What are the treatments for a Superior Labrum from Anterior to Posterior (SLAP) tear?

From the Guidelines

Treatment for a SLAP tear should begin with conservative approaches, including rest, ice, and anti-inflammatory medications, before considering surgery, with arthroscopic repair being the standard approach for active individuals who fail conservative treatment after 3-6 months. The initial treatment includes rest, ice application for 15-20 minutes several times daily, and over-the-counter anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) for pain and inflammation 1. Physical therapy is crucial, focusing on strengthening the rotator cuff muscles and improving shoulder stability through exercises like internal/external rotation with resistance bands, scapular stabilization exercises, and progressive range-of-motion work over 6-12 weeks. For persistent pain, corticosteroid injections may provide temporary relief.

Some key points to consider in the treatment of SLAP tears include:

• The type of SLAP tear (Types I-IV) influences treatment decisions, with Type I tears often responding well to conservative treatment while Types II-IV more frequently require surgical intervention 1.
• Recovery from surgery typically requires 4-6 months before returning to full activity, with physical therapy being essential throughout the rehabilitation process.
• Arthroscopic repair is the standard approach for active individuals who fail conservative treatment after 3-6 months, with microfracture being a simple and effective modality for management of chondral injuries of the hip, as reported by Karthikeyan et al 1.
• The size of the defect is an important factor in determining the treatment approach, with microfracture being suitable for lesions <3 cm2 in size, as reported by Haviv et al 1.

In terms of surgical options, arthroscopic repair is the preferred approach for active individuals with SLAP tears, with microfracture being a viable option for managing chondral injuries of the hip. The goal of treatment is to improve functional outcomes and reduce pain, with a focus on preserving the joint and preventing further injury. As reported by Sekiya et al 1, articular cartilage repair is appropriate only for small lesions of delaminated cartilage, with limited evidence supporting its use in the hip despite relatively favorable outcomes.

From the Research

Treatment Options for SLAP Tears

• Nonoperative management is the first-line treatment for most young, active patients without history of trauma, mechanical symptoms, and/or demand for overhead activities 2
• Conservative measures include rest, avoidance of aggravating factors, injections, and physical therapy focusing on correcting scapular dyskinesis, restoring range of motion and strength, and evaluating the biomechanical throwing motion 2
• Operative treatment is reserved for failure of nonoperative treatment and those with persistent symptoms that prevent individuals from participating in sports activities or activities of daily living 2

Operative Treatment Options

• Arthroscopic repair can be considered in younger athletes (<30 years old) and elite athletes who are involved in overhead sports (baseball, tennis, volleyball) 2
• Biceps tenodesis is the first-line treatment option for failed SLAP repairs, and as an index procedure, traditionally has been reserved for middle-aged individuals (>30 years old), patients receiving workers' compensation, nonoverhead athletes, or in those with concomitant rotator cuff tears 2
• Biceps tenodesis may produce more reliable pain relief and functional improvement when compared to primary SLAP repair in patients over the age of 40 3

Return to Play Rates

• The return-to-play rate was 53.7% in all athletes and 52.5% in elite or higher-level athletes who underwent nonoperative management 4
• In athletes who were able to complete their nonoperative rehabilitation program, the return-to-play rate was 78% in all athletes and 76.6% in elite or higher-level athletes 4
• The overall rate of return to prior performance was 42.6%, which increased to 72% for those athletes who were able to complete their rehabilitation 4

Factors Associated with Failure of Nonoperative Management

• Older age, participation in overhead sports (especially baseball pitchers), traumatic injury, positive compression rotation test, concomitant rotator cuff injury, longer baseball career, longer symptomatic period, and the presence of a Bennett spur are factors associated with failure of nonoperative management 4