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SLAP Tears of the Glenoid Labrum in contact athletes

Authors: L Funk, M Snow

References: Clin J Sports Med, 2006

Abstract
Introduction: The association of SLAP tears with the throwing athlete has been well documented in the literature. SLAP tears in contact athletes are not well described. The aim of the study was to describe the distribution, clinical presentation of SLAP tears in rugby players and time taken for return to sport

Method: A retrospective review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period was carried out. From this population all patients diagnosed with a SLAP lesion at arthroscopy were identified. Each patient’s records were reviewed to record his age, injury side, mechanism of injury, clinical diagnosis, investigations and results, surgical management, and return to play.

Results:

The incidence of SLAP tears in our study population was 35%. All 18 patients were male, with an average age of 27years ( 20-35yr). 55% of injuries involved the dominant extremity. There were 11 isolated SLAP tears (61%), 3 SLAP tears associated with a Bankart lesion (17%), 2 SLAP tears associated with a posterior labral lesion (11%) and 2 SLAP tears associated with an anterior and posterior labral injury (11%). Of the 18 SLAP tears, 14 (78%) were Type 2, 3(17%) were Type 3 and 1(5%) were Type 4.

All patients recalled a specific heavy tackle with fall onto the lateral aspect of shoulder. No patient sustained a complete dislocation. None of the patients presented with symptoms of instability. MR Arthrograms were performed in 17 of the 18 patients prior to arthroscopy. SLAP tears were detected in 13 patients ( 76%).

All patients underwent arthroscopic reconstruction within 6 months post injury. Preoperatively 11% of patients were satisfied with their shoulder. By 6 months post surgery 89% of patients were satisfied and 95% felt that they were back to their previous level of activity. Patients with isolated SLAP tears were the quickest to return to sports, at an average of 2.6 months post surgery.

Discussion:

Eccentric contraction of the biceps and direct blow with antero-superior displacement of the humeral head are two possible mechanisms of injury in our study population . MR arthrogram was found to be a useful diagnostic tool, although a high index of suspicion is essential. Type 2 SLAP lesions were found to be the most common injury, siimilar to overhead athletes.

Conclusion: SLAP tears are a common injury in rugby players with shoulder pain following injury. These can often be diagnosed with MR arthrography. Arthroscopic repair is associated with excellent results and early return to sports.

The average time to return to full sporting activity for isolated SLAP tears in our study was 2.6 months with no complication. We support the theory that patients with isolated SLAP tears can undergo an accelerated rehabilitation programme.

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