SLAP Management in Athletes: Repair vs Tendonesis

Description

In this presentation, Dr. Mary Mulcahey, a sports medicine surgeon at Tulane University, discusses the management of SLAP (Superior Labrum Anterior to Posterior) tears in athletes, highlighting their significance in sports-related shoulder injuries. Starting with an overview of the shoulder anatomy and the labrum's crucial role in joint stability, she delves into the classification system for SLAP tears as described by Snyder, ranging from type 1 (degenerative) to type 4 (bucket handle involving the biceps tendon). Dr. Mulcahey addresses the various mechanisms of injury commonly seen in overhead sports like baseball and volleyball, noting the challenges associated with clinical diagnosis—often complicated by concurrent shoulder pathologies.



She outlines diagnostic approaches, including clinical tests like O'Brien's and the Dynamic Labral Shear Test, and discusses the role of imaging, such as X-rays and MR arthrograms, in confirming SLAP injuries. Treatment options range from initial non-operative management, including physical therapy and medications, to more invasive surgical options like SLAP repair or biceps tenodesis, depending on the tear type and patient age.



In discussing surgical techniques, Dr. Mulcahey emphasizes the importance of careful surgical planning and the selection of appropriate procedures based on patient needs. She presents evidence from recent studies illustrating post-surgical outcomes and the challenges in returning athletes to pre-injury levels of play. Notably, she points out a trend favoring biceps tenodesis in cases of failed SLAP repair or in older athletes.



Through this comprehensive overview, Dr. Mulcahey aims to inform orthopedic professionals of the current best practices in managing SLAP tears, while also encouraging an evidence-based approach to treating active patients. The presentation concludes with an invitation for questions and further discussion.

DOI: 10.1302/3114-210601

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