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Returning to Play After a SLAP injury

Posted December 3, 2019

By Sara Nuechterlein, MEd, ATC, LAT

Clinical Presentation

Superior labral anterior-posterior (SLAP) lesions are acute or chronic shoulder injuries associated with frequent overhead activity. Mechanisms of SLAP lesions are associated with repetitive abduction and external rotation of the shoulder during tasks such as throwing, hitting, swimming and certain occupations. Acute mechanisms for SLAP lesions include hyperextension, falling on an outstretched hand, heavy lifting or direct trauma. According to L. Michener, J. Abrams , K. Huxel Bliven, S. Falsone, K. Laudner, E. McFarland, J. Tibone, C. Thigpen andT. Uhl in the “National Athletic Trainers’ Association (NATA) Position Statement: Evaluation, Management, and Outcomes of and Return-to Play Criteria for Overhead Athletes with Superior Labral Anterior-Posterior Injuries” published in the Journal of Athletic Training in 2018, patient age is also associated with SLAP lesions, as degenerative changes of the superior labrum in asymptomatic have been discovered in patient populations who are 35-years-old or older. Clinically, patients may present with painful and decreased range of motion, decreased strength and instability.

Conservative Intervention

After diagnosis, Athletic Trainers (ATs) should initiate a three- to six-month conservative care rehabilitation program focusing on restoring pain free range of motion and scapular and rotator cuff stability; nonsteroidal anti-inflammatory medications and injections may be incorporated to support rehabilitation efforts. According to the NATA position statement patients should have 70 percent of strength and 90 percent of range of motion compared to the unaffected side before starting to return to sport or recreational activity. Surgical intervention should be considered if the patient fails to improve after six months of consistent conservative care.

Types of Surgical Intervention

There are a number of surgical interventions possible for management of a SLAP injury, depending on post-surgical goals and severity of injury. The clinician should be familiar with the patient’s procedure and physician’s recommendations, according to the NATA position statement.

Returning to Full Activity after Surgical Intervention

Time-based criteria are frequently utilized as a guide, but patients will progress at their own pace dependent on a variety of factors. Post-operative programs suggest return to activity programs begin around four months, with full return after approximately six months, but overhead athletes should expect longer for full recovery. Early rehabilitation goals include protecting the post-operative shoulder, activating rotator cuff and scapular stabilizers, and regaining full active range of motion up to three months post-operation.

Around four months, the patient should demonstrate high velocity functional activities with limited compensatory patterns and no apprehension with overhead activities, according to M. Sherry in “Rehabilitation Guidelines for SLAP Lesion Repair” retrieved from uwhealth.org. The patient may begin an interval return to activity programs adhering to the physician’s recommendations that is specific to functional demands of the sport of occupation at the point. The NATA position statement cautions that publicly available programs are incredibly varied, so always review programs with the physician and sports medicine team to ensure appropriateness.

Long-Term Outcomes

ATs should utilize outcome measures that include patient satisfaction to track the patient’s experience and confidence throughout the rehabilitation process. Patients should expect 85 percent of normal function after two to three years, regardless of surgical or nonsurgical intervention. Patients should be aware that return to play rates vary, with literature citing an average of 74 percent returning to sport and 63 percent returning to overhead sport, according to the NATA position statement.

Resources

Michener, L., Abrams, J., Huxel Bliven, K., Falsone, S., Laudner, K., McFarland, E., Tibone, J., Thigpen, C., Uhl, T. (2018). National Athletic Trainers’ Association Position Statement: Evaluation, Management, and Outcomes of and Return-toPlay Criteria for Overhead Athletes with Superior Labral Anterior-Posterior Injuries. Journal of Athletic Training, 53(3), 209–229.

Sherry, M. (2011). Rehabilitation Guidelines for SLAP Lesion Repair. Retrieved from https://www.uwhealth.org/files/uwhealth/docs/pdf/SM14888_SLAP_Repair6.pdf.

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