Microfracture Procedure

A SLAP lesion tear is an injury to the shoulder. This can cause painful symptoms and difficulty with overhead activities whether they be athletic or those of daily living. In 1985, Andrews et al were the first to describe the superior labrum tear. In their experience, they identified tears of the labrum from throwing athletes located anterosuperor near the origin of the bicep tendon. The cause of the lesion to tear was the bicep tendon being pulled off the labrum from the force generated during the throwing motion. As time went on, the labral tears got categorized into four different types of classifications called SLAP lesions by Snyder in 1990. A SLAP lesion, as described by Snyder involves tears of the superior

Baseball is America's pastime. Everyone in this country knows a person who plays the game and the struggles they face throughout their entire baseball endeavors. Baseball is an overhead throwing sport that requires countless amount of repetition in order to perfect the art of throwing a baseball with different spins and velocities. Because baseball has become a non-season based sport in this modern era, it has risen health risks to the elbows of athletes that play continuously. The Ulnar Collateral Ligament, commonly coined as the Tommy John Ligament, is the

Russell Carrington is a 25 year old right handed relief pitcher for the MLB team the Baltimore Orioles. Carrington has been playing baseball since he was seven years old and this was his third season in the Major Leagues. Carrington was at the mound and in the motion of throwing a fastball, when he felt a “pop” in his overhand motion. He dropped to his knees and clinched his right shoulder in pain. Athletic trainers came onto the field an upon examination Carrington stated his arm felt like it was “dead” and felt like it was “catching”. Carrington was seen by the team physician. She performed ROM exercises, strength, and stability tests on his shoulder and examined his neck and head to ensure pain wasn’t coming from a pinched nerve. She concluded that further testing and imaging was necessary. Carrington had an X-ray and MRI done on his shoulder and he was diagnosed with a type II SLAP (Superior Labrum Anterior and Posterior) lesion. He didn’t want surgery done because he would miss the remainder of the season and possibly the next, so doctors prescribed non-steroid anti-inflammatory medication and five months physical therapy to strengthen the shoulder capsule. After completion of physical therapy, the pain didn’t improve and arthroscopy surgery was recommended.

There are a very small amount of easy treatments possible for this injury. Depending on the type of labral tear and intensity of symptoms, one may need surgery. Most tears, both shoulder and hip, do not depend upon surgery, but patients that obtain

The patient notes that the injury happen when he was lifting some metal trash trays into a trash bin when he felt a sharp pain in his shoulders. Treatment history notes that the treatment to date has consisted of medications. Of note, the MRI done showed a large full thickness tear with retraction of the tendon. Physical examination of the left shoulder revealed that the range of motion has forward flexion of 0-175 degrees, external rotation of 0-40 degrees, and internal rotation to T12. There is positive Hawkins’ and Neer’s sign for impingement. There is weakness with abduction testing. Treatment plan notes recommendation, surgical intervention in the form of a left shoulder, subacromial decompression, rotator cuff repair surgery as necessary. A follow up of 2 to 3 weeks if surgery is authorized. As per medical summary and work status dated 6/14/16, it was noted that the patient has not improved significantly and would be needing surgery. The patient’s return to work date is 6/14/16 with no lifting over 10 pounds and no overhead reach. Follow up to clinic date is on

DOI: 9/26/2015. Patient is a 29-year-old male construction worker who sustained a work-related injury to his neck, back, left shoulder and right knee when he slipped and fell. He is status post left shoulder arthroscopy on 8/05/2016.

Labral injuries can occur in the superior and posterior labrum from impingement during the cocking phases. Pain will be present deep in the shoulder joint. Capsular injuries will present a slipping shoulder feeling, loss of control and velocity. Scapular dyskinesis appear with anterior lateral cuff impingement pain. The pain can radiate through the posterior and medial portions of the scapula. Ulnar collateral ligament sprains can present with various forms of pain and locations. All of these injuries can be treated with physical therapy and surgery if need be (Madden, 2010). It is also a good idea to have a rehabilitation throwing program in place to assist with training the body correct movements of throwing mechanics. This can prevent injuries from reoccurring or other injuries from taking place (Donatelli,

The clinical evaluation of labrum pathology can be difficult to diagnose due to each type of SLAP lesion having different mechanisms of injury, pain, and area that is affected. Type 1 SLAP lesions can usually be associated with rotator cuff pathology with a partial thickness tear of the supraspinatus ligament due to micro-tears. ^1,5 This is quite common in baseball players and other overhead athletes. Type II lesions can vary based on age; younger patients have more instability than older patients who tend to have rotator cuff pathology. ^1,6 Type III and IV lesions are more commonly associated with traumatic instability. ^1 As with all injuries, the evaluation should start with the history making sure to include the exact mechanism

DOI: 2/24/2016. Patient is a 46-year-old male production technician who sustained injury while he was lifting a heavy door when he felt immediate pain in his right shoulder. Per OMNI, he was initially diagnosed with right shoulder strain.

Once torn, if the patient desires to become active in sporting or physical activities ever again, surgical repair of the ligament is almost an unavoidable option. There is

In spite of the complexity and the severity of David’s shoulder injuries, Dr. Tehrany managed to solve the overwhelming situation by recommending an arthroscopic surgery to address all injuries at once.

Because there are numerous variations of SLAP lesion, doctors classified SLAP lesions into 10 categories. Type I SLAP lesion, typically degenerative in nature, is classified as isolated fraying of the superior labrum. The labrum, however, is still attached to the glenoid. Type II SLAP lesion is described as the detachment of the superior labrum and origin of tendon of the long head of the biceps brachii from the glenoid. This kind of SLAP lesion results in the instability of the biceps-labral anchor. A patient has type III SLAP lesion when there is a bucket-handle tear of the labrum with the bicep insertions still attached. Type IV SLAP lesion is described as a bucket-handle tear of the labrum that extends into the biceps tendon. Similar to

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

Glenohumeral joint kinematics change in an adaptive manner to chronic overhead activity, seen in multiple sports especially in baseball, volleyball, handball, and basketball(16-18). This involves all tissues of the shoulder – bone, capsule, and muscle(19). During normal human development the humeral head rotates from a retroverted position at birth to an anteverted position as an adult. However, when individuals begin overhead throwing at an early age, extrinsic forces on the humerus cause the humeral head to remain in relative retroversion compared to that of the non-dominant arm. This, combined with tightness of the posteroinferior capsule from chronic reactive scarring, and with scapular

SLAP is a superior labrum tear in an anterior to posterior direction of the shoulder, affecting more than 4000 people in a year, usually men between the ages of 20-30 and 40-50. The purpose of this case report is to show the relevance of the amount of physical therapy session after a SLAP surgery repair.