SLAP repair. An information guide for patients. Delivering the best in care. UHB is a no smoking Trust
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1 SLAP repair An information guide for patients Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit
2 Shoulder anatomy The shoulder complex is made up of three bones; the humerus, scapula and clavicle. Together these form a ball and socket joint. Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles, ligaments and a rim of cartilage (called the labrum) to stabilise it during movement. Acromion Clavicle (collarbone) Rotator Cuff Humeral Head Humerus Shoulder joint Shoulder Blade (scapula) SLAP lesions, or tears of the labrum (superior labrum, anterior and posterior) can be caused by trauma such as a fall, or because of degenerative changes. The tendon of the biceps muscle also attaches to the labrum in this area and may also be affected by the injury. What is a SLAP repair? The purpose of a SLAP repair operation is to reattach the damaged labrum (cartilage) to the socket of your shoulder joint. The aim of this is to restore your shoulder stability and reduce your pain and symptoms. The operation will be done under general anaesthetic and may be done arthroscopically (key hole surgery) or through a small 2 PI17_1103_03 SLAP repair
3 incision. The type of approach used will be determined by the size and nature of the damage. A SLAP tear occurs where the biceps tendon anchors to the labrum. Humerus Glenoid Labrum After the operation After your operation you will wake up in the recovery room wearing a sling. Your shoulder will have dressings on and you may have a small tube coming from your shoulder, in order to put painkillers into the shoulder. You may also have a drain. A nerve block may be used during the procedure, which means that immediately after the operation the shoulder and arm may feel numb. This can last for a few hours. Your arm will be supported in a sling straight after your operation to protect the repair. It is essential that you wear the sling day and night for 2-6 weeks. The amount of time will depend on the nature of the repair. This will be explained to you after your surgery. You can remove the sling to carry out your exercises and for washing and dressing only. PI17_1103_03 SLAP repair 3
4 Pain It is normal to feel some pain following your operation. You will be given some painkillers and/or anti-inflammatory medication to take in the days following the operation. Using ice on your shoulder can be helpful in reducing pain. Wrap a bag of crushed ice, or frozen peas in a damp towel. Protect your dressings from getting wet with a layer of cling film, or a plastic bag, before applying the ice pack for minutes at a time. Posture can make a big difference to your pain after surgery. Avoid hitching your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders as this puts more stress onto your shoulder. Getting back to normal It is normal to feel more tired than usual for a few days after having an operation. Sleeping can be uncomfortable and it is important to try not to lie on your operated shoulder. You should wear your sling in bed for the first 2-6 weeks (your Physiotherapist will advise you) to protect your shoulder. Using pillows to support your operated arm and maintain your posture when sleeping will help with the discomfort. Washing and dressing Dressings and bandages that are applied in theatre need to stay dry. Remove your sling when bathing or showering, but keep your arm close to your body. Ensure that the area is dry before dressing to prevent irritation in the armpit. It is easier to wear looser fitting clothes and dress by putting your operated arm into position in your top first. Wound care Your wound also needs to stay clean and dry. If you have removable stitches they will be removed after days at 4 PI17_1103_03 SLAP repair
5 an outpatient clinic appointment or by your GP. If dissolvable stitches are used, they will not need to be removed. Rehabilitation Rehabilitation is important if you are to get the most out of your shoulder after the operation. You should be given an exercise booklet before leaving hospital with information about your first physiotherapy appointment. The amount of physiotherapy you will need will depend on your individual progress and the level of activity you wish to return to. Returning to work The amount of time you have off work depends on your job. If you have a manual job, or one that involves lifting or overhead activities, you will not be able to do this for 8-12 weeks. Please discuss this with your Consultant or Physiotherapist. Driving When you are comfortable and in control of your shoulder and arm you may return to driving. You must be able to comfortably control your vehicle and perform emergency manoeuvres. This should not be attempted until at least 4 weeks. You should discuss this further with your Consultant or Physiotherapist. Sports and activities The timescale for which you can go back to any previous sport or activity will depend on your movement and strength and the particular activity you have in mind. Please discuss returning to any activity or sport with your Consultant or Physiotherapist. PI17_1103_03 SLAP repair 5
6 Post-operative exercises With all of your exercises you should aim to repeat 10 repetitions, 3 times a day unless otherwise advised by your Physiotherapist. 1. Active hand and wrist exercises with forearm supported Use your non-operated hand to support the forearm on your operated side. Move your wrist up and down and side to side as far as you are comfortable With the same support, make a fist and then stretch your fingers as far as you can Slowly turn your forearm over so your palm faces up and then down 2. Passive elbow exercises Sit with good posture. Use your non-operated hand to grip the forearm on your operated side Use the non-operated arm to slowly bend your elbow as far as you are comfortable and then straighten it as far as you are comfortable PI17_1103_03 SLAP repair
7 3. External rotation with a stick Lie on your back with a folded towel under the operated arm with the elbow bent to 90 degrees with a stick held in your hands (as per photo) Keeping the affected elbow on the towel close to your body, rotate the arm away from your body using the stick to start and help the movement. The operative arm should be relaxed throughout the exercise. DO NOT FORCE or produce a STRETCH 4 4. Towel Press Lie on your back as in the picture. Hold a towel with your hands touching and palms facing towards your feet with your elbows bent to 90 degrees and tucked into your sides To start the exercise push your hands up to the ceiling until your elbows are straight (as if conducting a chest press) and then return to start position 5 Continue to wear your sling as advised by your Physiotherapist or doctor. This should only be removed for washing, dressing and for completing your exercises. Do not force or stretch any movement. Do not attempt any lifting with your operated arm. PI17_1103_03 SLAP repair 7
8 Contact details If you have any questions regarding your operation or treatment, please do not hesitate to call us. Consultant secretaries Mr Kalogrianitis: Mr Massoud: Mr Chan: The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit Physiotherapy Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston Birmingham, B15 2GW Telephone PI17/1103/03 Author: Julia Sawking, Caroline Miller, Nicola Birch Date: January 2018 Review date: January 2020
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