Dr. Adam Farber 2014-07-03 00:26:04
SLAP Tears The shoulder is a ball and socket joint. The ball (known as the head of the humerus) sits in the socket (known as the glenoid). The socket is surrounded by a ring of soft-tissue called the labrum; the labrum functions to deepen the socket and thus stabilize the humeral head in the socket. In addition, the long head of the biceps tendon attaches to the superior (top) part of the labrum. SLAP (Superior Labrum Anterior to Posterior) lesions are tears involving the superior part of the labrum, where the biceps tendon attaches. These lesions may be due to an acute traumatic episode, such as a shoulder dislocation or a sudden traction injury to the arm. This can occur, for example, when trying to lift a heavy object or when trying to stop a fall or slide. These lesions are also seen in overhead throwing athletes, such as baseball pitchers, in which case repetitive micro-trauma is thought to cause the injury. Anatomic changes of the superior labral region frequently exist in patients over the age of 40. Radiologists often report a SLAP lesion on an MRI scan when in fact this represents normal labral changes associated with the aging process. Care must be taken to avoid treating this situation with surgery. It is often unnecessary and may in fact make the patient’s symptoms worse. Patients with SLAP lesions typically complain of shoulder pain. The pain may be in the front of the shoulder, deep within the shoulder, or in the back of the shoulder. The pain is often worse with overhead arm activities or throwing. Many patients report pain radiating down the front of the arm in line with the biceps tendon and muscle. Frequently, mechanical symptoms such as painful clicking or popping are experienced by patients with SLAP lesions. The diagnosis of a SLAP lesion is typically suspected by the nature of the claimant’s injury, their symptomatic complaints, and the findings on physical examination. The lesion can be confirmed by an MRI scan; frequently a contrast dye injection into the shoulder is performed to make the SLAP lesion easier to visualize on the MRI. As stated above, care must be taken to avoid over-diagnosing SLAP lesions, especially in older patients, in which degenerative changes in the superior labrum can be confused with clinically significant SLAP lesions by radiologists. The claimant’s history and physical examination findings are critical to make this distinction. The treatment of SLAP lesions depends on the nature of the injury and symptoms. Asymptomatic SLAP lesions can be ignored. In patients experiencing pain, but no mechanical symptoms (such as locking, painful popping or instability episodes), a trial of non-operative treatment is often performed initially. This usually includes anti-inflammatory medications, a course of physical therapy, and possibly a cortisone injection. In patients with an acute traumatic injury, patients with mechanical symptoms, such as clicking and popping, or patients who fail to improve with a course of non-operative treatment, arthroscopic labral repair surgery is often recommended to repair the torn labrum. Alternatively the biceps can be cut from its attachment on the superior labrum and be surgically reattached further down the arm to avoid tension on the injured superior labrum. Although less anatomic this procedure is very effective in treating symptoms associated with SLAP tears. Dr. Adam Farber, an orthopedic surgeon, specializes in sports medicine surgery at Phoenix Shoulder and Knee. He is double- board certified in orthopedic surgery and orthopedic sports medicine, focuses his practice on the treatment of the shoulder, knee and elbow. He is one of the team physicians for the Los Angeles Angels; the head team physician at Scottsdale Community College; and also takes care of several local high schools. In addition to treating athletes, his practice focuses on IMEs for workers’ compensation as well as personal injury cases. He holds active medical licenses in Arizona and New Mexico. For more information, please call ExamWorks at (866) 800-4637.
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