A SLAP is an acronym for an injury at the Biceps tendon-labrum complex. The area where the biceps tendon attaches to cartilage rim (labrum) surrounding the Glenoid. The injury is commonly seen in throwing sports, but a sudden eccentric load on the biceps tendon may also lead to its traumatic tear. Other instances maybe due degeneration (wear and tear)
Patients presenting with such symptoms for the first time to our clinic, are ususally given a thorough clinical assesment and appropriate investigations like x-rays or MRI scans may be requested. After diagnosis, a physiotherapy protocol is initially recommended for most patients. Patient's who fail the above protocol are recommended for surgery.
Pre-Operative assesment
This involves being assesed by a Physician / Anaesthetist to decide on fitness for surgery and the type of anaesthesia. Appropriate blood tests, X-rays and Scans may be requested. This is usually a General Anaesthesia with a nerve block for post-operative pain releif, if necessary.
Admission
This maybe done as a day-care or an over-night(s) admission procedure, depending on other co-morbidities (illnesses) and insurance provisions.
Procedure
Inside the operating theatre, our Anaesthetisit will give the General Anaesthesia, and a block sometimes, for post-operative pain relief.
Position
This is usually done with the patient in the lateral position (lying-by-the-side) or sometimes by the beach-chair position (semi-sitting). With the former position, the arm is suspended by a simple pulley traction system. to facilitate the procedure. If a beach-chair position is used, mechanical compression stockings may be used, to facilitate blood flow from the legs.
Arthroscopic Procedure
After Anaesthesia, the area is prepared by cleaning thoroughly with anti-septics (e.g. Chlorhexidine), and draped with sterile sheets to maintain sterility during the procedure. Antibiotics also may be administered.
A small (less than a cm) stab incision called a portal (key-hole size), is made at the back of the shoulder to facilitate entry into the joint. A cannula (conduit) is inserted to keep the portal open. A tiny camera (Arthroscope), with a light source and water inflow are used to visualise the joint. The landmarks inside the shoulder joint are duly noted, and the integrity of structures may be probed with a tiny probe through another portal made from the front of the joint.
The presense of a SLAP leison is confirmed by probing the tear. It is carefully assesed along with that of the Biceps attachment, noting the extent of damage. Certain bucket-handle type tears are trimmed, but if there is disruption of the tendon-biceps complex, it has to re-attached to the bony rim. In elderly individuals with an associated wear and tear of the rotator-cuff, it may be preferable to cut the biceps tendon (tenotomy/tenodesis) than repair the SLAP leison. So, the initial assesment is crucial for confirmation of the problem, as well as to determine appropriate surgery.
When a decision, is made to repair the leison, one or two additional portals are made. Two specialised anchor sutures are inserted on either side of the biceps tendon attachment, and using specialised techniques, threaded through the labrum, and the whole complex is secured back to the rim.
After the Procedure, the patient may find himself or herself, in the Recovery Room, which is a specially equipped and staffed room for recovering patients from Anaesthesia. They may notice that their arm is supported in a sling, to protect them from moving their operated shoulder. And after recovery, they will be shifted to the ward. Usually, if it was a planned day-case procedure they may be discharged on the same evening, if not the following day.
After discharge, the patient is asked to return to the clinic for regular dressing changes till, sutures are removed.
Re-habilitation involves six weeks of immobilisation in the sling, followed by gradual mobilisation to obtain a good range of motion. The special Re-habilitation protocol is individualised according to patient's needs. It is often a fine balance between delaying it just enough to let it heal un-disturbed and starting it early enough, to minimise stiffness. After due re-habilitation, sports specific exercises are instituted, for sportspersons who are intending to get back to play.
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