Review Question - QID 4470

Figure A shows a superior labral anterior to posterior (SLAP) tear. Passive and active-assisted flexion in scapular plane are usually allowed immediately post-operatively. In general, the early focus is on healing and re-establishing motion, followed by strength training. Post-operative protocols do vary among surgeons (some delay active assisted range of motion) as there is no high level evidence supporting a certain protocol.

SLAP tears can occur as isolated lesions or associated with other injuries such as: internal impingement commonly seen in overhead throwers, rotator cuff tears (usually partial-articular sided), and instability (including micro-instability).

In a biomechanical cadaver study, Shepard et al. tested if the direction of biceps anchor loading would result in differences in the ultimate strength of the biceps anchor and the generation of SLAP lesions. They found that the biceps anchor was significantly weaker when loaded with a posterior vector, as opposed to an in-line pull, and concluded that the superior labrum may be most vulnerable to injury in late cocking.

Figure A shows a T2 coronal MRI that demonstrates an isolated SLAP tear.

Incorrect answers:
Answer 1- Would place stress on a SLAP repair, and is usually avoided for about 4 weeks.
Answer 2- Isotonic shoulder strengthening exercises are usually initiated around weeks 4-6 (isometrics for muscle activation may be started earlier).
Answer 3- Resisted active isokinetic elbow flexion would place stress on a SLAP repair, and is generally usually avoided for 6 weeks.
Answer 5- Concentric latissimus pull down exercises would generally be avoided as immediate shoulder abduction and active elbow flexion would place stress at the SLAP repair site.