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Slap lesion

With the term Slap Lesion it is usually understood the anatomic condition of a lesion of the anteriorsuperior part of the glenoid labrum associated with the detachment of the tendon of the long head of biceps. 
This is an injury that can appear after a violent movement in throw sports or fall on the limb. 

The arising of symptoms is rarely due to a definite trauma. More commonly the clinic history refers to various traumatic episodes during the “overhead” activity. Very often you can also be able to reproduce the dislocation voluntarily and it usually occurs in a throw position. 

You probably feel pain when resting and it tends to worsen when performing overhead movements, being adjoined by the sensation of “joint” of the humeral head, laxity and articular noises.

In the slighter cases, surgery can be avoided through the total abolishment of the sports or working “overhead” movement that tend to distress the lesion. Rehabilitation has to emphasise the reinforcement of intrarotatory muscles, recovering in the shortest time possible the complete range of movement without forcing the extra-rotation. Stretching of the capsule and posterior cuff can mitigate symptoms.

Slap lesion - Surgical Interventions

The surgical treatment consists in the regularisation of the glenoidal labrum, in the anchorage of the detached side of the glenoid ligament and tenodesis and anchorage of the long head of biceps, associated or not with the intervention on the rotators cuff. Surgery can be performed by arthroscopy or open-pit. 

Slap Lesion - Rehabilitation

After the surgery for Slap Lesion, the use of a brace in a moderate abduction and a neutral position is generally suggested for 3 or 4 weeks. 

Between the 3
rd and 6th week post-surgery, a gradual recovery of passive mobility on all levels will be allowed. At this point the rehabilitation to restore the range of motion can be increased so to achieve the total mobility in 10-12 weeks from surgery. 

Starting from the 3
rd week, the isometric submaximal reinforcement can begin, paying a particular attention to exercises that can stimulate the long head of biceps. 

However, active mobility is maintained below the 90° of elevation up to the 6
th week from surgery when the protection phase is completed. 

In case of sportive patients, the rehabilitative programme will be more aggressive and accelerated, aiming at recovering the full range of motion within 6 or 8 weeks after surgery (if the shoulder is not immediately immobilised, it is likely the risk of having shoulder rigidity with a deficit in extra-rotation). 

The return to sports (in physical activities involving contact or throw), will take 6 month of rehabilitation after the surgical intervention.
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