Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Slap Tear

SYMPTOMS

There is sharp impingement-type shoulder pain and weakness when trying to perform specific overhead activities, such as throwing a ball or serving in tennis.

AETIOLOGY

The SLAP ligament (Superior Labrum Anterior to Posterior) is the superior part of the glenoid labrum. Besides stabilising and centring the humeral head to the glenoid, it stabilises the long head of the biceps tendon, which originates from the anterior part. When the SLAP ligament is damaged, the gleno humeral joint becomes unstable. SLAP injuries are common in many sports involving overhead activities, like rugby or tennis. It can also be caused by falling on to an outstretched arm. SLAP injuries are often associated with other injuries such as rotator cuff tears or Bankart lesions.

CLINICAL FINDINGS

There are various clinical tests to verify the diagnosis. O’Brien’s test, internal impingement tests and the ‘palm-up’ test are often positive. There are different types of SLAP tear and it is an injury that varies in severity. Additionally, it is seldom isolated, and for this reason the tests have to be done in the positions the athlete refers to as painful − a functional impingement test.

INVESTIGATIONS

MRI, arthrogram and arthroscopy are most reliable to identify this injury.

TREATMENT

Minor and stable SLAP tears are left to heal with physiotherapy and modified sporting activities. Unstable tears require either vaporisation or surgical refixation.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to assess thoraco-scapular control and muscle function. Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon if the pain/weakness is severe or if physiotherapy does not relieve symptoms.

EXERCISE PRESCRIPTION
This is an injury with which you can undertake virtually all non-overhead activities throughout the healing process. For this injury, a three- to four-month rehabilitation programme is usually sufficient before returning to overhead sport.

EVALUATION OF TREATMENT OUTCOMES

Clinical evaluation of symptoms.

DIFFERENTIAL DIAGNOSES

The main problem is that this injury is often associated with impingement, caused by a variety of conditions such as a partial rotator cuff tear, partial subscapularis tendon tear, biceps tendon disorder or multi-directional instability. This frequently blurs the clinical presentation.

PROGNOSIS

Excellent if appropriately diagnosed and repaired.

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