Biceps tendon disorders - SLAP (Superior labrum) tears

At Schoen Clinic, you can receive comprehensive advice from our shoulder and elbow specialists and discuss which treatment is best for your symptoms.

Overview

The shoulder is a ball and socket joint. The socket of the shoulder is like a flat saucer, while the ball is a hemisphere. This arrangement of a shallow socket and a hemispherical ball allows for a large range of movement, but makes the joint prone to instability. To increase the stability of the joint without compromising the movement, the socket is deepened by the attachment of a cartilage along its circumference called the 'Labrum' which resembles a ring of gristle around the socket. Along the upper part of this ring, the tendon of the biceps attaches to the labrum.

Causes & Symptoms

A SLAP lesion occurs when the upper labrum (superior labrum) is torn at or near it's attachment with the biceps. The tear occurs on either side of the 12 o'clock position on a clock face hence the name Superior Labrum Anterior and Posterior (SLAP) Tear.

A SLAP tear usually occurs with heavy forceful lifting, repeated overhead activity (tennis, throwing) or a fall on the outstretched hand.

Diagnostics

The diagnosis is made from the history and findings at an initial consultation. The patient can present with pain or mechanical symptoms in the joint. If associated with an anterior labral tear, they may present with a history of shoulder instability or dislocations. In addition, special imaging such as an MR-Arthrogram help in confirming the diagnosis, however, in the absence of findings on examination or MR, a diagnostic arthroscopy may sometimes be performed.

Treatment

If symptomatic, the tear can be treated surgically using 'keyhole' surgery as a day procedure. Using special bone anchors (screws) and sutures, the torn labrum is attached back to its normal position. Sometimes, the tear may be irreparable. In such cases, it is smoothed down (debrided) to a stable surface and the long head of biceps is fixed into the humeral head (biceps tenodesis).

As with all surgery there is a risk of some complications. These are rare, but you should be aware of them before your operation. They include:

•     Complications relating to the anaesthetic

•     Infection

•     Failure to achieve successful result

•     A need to redo the surgery

•     Injury to the nerves or blood vessels around the shoulder

•     Fracture

•     Implant failure

•     Complete tear of biceps

•     Prolonged stiffness and or pain

Aftercare

You will usually be in hospital either for a day or overnight. Your consultant or physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery. You will be given a sling. This is required for up to 3-4 weeks. You should avoid forced straightening of the elbow or heavy lifting for at least six weeks. You can expect to be back at work between 6-10 weeks depending on your job. Your symptoms should be approximately 80% better after three months but may take 6-12 months to totally settle.

Pain:

A supplementary local anaesthetic or nerve block is often used during the operation which means that immediately after the operation the shoulder and arm may feel numb. This may last a few hours. After this the shoulder may well be sore and you will be given painkillers to help this whilst in hospital. These can be continued after you are discharged home. Ice packs may also help reduce pain. Wrap frozen peas or crushed ice in a damp, cold cloth and place on the shoulder for up to 20 minutes.

Wearing a sling:

You will return from theatre wearing a sling. This is required for up to four weeks, to allow the repair to heal. You should avoid forced straightening of the elbow or heavy lifting for at least six weeks.

Exercises:

After leaving hospital you should exercise the arm frequently throughout the day. The arm may feel sore whilst you are doing the exercises but there should be no intense or lasting pain. Aim for two exercise sessions per day. Your physiotherapist will advise you regarding the exercises prior to discharge.

The wound:

There will be no stitches (or absorbable ones) only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5-7 days.

Driving:

You may begin driving 4-5 weeks after your operation.

Returning to work:

This will depend on your occupation. If you are in a sedentary job you may return as soon as you feel able, usually after one week. If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence (eight weeks).

Leisure activities:

You should avoid sustained, repetitive overhead activities or activities involving forced elbow extension  for three months. Golf can begin at twelve weeks. For guidance on DIY and racquet sports you should speak with your physiotherapist

Follow up Appointment:

You will be made a follow up appointment at the hospital around three weeks after your surgery. At this stage you will be reviewed by your consultant  who will check your progress, make sure you are moving your arm properly, and give you further exercises as appropriate.

Treatments are available at the following locations

Schoen Clinic London

Our Address
Schoen Clinic
Orthopaedic and Spinal Hospital London
66 Wigmore Street
London W1U 2SB
General Telephone Enquiries
+44 (0)203 929 0801
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Specialists

Mr Adrian J Carlos

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Mr Giuseppe Sforza

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Dr Philip Batty

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