slap repair

SLAP Repair

By: Katy Lutz

Anatomy

Shoulder joint involved 3 bones: scapula, clavicle & humerus

Humeral head rests in a socket on the scapula called the glenoid

A soft fibrous tissue called the labrum surrounds the glenoid to help deepen and stabilize the joint

The labrum deepens the glenoid by up to 50%

so that the head of the humerus fits betterIt also serves as an attachment site for several ligaments

Injuries

Falling on an outstretched arm

Direct blow to the shoulder

Sudden pull, such as when trying to lift a heavy object

Forceful overhead motions

Location of Tears

A SLAP lesion (superior labrum, anterior to posterior) is a tear of the labrum above the middle of the glenoid that may also involve the biceps tendon

A Bankart lesion is a tear of the labrum

below the middle of the glenoid socket that also involves the inferiorglenohumeral ligament

Signs and Symptoms

Pain, usually with overhead activities

Catching, locking, popping or grinding

Occasional night pain or pain with daily activities

A sense of instability in the shoulder

Decreased range of motion

Loss of strength

SLAP Repair Surgery Procedure

https://www.youtube.com/watch?v=1-pKLJRvJpg

Phase 1: 0-4 Weeks after Surgery
-Passive ROM Phase

Goals:

1. Protect the surgical repair

2. Ensure wound healing

3. Prevent shoulder stiffness

4. Regain ROM

5. Control pain and swelling

Use your sling most of the time for the first 2 weeks

You may use your hand on the operated arm in front of your body but DO NOT raise your arm overhead

You may shower or bath and wash the incision area

Exercise Program--ICE: 7 days a week, 4-5 times per day for 15-20 minutes

STRETCHING / PASSIVE ROM (w/ therapist help)Days per Week: 7 Times per day: 4-5

-1-2 sets of 10-20 reps of each exerciseProgram:Pendulums & wand exercises

Supine External Rotation

Supine assisted arm elevation

Behind the back internal rotation

Isometric exercises: internal and external rotation at neutral

Rhythmic stabilization and proprioceptive training drills with physical therapist

Ball squeeze

Scapular retraction

https://www.youtube.com/watch?v=dHxzx0abAGs

Phase 2: 5 to 7 weeks after Surgery
-Active ROM Phase

Goals:1. Protect the surgical repair

2. Improve ROM of the shoulder

3. Begin gentle strengthening

Your sling is no longer necessary unless your doctor instructs you to continue using it

You can now move your arm for most daily activities, but do not lift objects heavier than 1 or 2 pounds

https://www.youtube.com/watch?v=mP1hrnOamsY

STRETCHING / ACTIVE MOTION (patient performs)Days per week: 7 Times per day: 1 to 3

- Do 2-3 sets of 15-20 repsPendulum exercises

Wall walks

Thera-band internal and external rotation

Table slides

Prone row

Supine passive arm elevation

Prone horizontal abduction Ts

Seated-Standing Arm Elevation


STRENGTHENING EXERCISES Days per week: 7 Times per day: 1

Prone extension

Side lying external rotation

-Strengthening Phase

Goals:1. Protect the surgical repair

2. Regain full ROM- passive & active

3. Use arm in all plane for daily activites

STRETCHING / RANGE OF MOTIONDays per week: 7 Times per day: 1-2

Pendulum exercises

Standing External Rotation / Doorway

Seated Row

Wall slide Stretch-- Start the 11th week after surgery

Hands-behind-head stretch-- Starting the 9Th week after surgery

Standing Forward Flexion


Supine Cross-Chest Stretch

Side lying internal rotation (sleeper stretch

https://www.youtube.com/watch?v=EMAepitmJ8w

STRENGTHENING / THERA-BANDDays per week: 7 Times per day: 1, 2 sets of 15-20 reps

External Rotation w/ towel roll

Internal Rotation w/ towel roll

Standing Forward Punch - Add resistance 1 to 3 lbs.

Shoulder Shrug

Military press

Dynamic hug

Ws

Biceps curl-- Start the 9 week

STRENGTHENING / DYNAMICDays per week: 7 Times per day: 1

Side-lying External Rotation

Prone Horizontal Arm Raises Ts

Prone row

Prone scaption Ys

Prone extension

Weight Training

You should not return to training using heavy weights or on weight machines until your doctor says it is safe

Usually safe to return to heavier weight training at three months following labrum repair

You should have full range of shoulder motion and normal strength in the rotator cuff and scapular muscles

The doctor or a physical therapist will test your motion and strength before you start weight training

You can start with 3 sets of 15-20 repetitions, high repetition sets ensures that the weights that you are using arent too heavy.

***NEVER perform any weight training exercise to the point of muscle failure

WEIGHT TRAINING cont

The following weight training exercises should be avoided:1. Pull downs behind-the-neck (wide-grip)

2. Behind-the-neck shoulder press

3. Wide-grip bench press

4. Standing lateral deltoid raises

5. Triceps press overhead

Exercises Usually Problem-Free:1. Biceps Curls

2. Cable and bent-over rowing

3. Shoulder shrugs

-Sport Specific Phase

Goals:1. Gradual initiation of functional activities

2. Progress to normal ROM & strength

3. Progressive use of arm for daily activities

STRETCHING / RANGE OF MOTION Times per day: 1 Days per week: 5-7

-1-2 sets, 15-20 repsPendulum exercises

Standing External Rotation / Doorway

Resisted wrist flexion-extension

Wall slide Stretch

Hands-behind-head stretch

Push-ups

Side lying internal rotation (sleeper stretch)

External rotation at 90 Abduction stretch

STRENGTHENING / THERABAND Times per day: 1 Days per week: 3

Continue exercises from phase 3

External rotation at 90

Internal rotation at 90

Standing Ts

STRENGTHENING / DYNAMICTimes per day: 1 Days per week: 3 ; 2-3sets, 15-20 reps

Continue exercises from phase 3

Prone external rotation at 90 abduction Us

Biceps curls

Resisted forearm supination-pronation

PLYOMETRIC PROGRAM Times per day and days per week: as directed by PT

Rebounder throws with arm at side

Wall dribbles overhead

External rotation at 90& Internal rotation at 90,Standing Ts, Resisted forearm supination-pronation

Rebounder throws with arm at side, Prone external rotation at 90 abduction Us

-Return to Activity Phase

Goals:1. Progression of functional activities

2. Maintain full ROM & strength

3. Begin sport progressions with clearance

STRETCHING / RANGE OF MOTIONDays per week: 5-7 Times per day: 1

-1 set, 15-20 reps*Continue all exercises from phase 4

https://www.youtube.com/watch?v=doQOyz8cxfk

STRENGTHENING / THERABAND -2-3 sets, 15-20 repsDays per week: 3 Times per day: 1

Continue from phase 4

STRENGTHENING / DYNAMICDays per week: 3 Times per day: 1

*Continue from phase 4

PLYOMETRIC PROGRAM Days per week: 1-2

Rebounder throws with arm at side

Wall dribbles overhead

Rebounder throwing/weighted ball

Deceleration drills with weighted ball

Wall dribbles at 90

Wall dribble circles

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slap repair

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