Description of the disorder - SLAP lesion - Labral tear shoulder
The shoulder joint includes a socket and where the head from the upper arm is running. Around the socket, is a labrum, and this labrum is a structure in between cartilage and ligaments. The labrum acts as a kind of seal, which makes the socket a little wider and is like a package that provides stability to the joint head. On the labrum inserts the long head of the biceps tendon. A pull or twist of the arm, can result in that the biceps pulls the labrum from the socket and this is called a SLAP tear or a labrum tear. See Figures 1 and 2. The typical symptoms are pain and clicking deep in the shoulder, or simply diffuse pain around the whole shoulder. If you have been diagnosed with a SLAP lesion, an shoulder arthroscopy could be needed. The diagnosis can be very difficult to make as the injury frequently can be difficult to diagnose on MRI scans - even MRA (arthrography), but only determined by keyhole surgery.
Purpose of the operation
SLAP lesions may be operated in 3 different ways.
- SLAP re-fixation: The labrum is reinserted back by arthroscopic technique (typically for those under 30. The arm must after the surgery be kept in a sling for about 4 weeks) See Figure 1.
- Biceps tenodesis: The biceps tendon is released from the attachment on the labrum and reattached again at the top of the upper arm. When biceps no longer pulls in the labrum, the labrum will automatically heal back to the socket rim. (Typically for those over 30 years and the arm must be kept in a sling for about 4 weeks after surgery) See Figure 2.
- Biceps tenotomy: The biceps tendon is released from the attachment on the labrum, but unlike the Biceps Tenodesis (the method no. 2), the biceps tendon is not reattached. After the operation used a sling as pain management, but the arm must be well used.
Figure 1 - SLAP fixation
Figure 2 - Biceps tenodesis
Advantages and disadvantages of the three different methods:
- SLAP fixation: Typically, a technique that gives good results for those under 30 years. The arm should after surgery be kept in a sling for about 4 weeks
- Biceps tenodesis: Typically, a technique that gives good results for over 30 years and the arm must be kept in a sling about 4 weeks after surgery
- Biceps tenotomy: Typically, a technique used for those over 50 years. The downside is that some of the biceps muscle can end sitting a little lower on the upper arm, and thereby provide cosmetic nuisance. In addition, it can cause a 15% reduced force in the biceps muscle. The advantage is that after the surgery do not need to use an arm sling and have less pain after surgery and to recover so quickly.