Shoulder: SLAP Tear... Anyone else?

[DeanMoriarty]

So im having an arthroscopic labrum repair next week and was wondering if anyone else ever had this procedure.

More importantly how you felt after full recovery and getting back on the mountain and riding.

thanks

[carpbum]

I had it done last year; due to problems with adhesions, the doc had to perform 2 follow up procedures. The pain was not good, but the drugs weren't so bad. The doc wasn't able to talk me into renting an articulating electric chair until after the third procedure, I probably wouldn't have needed the second two procedures if I'd gotten a chair after the first operation. I stayed on skis all season, except for a two week break in early Feb after the first operation. I got used to skiing without poles and I was REALLY careful not to fall. The most painful ski-related incident was the first time after surgery, when I got on a chair and I instinctively reached back to feel for the chair, HOLY SHIT that hurt.

[carpbum]

BTW, mine took 8 anchors to make the repair. Doc Martin at Orthpeodic Center of the Rockies told me he never did one that took more anchors.

[DeanMoriarty]

damn that sucks.

so do you think your better now than before you got the surgeries?

I hope mine goes ok.. the doc presented it to me as not being that big of a deal.

[The Reverend Floater]

I had this along with a few other items done 3 years ago. It was a total success--my shoulder seriously feels great these days. Just rehab the tits out of it.

[Arty50]

Had it done a dozen or so years ago. My doc used a biodegradable tack instead of a screw. That way he wouldn't have to go back in to remove the screw. Unfortunately, he didn't send me to PT afterwards though. Lame.

Still, the surgery was a complete success and the pain I had before was gone. My shoulder was still a bit off though until I finally saw a PT a year or two later.

The pain wasn't too bad either. Took darvocet for 3-4 days, and was fine after. I couldn't move my arm for a week or two after the surgery, and things were tight for a while longer. But all in all it wasn't that bad.

[DeanMoriarty]

thanks for the info and support. looks like im going to be gimping for a while... the good news is i will have plenty of time to recover and heal before next ski season. My doc is the team doc for the miami dolphins... but judging by their performance as of late that does not seem to comfort me. lol

[drmark]

I am not a believer in the SLAP lesion, except perhaps in the throwing athlete. I think it is an incidental finding. Although, there is a treatment in search of a conditon. I usually don't operate on it and my results with rehab and no surgery have been confirmed in the medical literature.

Here is the article.




July 13, 2007 (Calgary) –– Treating superior labral tears (superior labrum anterior posterior tears [SLAPs]) with physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) was as effective as surgery in a long-term study reported at the American Orthopaedic Society for Sports Medicine (AOSSM) 2007 Annual Meeting here.

Physicians are more likely to recommend nonoperative treatment based on these results, Jeffrey R. Dugas, MD, an orthopedic surgeon with Andrews Sports Medicine and Orthopaedic Center in Birmingham, Alabama, and the session comoderator, told Medscape. "It will change the way physicians practice."

SLAPs are injuries to the top part of the cartilage that stabilizes the shoulder joint. They can occur as a result of acute trauma, such as a fall, or as a result of repetitive motion, such as pitching a baseball. Previous research has shown surgery to be effective in up to 87% of patients, said lead researcher Sara Edwards, MD, an Oakland, California, orthopedic surgeon, in her presentation. Dr. Edwards worked with researchers at Columbia University on this retrospective study.

The research group identified 45 patients with clinically documented SLAP lesions. To qualify for the study, these patients had to have positive O'Brien's tests and provocative biceps tests with at least 1 year of follow-up data available.

The patients were all recreational, rather than professional, athletes and participated in a wide variety of sports.

Of the 45 patients, 26 chose surgery and 19 elected to remain on a treatment that involved varying dosages and types of NSAIDs and physical therapy. The physical therapy consisted of scapular stabilization exercises, isometric tension band training, and posterior capsular stretching.

After an average of 3.12 years, patients showed significant improvement compared to pretreatment by a variety of measures: on the American Shoulder and Elbow Surgeons scale, a measure of functional ability, scores improved from 58.5 to 85.9 (P = .001); on the Simple Shoulder Test, another functional scale, scores improved from 8.3 to 11.1 (P = .02); Euroqual scores, a measure of quality of life, improved from 0.76 to 0.90 (P = .009); visual analog scale scores, a measure of pain intensity, decreased from 4.5 to 2.0 (P = .043); and 18 of the 19 patients were able to resume their chosen sport.

When Dr. Edwards and colleagues compared these results to those of the 26 patients who had surgery, they found no statistical differences in either pain relief or functional improvement.

"The point of this study is that nonoperative treatment is successful in a certain percentage of patients," Dr. Edwards told Medscape. "Based on this I would suggest a trial of conservative treatment."

Most physicians who treat SLAPs do already recommend that their patients try nonoperative treatments first, Dr. Edwards said, "but it's possible that not all physicians are doing that."

She also acknowledged that there has been little or no research measuring what happens when patients are not treated at all, and thus it is not clear how much of the improvement patients experience might occur in the absence of physical therapy, medication, or surgery.

Despite this flaw, the study won the AOSSM's Aircast Award for Clinical Science. "It was a very well organized, well-done study," said Dr. Dugas.

However, he cautioned that the results could not be applied to athletes who specialize in throwing. Six of the 19 patients in the nonoperative group and 4 of the 26 patients in the operative group participated in softball or baseball.

Although a randomized, prospective study would provide more solid evidence, Dr. Dugas said such a trial is unlikely because patients want to be treated and are unlikely to agree to be randomly assigned to a control group.

The study received no outside funding, and neither Dr. Edwards nor Dr. Dugas report any relevant financial relationships.

American Orthopaedic Society for Sports Medicine 31st Annual Meeting. Presented July 12, 2007

[jma233]

I know another (very good) surgeon who doesn't believe in operating on SLAP lesions. I'd say "rehab the tits" out of the shoulder before you get surgery. What do you have to lose?

[comish]

I busted my shoulder about 14 years ago decending a Volcan Villarica in Chile. Boot skiing can have bad consequences when one falls on hard ice. Ouch. Lived with it, rehabed, etc for 12 years. Crashed dropping Balls at Mammoth 2 years ago, had the arm sublex again (happened with pretty significant regularity from a movement as simple as rolling over in bed for 12 years). This time it ripped a piece of cartilage that locked my shoulder so couldn't raise my arm above the level of my shoulder. Normally when it would sublex it would hurt like a motha and then after a few weeks feel ok again. Dr. said I didn't have a choice since the joint was locked.

Had the surgery about 2 years ago and couldn't be happier. Used sutures like Arty. Didn't feel too good for about 3ish days, but seriously it was the surgery/anesthesia, not the shoulder. Shoulder never reeallly hurt too bad. Was off pain meds after somewhere between 2 - 4 days. Sleeping in the brace was a pain. Rehab the shit out of it. I probably did 95% of the rehab as once it got to where I could surf, etc again I slacked a bit. I'm thinking I was 4-6 months before doing sports again, but honestly can't quite remember. I felt relatively normal fairly quickly, especially when compared with my fackin knee.

For me and my situation, the surgery has made me 100% better. I can sleep any which way, pick up my ski boots with my left arm again, surf and not have to baby the left shoulder, duck dive without the fear that a wave would cause my shoulder to pop (which unconveniently happened surfing in Nircaragua = not pleasant). I wish I had the surgery earlier. I get some occasional popping sounds and its probably not 100%, but its about 95% as opposed to previously where I felt wounded.

I see the reasoning behind rehab this shit out of it and try to live with it. I did that for 12 years, but in retrospect, wish I had the surgery a lot sooner as I'm in far better condition now than before and probably would have saved the shoulder a bit of trauma from multiple sublexes (is that the right term? Basically arm tries to dislocated, but doesn't come all the way out)

Probably totally depends on the extent of the injury and exact nature of it, but I would absolutely do it again.

[seldon]

looks like i'm going to be going for this... appointment with the doc tomorrow.

[carpbum]

damn that sucks.

so do you think your better now than before you got the surgeries?

I hope mine goes ok.. the doc presented it to me as not being that big of a deal.

Absofreekinglutley better. I permanently lost some some flexibility, but the only common thing i really have a hard time with is taking things out of the rear pocket of a bicycle jersey.

[B Rad]

I had a labrum repair. I had 85% torn in the labrum and 30% of my bicep. Not to scare you but the surgery was by far the most pain I have ever been in.

Before I had the surgery I did 2 months of PT and then went for the surgery. Pain management was okay in the hospital but once I got home it went down hill. I'm serious, I actually cried which made it hurt to even more! so then again I did 2 months of PT. It was not getting better. It turns out the I broke a pin and one worked its way loose.

So I had a second surgery. For this one I stayed over night for pain control. it went much much better. 3 months of PT and I would say that my shoulder is good. I've got all my motion back but don't think about entering into a snow ball fight you'll never be able to throw as hard as you use too. My friends through stuff at me just to laugh at me throw it back at them...

The more you put into PT the better off you'll be. I would have the PT guy "destroy" me; it paid off big time. buy a recliner, and if you are a person that sleep on your stumach, after surgery you'll be a person that sleeps on your back .

The thing for me was pain management. They had a hard time knocking me out for surgery, I have a very high tolerance to that stuff. he told me to count to 10 and most people make it to 3 I got to 10 and said "now what" the doctor was like WTF! I then made another 10 count and things got fuzzy after that. the second surgery, Well, I don't even remember counting, they gave me enough to knock an elephant out. I would talk this over with the surgeon before surgery. Best of luck!

[DeanMoriarty]

Dr. Mark,
Thank you for the info. I will be bringing that up with my doctor.

[drmark]

The article is on SLAP tears which are tears of the upper labrum. They are completely different animals from lower tears which are associated with dislocatablilty of the shoulder. It seems that several of the folks have confused the two.

[Arty50]

Mine was a SLAP lesion, and the surgery was a god send. My only regret was that I hadn't seen a doc and had it done sooner. Yes, every case is different and perhaps rehab is a good choice for some. But there's no way I could have rehabbed this injury. The pain I was experiencing prior to the surgery was excruciating.

[MashedPotatoes]

regrettably bumping this thread.

back in mid-december I jacked my shoulder chasing Huck4Bucks at Sugar Bowl. couldn't raise my arm at first... gradually it got better and I kept skiing (carefully) figuring it would heal itself.

ffwd to now, it's still lingering so I got an MRI and started PT. just had my MRI followup:

Diagnosis is shoulder impingement, SLAP tear. If no improvement with additional PT over the next few weeks the doc recommends shoulder arthroscopy with subarcromial decompression and possible SLAP repair vs. debridement. The MRI mostly shows inflammation, (there was also a minor fracture in the clavicle apparently). Doc says MRI is only 80% accurate in detecting tears like this one and I could get off easy if she only has to go in and do some cleanup, but if there's a repair I'm in for a long recovery..

I went ahead and scheduled surgery since I need to be 100% whole again ASAP. I figure I can always cancel if there's marked improvement.

My issues seem nowhere near as drastic as others in this thread, but that's why I'm here.. looking for support or advice from anyone who's had this issue and been borderline on surgery.. any thoughts appreciated, muchos gracias.

[kboo]

Mashed potatoes:

I dislocated my left shoulder in a water polo game, and my shoulder surgeon was pretty conservative, so I did *months* of PT. Two months after the injury I started gentle swimming again, and after another 3 months of hard work and easing into it, I played in a full on water polo tournament. I'm left handed, and also a woman playing mostly with men, and during the tournament in the evenings I noticed my arm was a little sore, and I never regained full throwing power. It probably didn't help that there were people yanking and hanging on my arm in the games.

i.e. I could move my arm in the throwing motion, but all the time my arm was behind the plane of my body, it had no force, so my throwing was mainly "pushing" the ball after may arm made it even with my head.

Then I got the contrast MRI and it seemed to show some tears, we thought at most it was a SLAP lesion.
My dr. specifically told me that if I was willing to cut water polo out of my life (and basically no longer do any real throwing), I could do fine without surgery, but that wasn't an option for me. Turns out I had a 360-degree labral tear that was repaired arthroscopically with 7 anchors. Am 4 months post-op and getting my other shoulder done on Thursday (dislocation after ski fall at the end of December; PT only took me so far).

If you're thinking of going the PT-first route, it was a good 6 months from the left shoulder injury to the decision to have surgery, because the PT is a fairly long road and you really have to work at it and give it time. Surgery is no small matter and the rehab after that is a lot harder. I'm glad I took the conservative route even though it meant a longer time of not playing water polo, because the surgery recovery is pretty painful even though it's not that huge a procedure.