SLAP lesion surgery

A SLAP lesion (Superior Labrum tear from Anterior to Posterior) is a shoulder condition that is often operated on. Not all SLAP lesions are operated on. This depends on the type of SLAP lesion.

In a SLAP lesion, the labrum is damaged. The labrum is a raised rim on the socket of the shoulder. This rim provides extra stability to the shoulder joint.

Surgical treatment

The chosen treatment for a SLAP lesion partly depends on the type:

Type I SLAP lesion
Type I SLAP lesions are often treated without surgery. This type often results from loss of quality of the labrum. The loss of quality does not cause instability of the labrum or the biceps tendon. Therefore, surgery is not useful and nonoperative treatment often works better. If the nonoperative treatment does not work well, surgery can still be performed. The surgery will then consist of “cleaning up” the frayed labrum. These frays of the labrum can namely cause pain and/or impingement in the shoulder.

Type II SLAP lesion
Type II SLAP lesions are usually repaired during surgery using a so-called single-anchor, double-suture technique. This means that a suture anchor is fixed into the bone of the glenoid. That is the anchor. From the anchor, a sling is formed that is pulled in a V-shape around the biceps tendon and the labrum. This provides good fixation of the labrum.

Type III SLAP lesion
Type III SLAP lesions are treated surgically with a resection of the bucket-handle. This means that the present bucket-handle/flap is removed. The labrum is then inspected for any remaining frays. If these are present, they are removed. In the case of larger frayed parts of the labrum, an additional anchor is used to secure the labrum to the bone.

Type IV SLAP lesion
In type IV lesions, the surgical treatment depends on the condition of the biceps tendon. If the biceps tendon itself is still minimally damaged and otherwise good, it is treated like a type III lesion. A biceps tendon that is more than 30% damaged is treated like a type II. The biceps tendon is then removed or repositioned, and the labrum is sutured.

In addition to the type of SLAP lesion, there are other factors that determine the surgical technique, such as:

• Age of the patient.
• Quality of all the shoulder muscle/tendon tissue.
• Activity level of the patient.
• Risk of complications.
• All these factors ultimately determine which surgery is performed.

After the surgery

The patient is given a sling to rest the shoulder. This sling must be worn for 5-6 weeks. Immediately after surgery, a patient may do mobility exercises for the elbow, wrist, and hand.

After one week, you may start with passive mobilizations. This means that a physical therapist moves the joint without muscle force from the patient. This prevents the joint from becoming stiff. In this way, the tissue around the shoulder also already receives some coordination stimuli to recover.

In the first 6 weeks, the most important aspect is the biceps tendon. This tendon must be protected from large forces to prevent the biceps from pulling the labrum loose again. The patient is therefore instructed not to lift anything with the operated arm.

For the rehabilitation of a shoulder after a SLAP surgery, timing is guided mainly by wound healing. The actual progression of training and intensity during rehabilitation depends on shoulder function at the time. Important here are mobility, function, and pain scores.

Only six weeks after the surgery may light strength training of the shoulder begin. After about three months, heavy lifting and sports activities below shoulder height may begin. Only after six months are activities above shoulder height allowed. A shoulder must first be able to move freely optimally before rehabilitation can be continued.