Slap Tear

ANATOMY

The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. This means that the bones of the shoulder are not held in place adequately, and therefore extra support is needed.Slap Tear

To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called  labrum that forms a cup for the end of the arm bone (humerus) to move within. The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of car-tilage makes the shoulder joint much more stable, and allows for a very wide range of move-ments (in fact, the range of movements your shoulder can make far exceeds any other joint in the body).


What is a SLAP tear?

Slap Tear - Dr Ashwani MaichandA SLAP tear is a specific kind of injury to your shoulder.To help make your shoulder more stable, there is a ring of firm tissue, called the labrum, around your shoulder socket. The labrum (say "LAY-brum") helps keep your arm bone in the shoulder socket.

SLAP stands for "superior labrum, anterior to posterior"-in other words, "the top part of the labrum, from the front to the back." It refers to the part of the labrum that is injured, or torn, in a SLAP injury

 

What causes a SLAP tear?

The labrum frays or tears because of an injury. You may get a SLAP tear if you:

 

  • Fall on your outstretched arm.Slap Tear
  • Fall on your shoulder.
  • Brace yourself with your outstretched arm in a car accident.
  • Lift heavy objects repeatedly or too suddenly.
  • Do a lot of overhead activities, such as throwing a baseball.

This injury was first identified in the 1980s in athletes, like baseball players, whose sport requires them to do a lot of overhead throwing.

Many people with SLAP tears also have other shoulder inju-ries, such as a tear in the rotator cuff.

What are the symptoms?

Symptoms of a SLAP tear may include:

 

  • Painful popping, clicking, or catching in the shoulder.
  • Pain when you move your arm over your head or reach back.
  • Pain when you throw a ball.
  • An ache often described as being deep inside the shoulder.

How is a SLAP tear diagnosed?

A SLAP tear can be hard to identify, because there are so many other things that can cause shoulder pain and because SLAP tears are not common.

Ways to diagnose a SLAP tear include:

· A series of tests in which your doctor moves your shoulder joint around to see which movements are causing your pain.

MRI. A special dye is injected into your shoulder before you have an MRI scan. When a dye is used, the test is called an MRI arthrogram.

Sub-types

At least ten types of this injury are recognized with varying degrees of damage, seven of which are listed hereSlap Tear - Dr Ashwnai Maichand

1. Degenerative fraying of the superior portion of the labrum, with the labrum remaining firmly attached to the glenoid rim

2. Separation of the superior portion of the glenoid labrum and tendon of the biceps brachii muscle from the glenoid rim

3. Bucket-handle tears of the superior portion of the labrum without involvement of the biceps brachii (long head) attachment

4. Bucket-handle tears of the superior portion of the labrum extending into the biceps tendon

5. Anteroinferior Bankart lesion that extends upward to include a separation of the biceps tendon

6. Unstable radial of flap tears associated with separation of the biceps anchor

7. Anterior extension of the SLAP lesion beneath the middle glenohumeral ligament

Nonsurgical Treatment

Immediately after an injury, the so-called R.I.C.E. treatment is recommended.R.I.C.E. stands for: Rest, Ice, Compression, Elevation
 

Nonsurgical treatment Includes:

 

  • Medications
  • Progressive physiotherapy and rehabilitation
  • Use Assistive and support Devices

Surgical Option

Indications for Surgery

  • Unremitting pain
  • Loss of ADL function
  • Significant loss of strength
  • Bony impingement with failed rehab
  • Moderate to massive tears w/active job, healthy and < 50
  • Isolated partial & full thickness tears with high probability of success without relief from rehab
     

Surgery Types

Advantage and disadvantage two type of surgery:

Arthroscopic

 

  • Less invasive
  • Faster recovery
  • No deltoid incision
  • Very less swelling/pain
  • Visualize the whole joint
  • Requires more technical skill

Open

 

  • More invasive
  • Slower recovery
  • Deltoid taken down
  • More swelling/pain
  • Can not visualize the whole joint
  • Less technical skill required

Dr. Ashwani trained in arthroscopic surgery and thus always prefer arthroscopic repair as it has various advantages.
 

The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look).

SLAP tears are repaired with arthroscopic techniques

The arthroscope is a small fiber optic instrument that is placed into the joint through a small incision. A camera is attached to the arthroscope and the image is viewed on a TV monitor. The arthroscope allows a complete evaluation the entire shoulder joint, including the ligaments, the rotator cuff, and the cartilage surface.

Small instruments ranging from 3-5 millimeters in size are inserted through additional small incisions so that any injury can be diagnosed, and damaged tissue can be repaired reconstructed or removed.
 

In SLAP tears, the damaged labrum and biceps tendon are identified and then repaired back to the socket. This is usually performed by using suture anchors (a small rivet with sutures attached) to
sew the labrum back in place.

The anchor is usually bioabsorbable, meaning the body absorbs the anchor over time. Some times a metal anchor is used, which does not need to be removed.
Occasionally, the biceps tendon is too damaged to repair. In this case, the tendon is cut and reattached in the upper arm (biceps tenodesis). This requires a small incision. If the tendon needs to be cut, there is no loss of strength that occurs

Upcoming Events
 
 
  • Coming up with a mega campaign "Lets Fight Arthritis" on the occasion of World Arthritis Day, at A4 Block, Gauri Shankar Mandir, Paschim Vihar, New Delhi. The campaign will be on 9th October 2016(Sunday). 

  • Health Awareness Campaign on 28th August at Gurudwara Singh Sabha E Block Karampura, Delhi.

  • Coming up with a mega campaign on Spine & Back Pain on 5th June 2016 at Gurudwara New Ranjeet Nagar (near Satyam Ciema), Patel nagar, Delhi in association with Sukhmani Charitable Trust, Delhi.

  • Coming up with an awareness campaign on Arthritis Management & Control on 22nd May 2016 at Guru Ram Dass Charitable Medical Centre - Gurudwara Sri Guru Singh Sabha, Moti Nagar, Delhi.  

  • Mega campaign on Arthritis Management on "Mother's Day" 8th May 2016 at West Patel Nagar, Delhi - 110008

  • Mega campaign on Arthritis Management in association with "Varishth Nagrik Kesari Club" - Punjab Kesari Delhi on 6th April 2016 (Wednesday)

  • Dr. Ashwani Maichand Participated in Shoulder Conclave 2016 at JWT Marriott, Pune

  • Dr. Ashwani Maichand was the Table instructor for young doctors at Cadaver Joint Replacement Training on 21st February 2016 at All India Institute of Medical Sciences (AIIMS)

  • Arthritis Awareness campaign on 28th february 2016 from 10 am to 1 pm at Minomax Knee & Shoulder Clinics (8/29, West Patel nagar, Delhi, India)

  • Participating as a speaker on "Dificult cases of Hip & Knee Replacement" in 2nd Masters Course in Arthroplasty at Meril Academy, VAPI, Gujarat from 4th to 6th February 2016

 
 

 

 

 

 

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Dr Ashwani Maichand
M.S., M.Ch. (Ortho)
Fellowship Joint Replacement
Specialist : Knee & Shoulder
 
Dr. Rahul Kakran
M.s., M.Ch (Ortho)
Specialist : Minimal Invasive Spine Surgery (MISS)
  
Dr. Rajni Koundal
BPT
Consultant Physiotherapy
 
For Appointment : 9999074745
( Mr. Sunny ) 
 
For Upcoming Events : 9999071715
( Mr. Sarabjeet Singh)
 
Address : 
 
MinOmaX Knee & Shoulder Clinics
8/29, West Patel Nagar,opp. D.A.V. Sr. Secondary School (near Metro Pillar no. 198, Delhi-110008)
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