Shoulders

Surgery Options for SLAP Lesions

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Published on Sunday, 01 August 2010 20:48

Written by Robert G. Klitzman, M.D.

Article written by Robert Klitzman, MD, Norman OK

As I discussed in my last SLAP article, "What are SLAP Tears?, SLAP lesions that do not get better with non-operative treatment may need surgeryto improve. There are several options and variables that need to be discussed before the treatment is decided upon.

As you know, with a SLAP tear, the biceps tendon anchor has been pulled off (along with the superior labrum) and the glenoid is at the 12:00 position. If it is only partially torn and the anchor still is well attached overall, the torn part of the labrum (anchor) may be trimmed and the symptoms my get better.

If the anchor is completely loose from the glenoid, it can be secured back down with anchors and stitches. This takes care of a floppy bit of labrum, but the biceps is still attached.

One of the issues that needs to be considered is why the injury happened

If the problem is that the biceps tendon pulled the labrum off the glenoid, couldn't it do it again? The answer is yes. At this point, we need to decide if this was a fluke (like in a shoulder dislocation), or a more chronic problem.

If it was a fluke, you might just want to secure the labrum and stop there.

If it was a chronic problem, the biceps tendon may need to be separated from the labrum to prevent continued problems.

If we decide to separate the biceps from the labrum, we have the option of cutting it and letting it go free vs. re-attaching it somewhere else. If we cut it, most people do not experience much of a problem with weakness in their biceps muscle. It still has another attachment outside of the shoulder joint that allows continued strength in the arm.

Occasionally, people will notice a minor decrease in strength in flexion or supination of the forearm (turning the hand palm up)

To put this into perspective, John Elway played most of his NFL career with a ruptured long head of the biceps tendon.

Commonly people will have what is called a "Popeye" deformity in the arm in which the biceps bulges in the middle of the arm. If we re-attach it, we can sew it to some soft tissue in the shoulder (more for low demand patients) or drill a hole in the proximal humerus and secure the tendon there with a screw. This avoids the "Popeye" deformity, but occasionally leaves the patient with pain at the site of reattachment.

When it comes to the decision about whether or not to cut the biceps tendon and whether or not to reattach it, I always have an in-deptch talk with my patents about the pros and cons of each treatment option. As a patient, you need to weigh the options and pick the treatment that you are most comfortable with and offers you the best quality of life based on what you do and your activity level.