Chapter 44 Superior Labrum Anterior to Posterior (SLAP) Repair
Surgical Overview
• The labrum is a fibrocartilaginous structure that surrounds the glenoid. It contributes to glenohumeral stability by increasing the contact area for the humeral head and provides resistance to humeral head translation.
• The superior labrum is loosely attached to the glenoid rim and may overlap the glenoid surface. The superior labrum also inserts into the long head of the biceps.
• Pathology resulting from the previously described mechanism of injury can include labral fraying, detachment of the labrum, the labrum being displaced into the joint, and partial rupture of the biceps.
• Surgical intervention for SLAP lesions is dictated by the extent of the injury.
Rehabilitation Overview
• The goals of rehabilitation are to restore normal strength, ROM, flexibility, and normal neuromuscular function.
• Early, controlled range of motion (ROM) is allowed to optimize healing and avoid excessive passive stretching later in the program.
• Throughout the program, the patient is progressed slowly into abduction and external rotation so as to avoid excessive stretch to the labrum and traction to the long head of the biceps.
• The reduced morbidity associated with new, improved surgical techniques will reduce the incidence of motion loss.
• The rate of progression is determined by the functional demands of the patient. Patients who require a great deal of external rotation, such as overhead athletes, will be progressed more aggressively.
• Throughout rehabilitation, a full upper extremity strengthening program will be progressed functionally and independently to prepare the patient for return to activity.
• Biceps strengthening is progressed very slowly because biceps activity can cause traction to the labrum and thus jeopardize the repair.
• The program is based on the patient returning to sport-specific activities no earlier than 3 to 4 months postsurgery.
