SLAP Repair

A SLAP (Superior labrum anterior and posterior) tear can develop after either recurrent shoulder dislocations or secondary to the excessive mobility of the long head of biceps tendon. Overhead athletes are particularly prone to this injury and if, after a full clinical and MRI assessment, it is decided that this needs to be repaired, then an arthroscopic (keyhole) procedure will be needed. The decision to undertake a SLAP repair is a complex one, and will require discussion. Amongst the risks of the surgery is stiffness, a risk which increases with age. The alternative is to consider a biceps tenodesis.

An arthroscopic SLAP / labral repair is undertaken by repairing the torn labrum back to the bony glenoid rim (socket). An arthroscopic labral repair can be performed as a ‘key-hole’ procedure through 3 or 4 small incisions. Small ‘anchors’ are then used to secure suture material into the bony rim of the glenoid. The sutures (threads) that are attached to the anchors are then used to repair the torn labral tissue back to the glenoid rim. By doing so, stability of the long head of biceps can be achieved however time is needed for the repairs to heal and therefore a sling is needed to support the shoulder for approximately 4-6 weeks.

Information for patients / operative Information

Risks and complications

  • Infection
  • Bleeding
  • Nerve injury
  • Stiffness
  • Residual discomfort
  • Degenerative change

Before admission

  • Please bring any X-rays or scans with you to the hospital. This will usually be on a CD disc. These will not be needed if it was Mr Falworth who organised the investigations.
  • No food for 6 hours, or drink for 4 hours, prior to surgery.
  • Please avoid smoking for 12 hours prior to surgery

In Hospital

  • A SLAP repair is usually performed as a day case or as a single overnight stay.
  • Three to four incisions, each approximately 1 cm in length, are made around the shoulder. These are closed with Steri-strips and/or dissolving sutures.
  • Splash proof dressings will be applied but the wound should remain dry for 10 days.
  • Prior to your discharge from hospital, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.

What to Expect

  • Swelling: immediately after an arthroscopic procedure there can be quite a lot of swelling around the shoulder but this settles after approximately 24 hours. A Cryocuff or alternative cold therapy compress, can be helpful in minimising swelling and inflammation. The Cryocuff will usually be issued to you upon discharge
  • Pain: an Interscalene Block is often used to reduce immediate post-operative pain. If any discomfort arises once the block has worn off, simple oral analgesics can be taken to manage this. These will be provided to you upon discharge.
  • Bleeding: there may be some oozing through the bandages but this should settle soon after the operation.

Post-operative care

  • A sling or brace will be provided to help rest the shoulder. This must be worn for 4-6 weeks after the surgery as deemed appropriate following the operative findings. To prevent the development of undue shoulder stiffness, the belt that is attached to your sling can be removed 24 hours after your operation.
  • The wound should be kept dry for 10 days.
  • At ten days the dressing and paper Steristrips can be gently removed. If the wound is ‘dry’ then it is all right to wash the wound. If not, please consult Mr Falworth or your GP for further advice.
  • The most important part of your post-operative care is to start an early exercise programme, which the ward physiotherapist will have commenced prior to discharge from hospital. This will maximise the benefit of your operation and will continue as an outpatient.

Post-operative appointments

  • You will be reviewed in clinic approximately 3 weeks following your surgery.

Return to Functional activities

  • Driving 4 - 6 weeks
  • Light duties 4 - 6 weeks
  • Return to work Usually 2 weeks but depends on occupation
  • Heavy Lifting 12+ weeks
  • Repetitive overhead activity/sport 16 weeks (stiffness may persist)