Superior Labral Anterior to Posterior Tear Management in Athletes

Abstract

Background: The diagnosis and treatment of Superior Labrum Anterior to Posterior (SLAP) tears have been evolving and controversial. The lack of clear diagnostic criteria on physical examination, Magnetic Resonance Imaging (MRI), and arthroscopic evaluation clouds the issue. The high rate of MRI diagnosed SLAP lesions in the asymptomatic population of athletes and non-athletes warrants consideration when planning treatment for those with shoulder pain.

Objective: To provide information on the evaluation, diagnosis and management of SLAP tears in athletes.

Methods: The results of a structured non-operative rehabilitation program are discussed and compared to traditional surgical techniques. The evolution of the author's treatment algorithm is presented. Results: The successful return to overhand throwing is more common with non-operative treatment than with surgical.

Conclusion: A rehabilitation program focused on stretching the posterior capsule and correcting scapular posture is more successful than surgery for most throwers with SLAP lesions.

Keywords: Baseball Players; MRI; Overhead Athletes; SLAP; SLAP Repair; Superior Labrum Anterior Posterior tear.

Fig. (1)

Clinical photograph demonstrating positioning of the Internal Impingement Test. The patient must delineate the location and character of pain (pinching, catching, and instability). Localized pain in the posterior joint line is suggestive of internal impingement.

Fig. (2)

Clinical photograph demonstrating position to assess for a Deceleration sign. With the patient in the follow through position of pitching, posterior pain with applied downward pressure of the wrist is suggestive of inflammation potentially due to eccentric failure or excessive strain of the posterior rotator cuff.

Fig. (3)

Clinical photograph demonstrating positioning to assess for Posterior Capsule Tightness. The forearm must be kept in neutral rotation to adequately access the posterior inferior capsule. An inability of the elbow to cross the midsagittal plane is suggestive of tight posterior capsule.