Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading…
Transcript
  • Head of humerus articulates with the glenoid fossa of the scapula.
  • The glenoid labrum surrounds the head of the humerus to deepen the fossa.

The rotator cuff muscles serve to further stabilize the glenohumeral joint.

Mechanism of Injury:

Athlete was leading off 2nd base when she dove head first back to tag up. When she did this her shoulder forcefully came into contact with the 2nd baseman's leg.

The athlete stated it felt as though her arm "came out of socket". However, she continued to play the game.

During her initial doctor's appointment she was diagnosed with biceps tendinitis.

Upon coming to Troy, she was re-evaluated and recieved an MRI that revealed she had a large SLAP lesion of her labrum that she had been playing with all summer.

Later, there was also an underside supraspinatus tendon tear that was found...more on that soon.

Beginning in the Fall of 2013 the athlete started a conservative "prehabilitation" program that was designed to strengthen the rotator cuff muscles so that labrum repair surgery could be delayed until the offseason.

The athlete would begin the session by warming up on the UBE and would then stretch her shoulder by using a T-bar and sleeper stretch. Then she would begin her exercises.

Exercises in this program include:

  • Retraction
  • scaption
  • Perterbations
  • Theraband IR/ER/FX/EX
  • Body Blade
  • IYTWs
  • Hughston Exercises
  • Codmans

Therapuetic Modalities that were used were:

  • Electrical Stimulation
  • Cryotherapy (Ice bag, Gameready)

After a few weeks, the athlete saw Dr. Dugas during a Monday Clinic because the pain in her shoulder was increasing. Dr. Dugas ordered additional tests and it was determined she had developed an underside supraspinatus tendon tear.

  • Dr. Dugas scheduled the athlete to have surgery on 11/7/2013

  • Five anchors total were used to fully repair her SLAP lesion labrum tear.

  • Her supraspinatus tendon and subacromial bursa were both debrided.

  • Besides debridement of the tendon, Dr. Dugas used a slip-not from one of the superior anchors to repair the supraspinatus tendon.

  • Nothing further was done to the tendon since she is a throwing athlete and needs rotator cuff flexibility.

Following her surgery, the athlete followed a rehab program for a full 360° labrum tear.

  • The athlete began seeing a physical therapist following surgery.
  • During PT the athlete followed the rehab program and did appropraite exercises depending on the Phase she was in.

Phase I (Immediate Postoperative Phase [Restricted Motion] ) Day 1- wk 6

  • Regain elbow and hand ROM
  • Gentle shoulder ROM, there is different goals for ROM depending on the week.
  • Isometrics
  • Rhythmic Stabilization drills
  • Proprioceptive Neuromuscular control drills

Phase II (Intermediate Phase [Moderate Protection] )

wk 7-14

  • Initiate Thrower's Ten Program
  • Shoulder ROM is progressed to include functional demands
  • Biceps and triceps strengthening may begin, and be progressed as seen fit
  • Neuromuscular control drills may progress
  • Stretching should be continued

Phase III (Minimal Protection Phase)

wk 14-20

  • Full shoulder ROM should be established
  • Continued stretching
  • Continue Thrower's Ten program
  • Functional movements, especially ER
  • Continue endurance exercises
  • Begin light plyometric exercies
  • Around week 18 a thrower's program may begin!

Phase IV (wk 20-26) and Phase V (Month 6-9) continue to progress the rehab.

  • Full ROM is maintained
  • Strengthening is continued, PREs are key
  • Plyometrics are progressed
  • Continue thrower's program
  • May partake in contact sports
  • Strength should be 75-80% of non-involved side

The athlete is progressing well within her rehabilitation, she is currently in Phase III. She is advancing quickly and experiences no pain and very little soreness when new exercises are presented to her.

Exercises in her rehab include:

  • Plyometrics (trampoline ball toss)
  • reactive neuromuscular control
  • isotonic muscle contractions (Therabands, IYTWs)
  • Core strengthening has been added to regular shoulder rehab exercises (IYTWs on Swiss Ball, half-moon on Swiss ball)
  • Functional sport movements (weighted t-bar swing)

The athlete is currently in week 21 of her rehabilitation

  • She began a throwing program on 3/20/2014
  • Her arm was not ready. Once we began throwing at 20' she began experiencing sharp pain and did not feel comfortable continuing to throw that day.
  • We modified her rehab program to strengthen her internal rotator muscles, mostly her subscapularis.

  • on 3/27/2014 we attempted the throwing program again. She completed a full warm-up that included running, cross-over symmetry bands, stretching, and warm-up throws. She then threw 25 throws at 45' twice.
  • 3/29/2014 the athlete progressed to throwing 25 throws at 60' twice.
  • So far, the athlete reports no pain or soreness immediately after throwing or one day post throwing.
  • We found a good warm-up routine that the athlete is comfortable with that gets her arm prepared to throw but not too tired. We ice for 20 minutes immediately following throwing.

Abrams, G. D., Safran, M. R. (2009). Diagnosis and management of superior labrum anterior posterior lesions in overhead athletes. The American Journal of Sports Medicine, 44, 311-318.

Baumgarten, K. M., Vidal, A. F., Wright, R. W. (2009). Rotator Cuff Repair Rehabilitation: A Level I and II Systematic Review. The American Journal of Sports Medicine, 1.2, 125-129.

Manske, R., Prohaska, D. (2010). Superior labrum anterior to posterior (SLAP) rehabilitation in the overhead athlete. The American Journal of Sports Medicine, 11.4, 1-23.

Nakagawa, S., Yoneda, M., Hayashida, K., Wakitani, S., Okamura, K. (2001). Greater Tuberosity Notch: An Important Indicator of Articular-Side Partial Rotator Cuff Tears in the Shoulders of Throwing Athletes*. The American Journal of Sports Medicine, 29.6, 762-770.

Nam, E. K., Snyder, S. J. (2003). The Diagnosis and Treatment of Superior Labrum, Anterior and Posterior (SLAP) Lesions. The American Journal of Sports Medicine, 31.5, 798-810.

Siskosky, M. J., ElAttrache, N. S. (2007). Management of Internal Impingement and Partial Rotator Cuff Tears in the Throwing Athlete. Operative Techniques in Sports Medicine, 15, 132-143.

Voos, J. E., Pearle, A. D., Mattern, C. J., Cordasco, F. A., Allen, A.A., Warren, R. F. (2007). Outcomes of Combined Arthroscopic Rotator Cuff and Labral Repair. The American Journal of Sports Medicine, 35.2, 1174-1179.

Wang, S. S., Trudelle-Jackson, E. J. (2006). Comparison of customized versus standard exercises in rehabilitation of shoulder disorders. Clinical Rehabilitation, 20, 675-685.

Questions?

Rehabilitation of SLAP Lesion with Underside Supraspinatus Tear

Carolyn Howard

The Injury

270° SLAP lesion and underside supraspinatus tendon tear.

Rehabilitation

The Glenohumeral Joint

Treatment

References

Learn more about creating dynamic, engaging presentations with Prezi