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After countless conversations, many meetings with large chiropractic clinic systems, and learning from hundreds of ChiroUp members; there is one differentiator that successful chiropractors possess—those who “classify” and those who don’t. There are outliers in any patient population, but the remainder of patients generally fall into a diagnosis “bucket.”  Classification of customized care pathways allows for greater organization, patient compliance, and let’s be honest–your sanity.

Watch Dr. Steele explain how to triage the management of SLAP lesions with four different care pathways.

 

Shoulder pain is the second most frequent musculoskeletal complaint, and superior labral tears are common in this population.  SLAP lesions often appear on imaging but carry debatable clinical significance – similar to a finding degenerative joint disease on a lumbar x-ray.  SLAP lesions may arise both traumatically ~25%, or as a result of long-term wear and tear.  As we know from the evidence, function determines structure until ultimately, structure determines function.  Degenerative SLAP lesions are a sign of long-term faulty biomechanics coupled with repetitive activity and poor postural control.

Once a diagnosis of a labral lesion is established, now comes the hard part; determining the treatment and prognosis of the condition based on the PATIENT presentation.  Fortunately, Hester et al. (1) have simplified your decision-making process by classifying SLAP lesions into 4 broad management categories:

Non-surgical

(1) Nonoperative management includes scapular exercise, restoration of balanced musculature, and would be expected to provide symptom relief in 2/3 of all patients.

(2) Throwing athletes should be in their own category and preferentially managed with rigorous therapy centered on hip, core, and scapular exercise in addition to restoration of shoulder motion and rotator cuff balance.

Surgical “repair should be reserved for those who fail rehabilitation programs”

(3) Patients with a clear traumatic episode and symptoms of instability that should undergo SLAP repair without (age < 40) or with (age > 40) biceps tenotomy or tenodesis

(4) Patients with etiology of overuse without instability symptoms should be managed by biceps tenotomy or tenodesis

Slap lesion prevalence increases with age.  Lansdwon et al. (2018) concluded that patients over 50 years old were significantly more likely to have superior labral abnormalities, regardless of concurrent shoulder injury or disease.  (2) Rehabilitation programs focused on restoring glenohumeral range of motion and correcting scapular posture can be more successful than surgery for most SLAP lesions. (3)

Click HERE for the ChiroUp SLAP CONDITION REFERENCE providing the current “best-practice” clinical tests, treatments, and exercises.

A diagnosis that was once considered a significant orthopedic condition is now more appropriately recognized as a normal part of aging – similar to degeneration in the lower back. These patients are looking for a non-surgical option, and there is no one better suited to provide that solution than you!

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REFERENCES

  1. Hester WA, O’Brien MJ, Heard WMR, Savoie FH. Current Concepts in the Evaluation and Management of Type II Superior Labral Lesions of the Shoulder. Open Orthop J. 2018 Jul 31;12:331-341.
  2. Lansdown DA, Bendich I, Motamedi D, Feeley BT. Imaging-Based Prevalence of Superior Labral Anterior-Posterior Tears Significantly Increases in the Aging Shoulder. Orthop J Sports Med. 2018 Sep 17;6(9):2325967118797065.
  3. Mathew CJ, Lintner DM. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018 Jul 31;12:303-313.

About the Author

Dr. Brandon Steele

Dr. Brandon Steele

DC, DACO

Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.

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