Doctors in the United Kingdom say magnetic resonance arthrography while having a high diagnostic accuracy for labral tears and Hill-Sachs lesions, is controversial. Arthroscopic diagnosis remains the gold standard. The revision surgery to fix the first surgery Surgeons writing in the Open Orthopaedics Journal 13 discuss what they see in patients with a failed SLAP tear surgery: Causes for failed SLAP repair are: misdiagnosis, poor healing, recurrent injury, suture anchor placement, over-tensioning the bicep tendon and labrum are pulled too tight failure of metallic proud anchors, loose tacks, infection.
History and physical exam findings lack specificity. There is substantial inter and intraobserver variability amongst experienced shoulder arthroscopists with surgeons having difficulty distinguishing normal shoulders from type II SLAP tears.
It has been noted that there was a trend to overtreat SLAP lesions in the US and it has been postulated that some patients with a failed SLAP repair underwent repair of a normal labral variant.
Eight studies were examined, 99 athletes; average age, about 20 to 47 years old , with baseball and softball players the most common among them 62 of the patients.
Sixty-eight patients had magnetic resonance imaging-documented SLAP lesions. All patients had failed 1 attempt at rehabilitation but had continued with supervised physical therapy. Treatment was according to an algorithm focusing on the correction of scapular dyskinesia and posterior capsular contracture with glenohumeral internal rotation deficit GIRD , followed by a pain-free return to throwing.
Scapular dyskinesis or SICK scapula syndrome is considered an overuse injury common in throwing athletes in which there is abnormal movement and resting location of the scapula. Posterior capsular contracture with glenohumeral internal rotation deficit GIRD also signifies the abnormal movement of the shoulder with overuse being a possible cause.
Those who failed 2 cycles of nonsurgical treatment were treated surgically. Sixty-eight athletes were identified with SLAP lesions. Twenty-one pitchers successfully completed the nonsurgical algorithm and attempted a return.
The rate of return after surgical treatment of SLAP lesions was low for pitchers. The return-to-play rate and RPP rates were higher for position players than for pitchers. Nonsurgical treatment should be considered for professional baseball players with documented SLAP lesions, as it can lead to acceptable return-to-play rate and return to prior performance rates.
In a study from late , doctors at Wayne State University School of Medicine published these findings: 16 Of the twenty-four Major League Baseball players who had SLAP tear surgical repair between and who met the study criteria: Of those able to return to play , The shoulder labrum works with the shoulder ligaments to provide shoulder stability. When labrum or shoulder ligaments are injured, the shoulder becomes unstable, the shoulder can dislocate or pop out of place.
There is a clicking sound on movement, athletes find that they have no overhand power. Why Prolotherapy? Because whatever the injury that caused the slap lesion will have likely injured the ligaments in the front of the shoulder and the back of the shoulder. Injury or tearing to the rotator cuff tendons and biceps tendon has probably occurred.
So you have to get all those areas treated. Typically people will get 4 treatments as far as rehabilitation after you get prolotherapy for a slap lesion after the first visit I normally waited to have them do exercises that limit their shoulder motion so the elbow stays close to the side.
They put the shoulder joint in an abducted and externally rotated position which puts increased strain on the labrum. The treatments we offer are Prolotherapy. This is a simple dextrose injection that promotes tissue healing through a controlled inflammation. Platelet Rich Plasma Injections which is the use of your own healing blood platelets to repair damaged tissue.
For significant damage or when healing needs to be performed on a more accelerated method, we may prescribe stem cell therapy. This is the use of your own stem cells. We do not offer stem cells to every patient. This procedure is explained in the video below. As explained in the video above and presented in more detail here. A patient may get 30 separate injections in one Prolotherapy treatment. Why so many treatments? Because we are treating the entire shoulder joint complex.
This includes the shoulder ligaments and tendons as well as the SLAP lesion. This, of course, would be especially beneficial to laborers and athletes because you are strengthening the other important areas of the shoulder. After treatment: We typically recommend exercises that limit their shoulder motion so the elbow stays close to the side. We would discuss altering work-related movements to keep the elbow close, like how to swing a hammer or use power tools.
For the athlete how to throw. It is important to keep pressure off the labrum while it is healing and rehab properly. Regenerative injection therapies, including prolotherapy , have shown promise in the treatment of several musculoskeletal disorders, but have not previously been applied to a glenoid labral tear. Here we review several important aspects of these lesions and present an initial case series of 33 patients with a labral tear that was treated in our clinic with intra-articular injections of hypertonic dextrose.
Patient-reported assessments were collected by questionnaire at a mean follow-up time of 16 months. Treated patients reported highly significant improvements with respect to pain, stiffness, range of motion, crunching, exercise, and need for medication.
All 31 patients who reported pain at baseline experienced pain relief, and all 31 who reported exercise impairment at baseline reported improved exercise capability. One patient reported worsening of some symptoms. Prolotherapy for glenoid labral tear appears to be a safe procedure that merits further investigation. Do you have a question about your shoulder? Make an Appointment Subscribe to E-Newsletter.
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Most SLAP injuries are first treated with nonsurgical methods. A physical therapist can show you how to do specific exercises for SLAP tears. These exercises will focus on improving the flexibility, movement, and strength of your shoulder. The most common method is an arthroscopy. During this procedure, a surgeon makes small cuts in your shoulder. They insert a small camera, or an arthroscope, into the joint. The surgeon then uses miniature surgical tools to repair the SLAP tear.
With proper rehabilitation, you can expect to regain full range of motion after a SLAP tear surgery. If you work a physically demanding job, you may need to miss work for most of this time. Otherwise, you might be able to return to work within a few weeks. While there are many types of SLAP tears, most can be treated with physical therapy or surgery.
The best method depends on your age, overall health, and specific injury. This will help your shoulder heal and regain its normal range of function. Having shoulder pain? It could be a torn labrum. Learn how to recognize and treat this condition. The rotator cuff is a group of four muscles that stabilize the shoulder. When you injure your rotator cuff, you need to exercise it for full recovery. Few would suspect the cause of shoulder pain to be something as typical and inactive as sitting at our desks.
Relative rest forms an important part of any rehab programme. NSAIDS can be useful for pain management and to help reduce swelling and inflammation — especially in the early stages. In some cases the pain may not respond to pain medication, in which case a corticosteroid injection may be appropriate. Steroids can, however, interfere with the healing process so it should only be used if really needed. Hands-on treatment consisting of soft tissue release and dry needling can be a very effective alternative to using pain medication or injections.
It can provide very good pain relief and does not come with so many side effects. The length of the rehab programme should really be tailored according to your injury, but 16 weeks is a good starting point. You may take longer if your injury is more severe or shorter if you only have a tiny tear in your labrum. The current theory with regards to why this injury happens is that, due to the high volume of repetitive overhead movements these athletes do, they:.
The tight capsule usually causes the shoulder to have less internal rotation than on the other side, so it is useful to test the total rotation range of motion in the one shoulder vs. These athletes often also develop a muscle strength imbalance between the internal rotators stronger and the external rotators too weak of the shoulder.
This will allow the tendon time to reattach and settle down. Your first aim should be to restore full range of motion in the shoulder into all directions. Free active movements, where you move the arm into all directions but stop just short of pain can be useful for this. The Sleeper stretch is one that is commonly prescribed to help stretch the posterior capsule and increase internal rotation, but it can actually cause a lot of pain during the early stages of this injury.
They are often caused by degenerative wear-and-tear on the labrum over time. Adults in their 40s and 50s commonly experience SLAP injuries because the labrum has become worn down. Certain types of arthritis can also contribute to SLAP tears by degenerating the cartilage surrounding the shoulder joint.
Your doctor will look at your medical history and evaluate your physical symptoms to accurately determine the cause of your SLAP injury. A SLAP injury will cause a range of specific symptoms in both acute or chronic injury. Labrum wear-and-tear is a common complaint among older adults and those with osteoarthritis.
Since the labrum is soft tissue cartilage, it can become worn down over time and with repetitive motions and symptoms can develop over time. Those who experience sudden symptoms, however, most likely have an acute injury. SLAP injuries are most often diagnosed with imaging tests, such as X-rays or MRIs, but your doctor will also consider your medical history and conduct a thorough physical examination to make the diagnosis.
By thoroughly examining your injury from every angle, your doctor can make the most accurate diagnosis.
First, your doctor will talk with you about your pain, where it is located, and when it first began. While some patients may recall a specific event or activity that triggered their pain, SLAP injuries commonly present without an obvious cause.
In that case, your doctor will talk to you about your daily activities, sports you play, and what you do for work to determine the cause of your SLAP injury. They will also run certain blood tests if they suspect arthritis might be to blame. Your doctor will test the strength, mobility, and range of motion in your affected shoulder by taking your arm through a series of movements to reproduce your symptoms.
SLAP injuries will predictably cause pain in certain positions and with certain movements, and testing positive for pain during these tests will help your doctor determine if additional testing or imaging is needed. It is also common for SLAP injuries to appear in conjunction with other shoulder pathologies, and your doctor may look for signs of other abnormalities as well for a thorough work-up. Doctors will use a combination of X-rays and MRIs magnetic resonance imaging to assess your injury.
X-rays provide clear pictures of dense structures like the bone. X-rays are ordered if your doctor suspects other problems, such as arthritis or a fracture, may be contributing to your symptoms. Sometimes a dye is used to more clearly see a SLAP injury. SLAP injuries cannot be healed naturally, and often times surgery is needed to make a full recovery.
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