopic fixation. Arthroscopy 2005
Slide 11-

Treatment DiRaimondo et al compared suture anchor fixation to bioabsorbable tack fixation and found that the suture fixation was superior with regard to pullout strength and performed better under cyclic loads DiRaimonodo CA, et al. A biomechanical comparison of repair techniques for type II SLAP lesions. AJSM 2004
Slide 12-

Treatment Unstable biceps anchor Prepared superior glenoid tubercle Place anchor (3mm) through myotendinous junction of supraspinatus
Slide 13-

Treatment Pass suture through Neviaser portal with spinal needle
Slide 14-

Treatment
Slide 15-

Summary Make sure that the treatment is not worse than the disease Fix lesion with as little collateral damage as possible Avoid fixing degenerative lesions (I very rarely fix a SLAP in a patient>40yo) I believe suture anchor fixation is better Perform RCR and SLAP concomitantly with caution (increased chance of stiffness)