Is there anything new in the way SLAP tears are being treated these days?
Diagnosing a SLAP lesion can be a difficult task requiring expertise in clinical examination and radiographic evaluation. However, once the diagnosis has been made, then a plan of care can be determined. Treatment may be nonoperative first. Athletes are shown how to change the way they do things in order to take the pressure off the structures and let them heal. Pain relievers, corticosteroid injections, and antiinflammatory drugs may be used. A program of physical therapy is prescribed. The therapist's focus is on reducing the glenohumeral internal rotation deficit (GIRD). The rehab program will also work toward improving the flow of movement and energy throughout the entire kinetic chain. Kinetic chain refers to various body parts connected and moving together (entire upper or lower extremity in connection with the body). Sometimes surgery is needed to débride (clean up) any frayed pieces, reattach the labrum, and/or repair the torn tendon. There are many different ways to approach the surgical treatment of SLAP injuries. It may be a while before we know which surgery works best for each type of SLAP tear. Outcome studies assessing each type of tear are just becoming part of the published literature. Surgeons are also seeing other injuries or diagnoses along with the SLAP tear. For example, shoulder instability with shoulder dislocation has been linked with SLAP injuries. Anterior (forward) dislocation leads to an anterior labral tear. When the force of the injury is enough to involve the rotator cuff, then the risk of a SLAP tear increases as well. There can be cysts along with SLAP lesions. If the cyst is large enough or in just the right spot, nerve compression can occur. Both components are usually repaired to assure a good outcome. But more recent research has brought this into question. It seems that patients get just as good of results whether or not the cyst is removed or aspirated (deflated). Much more study is needed to help improve the treatment of SLAP lesions. Type of injury, location of injury, and treatment of the lesion direct the clinical management of this problem. But more knowledge is needed of patient age, anatomy, and function of the labral mechanism. As our understanding of the risk factors and mechanisms for SLAP injuries increases, treatment will be refined with improved outcomes. Right now these things are hotly debated.