Case Study – Slap Tear Shoulder (Superior Labral Tear from Anterior to Posterior)

April 10, 2018 | By | Reply

– Dr. Ketki Bhosle

Hrishikesh Kulkarni, 17 years, young male student, state level cricket player, right handed batsman came with the complain of left shoulder pain since a month.

He was having difficulty in:

  • Overhead activities,
  • Lifting heavy weights,
  • Playing cricket.

His pain was relieved with rest.

History of:

He had a fall on left shoulder while fielding 1 year ago. He went to orthopaedic doctor, and his left shoulder was strapped for one and a half month. His pain got relieved, and he started his routine fitness workout, but the pain came back. He was referred to PhysioRehab by the orthopaedic doctor for further conservative management for 6 weeks and advised for surgery if it doesn’t get better.

After a physical examination it was learnt:

  • Faulty posture of left shoulder, rounded shoulders, scapular dyskinesia (abnormal movement of shoulder blades during shoulder movement).
  • Tenderness on shoulder joint and upper arm.
  • Shoulder movements were restricted, stiff and painful in daily life and could not play cricket a sport he loves and wants to be a professional
  • His MRI showed: discrete superior labral tear extending upto anterior and posterior equator (SLAP).

What is SLAP?

SLAP stands for “Superior Labral Tear from Anterior to Posterior”

The shoulder joint is a “ball-and-socket” joint. However, the ‘socket’ (the glenoid fossa of the scapula) is small, covering at most only a third of the ‘ball’ (the head of the humerus ).To compensate for the shallow socket, the shoulder joint has a circular rim of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. A SLAP tear is an injury to a part of the shoulder joint called the labrum.

Labral tear anatomical diagram

The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum.

The area of the labrum where the SLAP tear occurs is susceptible to injury because it is an area of relatively poor vascularity. Other parts of the labrum often heal more easily because the blood supply delivers a healing capacity to the area of the tear. In the area of SLAP tears this is not the case, and chronic shoulder pain can result.

Common Reasons for a SLAP Tear Include:

  • Fall onto an outstretched hand
    Falling on to an outstretched arm
  • Repetitive overhead actions (throwing)
  • Lifting a heavy object
  • Faulty shoulder posture and incorrect gym or exercise technique

We at PhysioRehab designed a specific rehab program and exercise regime 8-10 weeks Hrishikesh

  • Pain relief modality
  • To improve his shoulder range
    Improving shoulder range
  • Correct his Shoulder blade positioning and stabilization
  • Posture training
  • Dorsal spine mobility
  • Shoulder muscle strengthening focus on rotator cuff and biceps
    Shoulder muscle strengthening
  • Core and sports specific work
    Core work
  • Oblique muscle training
    Oblique muscle training
    Oblique muscle training

Physio Speak:
Once achieved his pain free full range, we started with sports specific drill that is cricket specific training for another 4 weeks for him.
In sports specific training we worked on his:

  • Advanced Core training
    Core training
  • Dorsal spine and oblique muscle strengthening
    Dorsal spine strengthening
  • To improve anterior and posterior sling system
    Improve sling system
  • Rotator cuff strengthening
    Rotator cuff strength
  • Balance proprioception training
    Balance training
  • Shoulder agility and endurance training.
    Shoulder agility
    Shoulder agility
    Shoulder agility
    Shoulder agility
    Shoulder agility
    Shoulder agility

After 20 sessions twice, a week he was absolutely pain free and started playing cricket without any discomfort. A happy Hrishikesh returned back to his training academy and participated in competitive games.An individualized, tailor-made exercise regime at PhysioRehab made him continue his passion and thus improved his quality of life.

Patient Speak:

Patient testimonial

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Category: Case Studies

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