Superior Labrum Injuries of the Shoulder

Normal Biceps tendon and Superior Labrum

Superior labrum avulsion and Arthroscopic Repair

This is a condition of the shoulder which usually affects younger people. It is most commonly caused by a fall on the arm although may also be seen in people who participate in overhead activities such as throwing. The oval bony glenoid has a rim of tissue (the labrum) around its edge that serves as a "road bump" for the humeral head (fist image above). At the top of this rim the biceps tendon also attaches and merges with the labral tissue becoming one unit. A superior labrum anterior posterior (SLAP) lesion is a pathologic condition where the labrum and the biceps tendon insertion along the bony glenoid is damaged. An advanced lesion in one where the labrum and the biceps tendon is avulsed off the bony glenoid as seen in the first picture above.

What are the signs and symptoms?
Usually patients complain of pain, clicking or a feeling of instability in the shoulder. It is made worse when they put the arm into the "cocked position" ready to throw. Some may complain of pain in the shoulder on lifting heavy objects. A clicking sound may also be heard when trying to throw.

How is the diagnosis made?
Your orthopaedic surgeon will listen to the description of events and examine the shoulder. X-Rays will also be taken to determine whether there is a piece of bone involved. An MRI scan with contrast is usually required, as the lesion itself will not show up on an X-Ray.

If there is any doubt about the diagnosis a diagnostic arthroscopy of the shoulder will be done.

What is the initial treatment?
Rest, ice, and anti-inflammatory medications is the standard treatment to reduce inflammation and swelling in the injured shoulder. Once the early intense pain is controlled, a rehabilitation program focusing on posterior shoulder capsule stretching, strengthening and balancing the muscles of the shoulder girdle is begun. Minor injuries may respond favorably to this treatment plan. Advanced lesions usually require labral reconstruction.

If initial treatment doesn't work, what's next?
If symptoms persist, arthroscopy will be required to reconstruct the superior labral lesion. If possible, the torn tissue is reattached to the bone using small suture anchors. In cases where the labral tissue has not torn off the bony glenoid, the frayed tissue is simply shaved and smoothed down. The surgery is done arthroscopically through 3-4 small puncture incisions. The surgery is done as an outpatient so you can go home the same day. On average, light sports will be allowed no sooner than 3 months. Contact sports are usually allowed at 4 months.

Post operative Instructions and SLAP Repair Rehabilitation