slap repairs versus biceps tenodesis in athletes 15 minforms.acsm.org/2014atpc/pdfs/40 kelly.pdf ·...
TRANSCRIPT
![Page 1: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/1.jpg)
SLAP Repairs Versus Biceps Tenodesis
in Athletes 15 min
![Page 2: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/2.jpg)
Power Points
• Not all SLAP tears need surgery
• Preservation of Native Anatomy GOAL
• Not all labral repairs are equal
• Kinetic chain MUST be addressed
![Page 3: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/3.jpg)
Power Points
• Biceps DOES have a function
• Tenodesis has consequences
• Tenodesis relieves pain reliably BUT……long term effects uncertain
![Page 4: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/4.jpg)
‘SLAPAHOLIC’ T. Romeo
• One who fixes EVERY SLAP TEAR and anything that remotely looks like one!
![Page 5: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/5.jpg)
Not all SLAP Tears Need Surgery
• SLAP tears way overdiagnosed
• Beware of positive imaging study - negative exam
• Slight labral separation may allow thrower to ‘get the slot’
![Page 6: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/6.jpg)
MRI May OVERDIAGNOSE
• Specificity ranges from 63% to 91%
![Page 7: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/7.jpg)
MRI and Anatomic Variants
• Meniscoid labrum
• Buford complex
• Cord like MGHL
• Age related attritional tear
• ALL CAN LOOK LIKE SLAP TEARS ON MRI!!
![Page 8: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/8.jpg)
Meniscoid Labrum
![Page 9: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/9.jpg)
‘Buford’ Complex
![Page 10: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/10.jpg)
Pfahler et al JSES 2003
Labral Tears are Part of the Aging Process!
![Page 11: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/11.jpg)
Nonoperative Treatment of Superior Labrum Anterior Posterior Tears
Improvements in Pain, Function, and Quality of Life Edwards et al
• Approx. 50% of non operatively treated patients avoided surgery!
Scapular strengthening, posterior capsular stretching
MANY LABRAL TEARS RESPOND TO REHAB!!!!
![Page 12: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/12.jpg)
Overtreat >>>> NIGHTMARE
![Page 13: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/13.jpg)
Make Sure History Consistent with SLAP “event”
• Sudden loss of velocity (dead arm)
• Large increase in pain
• “mechanical symptoms” usually present
• Rehab no longer effective
![Page 14: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/14.jpg)
Exam Hold Key!!!
• Load Shift
• Passive Distraction test
• Mayo Shear
• O’Brien’ Test (anterior)
• Kim test
• Relocation Test
![Page 15: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/15.jpg)
Mayo Shear Numero Uno in Literature
![Page 16: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/16.jpg)
Passive Distraction
![Page 17: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/17.jpg)
KIM Lesion
KIM Test
![Page 18: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/18.jpg)
Surgery?
• Failure of GOOD rehab
Experienced shoulder therapist
GIRD addressed
Scapula Rehab
Kinetic Chain Eval
Mechanical Symptoms (SLAP EVENT, frayed labrum from prolonged internal impingement)
MRI Confirmatory
![Page 19: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/19.jpg)
Kinetic Chain Must Be Addressed
• Hip abductors
• Spine Mobility
• Internal Rotation deficit Lead Hip
• Tight quads Lead Leg
• Scapula Dyskinesis
• Unrehabbed ankle sprain
• Poor balance
![Page 20: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/20.jpg)
Need True Pathologic Labral Separation (fissuring, hemorrhage, abortive healing) for TRUE LABRAL TEAR
![Page 21: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/21.jpg)
Biceps Tenodesis
• Becoming more frequent
• Reliable pain relief
• Higher ‘success’ labral repair (labral repair failure rates as high as 50%)
• BUT IS IT GOOD FOR ATHLETES??????
![Page 22: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/22.jpg)
Tenodesis
• Reasonable for salvage of failed labral repair in presence of POOR tissue
• Over age 35 reasonable option
• NON PHYSIOLOGIC
![Page 23: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/23.jpg)
Don’t throw away labral repair!!
• We can do a better labral repair
• Many degenerative, aged related ‘tears’ should not be repaired
• Tenodesis removes an important stabilizer (Biceps)
• Biceps tendon – ‘ACL of the shoulder’: Craig Morgan MD
![Page 24: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/24.jpg)
Biceps Has a Role
• Rodosky – Biceps confers anterior stability
• Patzer – Superior labrum requires intact biceps to ensure stability
• Warner – Joint compression afforded by biceps stabilizes joint
![Page 25: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/25.jpg)
Tenodesis: not a free ride
• Kumar 1989 Severing of LHBT > decrease over 5mm in acromial humeral distance
• Upward migration if humeral head may not cause symptoms initially!
![Page 26: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/26.jpg)
Hanypsiak AANA 2012
• Cadaveric study
• Biceps loaded 10, 20 and 40N
• Humeral translation measured 3D digitizer
• Tenodesis caused posterior shift humerus late cocking, ant. superior shift follow through
![Page 27: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/27.jpg)
Do Better Labral repair
• Bumper restoration only
• Address posterior capsule
• Avoid knot suture issues
• Address interval laxity
• FIX KINETIC CHAIN
![Page 28: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/28.jpg)
Surgery: Do it right and address all pathologic elements
• SLAP Tear
• Bankart
• Kim Lesion
• Interval Laxity
• Posterior Tightness
• Cuff Lesion
![Page 29: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/29.jpg)
![Page 30: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/30.jpg)
Goals: Preserve native anatomy
• Restore bumper
• Avoid knot/suture morbidity
• Avoid tensioning capsule
• Address interval
![Page 31: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/31.jpg)
Labral Surgery
• Lateral Decubitus
• Traction
• Kindness to tissue!
• Percutaneous Portals! (avoid cannulas in cuff)
![Page 32: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/32.jpg)
Lateral Decub….great Access
![Page 33: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/33.jpg)
Surgical Goals
• Fix true labral tears
• (Plicate anterior capsule/interval if necessary)
• Release posterior capsule if necessary
• Fix cuff ONLY if full thickness…..otherwise debride or do partial repair
![Page 34: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/34.jpg)
Restore Labral Bumper
• Lazarus 1996 – increase in glenolabral depth directly related to stability
![Page 35: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/35.jpg)
Be Wary of Capturing Anterior Capsule!
![Page 36: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/36.jpg)
Portals
![Page 37: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/37.jpg)
Percutaneous anchor insertion
Keep Knots Away !!!! Or…… go KNOTLESS Or…..use PDS (CDM)
Surgical Tips Labral Repair
![Page 38: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/38.jpg)
Prominent Knots Hard Suture Prediction?
![Page 39: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/39.jpg)
Percutaneous Portals
![Page 40: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/40.jpg)
Percutaneous Shuttling
![Page 41: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/41.jpg)
Address the Rotator Interval
• Unrecognized source of labral repair failure
• Potential attenuation with extensive throwing
• Anterior biceps pain in late cocking
![Page 42: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/42.jpg)
Rotator Interval – Biceps Outlet ( Pulley/ Sling ) Arthroscopic Anatomy: SGHL, SS Tendon, CHL
Morgan
![Page 43: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/43.jpg)
Mechanism of Injury: Throwing Across Body with High Flexion Angle during the Follow-Through Phase of Pitching
Morgan
![Page 44: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/44.jpg)
Arthrogram MRI - Sagittal Oblique Images Goniometric Measurement (Degrees)
The Sagittal Rotator Interval Angle
Morgan
![Page 45: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/45.jpg)
Arthroscopic Findings - SGHL Injured: Dorsal Biceps Hyperemic Synovitis
Morgan
![Page 46: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/46.jpg)
Operative Repair: 2 North-South Capsular Stitches between SGHL & MGHL Morgan
![Page 47: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/47.jpg)
Reliable Diagnostic Parameters for Rotator Interval Pathology: Clinical, MRI, & Scope
• Digital Pain in the Upper Bicipital Groove. • Anterior Superior Shoulder Pain in ABER relieved by Jobe Relocation
Maneuver. • Increased GH External Rotation and TMA on the Dominant versus the Non-
dominant Shoulder. • Asymmetric Sulcus Sign on the Dominant versus the Non-dominant
Shoulder ( Neutral and ER). • A Widened Rotator Interval on Sagittal Oblique Arthrogram MRI with
Bicep Tendon “Drop – Out” from central in the Pulley. • Arthroscopic visualized Widened Biceps Outlet. • Hyperemic Biceps, SGHL, and Upper MGHL with Parallel Adhesions going
into the Biceps Outlet. • Laxity in the Upper MGHL.
Morgan
![Page 48: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/48.jpg)
Address Posterior Capsule
• Posterior capsular release
non responders of sleeper stretch
more ‘mature’ throwers
capsule should be thick…..if not, don’t do it!!!
![Page 49: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/49.jpg)
Fig. 6
0.1053/jars.2003.50128 )
Copyright © 2003 Arthroscopy Association of North America Term
![Page 50: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/50.jpg)
![Page 51: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/51.jpg)
Hug Glenoid
![Page 52: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/52.jpg)
Address Rotator Cuff Hypertwist Leads to Failure
![Page 53: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/53.jpg)
Cuff Tear
• Anterior– leading edge supraspinatus (tension)
• Posterior- junction supra-infra. (internal impingement)
• Laminated tears “PAINT” – partial articular intratendinous tear (shear)
• May approach full thickness
![Page 54: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/54.jpg)
Internal Impingement
![Page 55: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/55.jpg)
ABER VIEW
![Page 56: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/56.jpg)
Cuff Testing
![Page 57: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/57.jpg)
Management Cuff
• Debride if less than 80-90%
• Side to side, laminar/intrasubstance tear repair
• Do not advance leading edge cuff to bone! (they will never find the ‘slot’ again)
• Cuff tear allows shoulder to ‘hypertwist’
![Page 58: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/58.jpg)
Side to Side Repair – ‘In Situ’
Conway
![Page 59: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/59.jpg)
College Pitcher
![Page 60: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/60.jpg)
PASTA
![Page 61: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/61.jpg)
Take Home
• Don’t be a slapaholic – choose wisely
• If addressing labral tear…..be kind, and use percutaneous portals
• Release posterior capsule in ‘stretch non responders’
• Don’t be a hero with the rotator cuff!
![Page 62: SLAP Repairs Versus Biceps Tenodesis in Athletes 15 minforms.acsm.org/2014ATPC/PDFs/40 Kelly.pdf · 2014-11-19 · SLAP Repairs Versus Biceps Tenodesis in Athletes 15 min . Power](https://reader030.vdocuments.net/reader030/viewer/2022040514/5e6ea9cdede0ba42267e54bf/html5/thumbnails/62.jpg)
Take Home
• Restore native anatomy
• Address the interval
• Correct kinetic chain
• Tenodesis LAST RESORT