My Preferred Treatments >SLAP Lesions The most important aspect of SLAP lesions is diagnosis. It is important for me to obtain thorough historical information from the patient regarding their symptoms, any injuries and response to previous treatment. Next I will carefully examine the patient’s shoulders. At this point I will generally have a suspicion about a SLAP and will order and MR arthrogram (MRA). With this test the radiologist injects dye into the shoulder and then an MRI is performed. The MRA is much more sensitive in diagnosing SLAP lesions than a regular MRI. Once the tear is diagnosed, I will discuss the treatment options with the patient. Unfortunately if they are having symptoms from the SLAP, the only definitive treatment is surgery. The only other option is to modify or eliminate activities that produce pain. In my experience, most patients do not want to eliminate activities and therefore usually select surgery.
>Bankart Lesions If a patient has a first-time dislocation and is under the age of 25 years, I will discuss options of immediate surgery vs. trying a period of immobilization. The latest research shows that immobilization in external rotation (with the arm rotated out) is best if non-surgical treatment is attempted. I carefully counsel the patient about the 75-90% risk of recurrent dislocations. For individuals over 40 years of age that have a first-time dislocation, I base my recommendations on the patients’ activity level and work requirements. Many patients can be treated without surgery unless they have strenuous hobbies or work. The middle group of patients, from 25-40 years of age, fall in a gray area. Again, it is important to note their activity level, how loose their shoulder feels when I examine it and how large the tear appears on the MRA. Regardless of age, if patients have recurrent dislocations or are apprehensive about participating in activities because of their shoulder, I will recommend and discuss surgery.
>My Surgical Technique for SLAP & Bankart Lesions I currently use an all-arthroscopic technique with knotless, dissolvable anchors. The key to the procedure is placing the anchors in the right place and appropriately mobilizing the labrum as I noted above.
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