SLAP lesion surgery

A SLAP lesion (Superior Labrum tear from Anterior to Posterior) is a shoulder condition that is often operated on. But not all SLAP lesions require surgery. This depends on the type of SLAP lesion.

In a SLAP lesion, the labrum is damaged. The labrum is a raised rim on the socket of the shoulder. This rim provides extra stability to the shoulder joint.

Surgical treatment

The chosen treatment for a SLAP lesion partly depends on the type:

Type I SLAP lesion
Type I SLAP lesions are often treated without surgery. This type often arises due to loss of quality of the labrum. The loss of quality does not cause instability of the labrum or the biceps tendon. Therefore, surgery is not useful and non-operative treatment often works better. If non-operative treatment does not work well, surgery can still be performed. The operation will then consist of 'debriding' the frayed labrum. These frayed edges of the labrum can cause pain and/or impingement in the shoulder.

Type II SLAP lesion
Type II SLAP lesions are usually repaired during surgery using a so-called single anchor, double suture technique. This means that a suture is fixed into the bone of the shoulder socket (glenoid). This is the anchor. From the anchor, a sling is formed that is pulled in a V-shape around the biceps tendon and the labrum. This provides good fixation of the labrum.

Type III SLAP lesion
Type III SLAP lesions are treated surgically with a resection of the bucket-handle. This means that the present bucket-handle/flap is removed. The labrum is then checked for any remaining fraying. If present, this is removed. With larger frayed parts of the labrum, an additional anchor is used to fix the labrum to the bone.

Type IV SLAP lesion
In type IV lesions, the surgical treatment depends on the state of the biceps tendon. If the biceps tendon itself is still minimally damaged and good, it is treated like a type III lesion. A biceps tendon that is more than 30% damaged is treated like a type II. The biceps tendon is then removed or repositioned and the labrum is sutured.

Besides the type of SLAP lesion, there are other factors that determine the surgical technique, such as:

• Age of the patient.
• Quality of all muscular/tendinous tissue of the shoulder.
• Activity pattern of the patient.
• Risk of complications.
• All these factors ultimately determine which operation is performed.

After the operation

The patient is given a sling to rest the shoulder. This sling must be worn for 5-6 weeks. Immediately after an operation, a patient may do mobility exercises for the elbow, wrist and hand.

After one week, passive mobilisations may be started. This means that a physiotherapist moves the joint without muscle force from the patient. This is to prevent a joint from stiffening. In this way, the tissue around the shoulder also already receives some coordination stimuli to recover.

In the first 6 weeks, the biceps tendon is the most important aspect. This tendon must be protected from large forces to prevent the biceps from pulling the labrum loose again. The patient is therefore instructed not to lift anything with the operated arm.

For rehabilitation of a shoulder after a SLAP operation, a time indication is used, mainly with regard to wound healing. The actual build-up of training and intensity during rehabilitation depends on the shoulder function at the time. Important factors here are mobility, function and pain scores.

Six weeks after the operation, only then may light strength training of the shoulder begin. After about three months, heavy lifting and sports activities below shoulder height may be started. Only after six months are activities above shoulder height allowed. A shoulder must first be able to move freely optimally before rehabilitation can be continued.