I'm 45 years-old and facing surgery for what's called a "SLAP" injury of my right shoulder. I've seen two different surgeons who have given me two different treatment choices. The one doctor said my age made a difference. The second one said it didn't matter. Who's right?
SLAP stands for superior labral anterior posterior and refers to a tear of the labrum located around the rim of the acetabulum (shoulder socket). The labrum is a ring of fibrous cartilage around the shoulder socket. It helps support and hold the round head of the humerus (upper arm bone) in the shallow socket.
The superior labrum is located along the top of the socket. It is attached loosely by elastic connective tissue. A force or load through the shoulder that is greater than the tensile strength of the thick connective tissue can cause tearing of the structures.
There are four types of SLAP lesions. The groups are based on severity and help determine treatment. Type 1 occurs most often in older adults. Fraying and thinning of the labrum is most common with this type of SLAP lesion. If surgery is called for, the surgeon will shave off any fragments and smooth the remaining edges of the labrum.
The other types describe the extent of injury. For example, in a type 2 SLAP injury, the biceps anchor where the labrum attached is detached. There may be some frayed edges of the labrum as well.
Type 3 is a bucket-handle shaped tear in the labrum but the biceps anchor is not disturbed. Type 4 has a similar bucket-handle shape that extends all the way into the biceps tendon. Sometimes people have more than one type of tear at a time. Surgery is often needed to repair the more severe injuries.
Studies show that more and more of these SLAP procedures are being done. Men have this surgery three times more often than women. And folks over 40 are more likely to have surgery now than in the past.
Why are there more older adults having this surgery? It may be because newer repair techniques (e.g., with suture anchors) makes this procedure more successful in that age group than ever before.
But other studies have clearly shown that tenotomy (tendon is cut) or tenodesis (stitching tendon back to the bone) procedures have better results than SLAP repairs in patients over 40. These findings may be what one of the surgeons you saw was referring to when he or she suggested that age makes a difference.
Alan L. Zhang, MD, et al. Demographic Trends in Arthroscopic SLAP Repair in the United States. In The American Journal of Sports Medicine. May 2012. Vol. 40. No. 5. Pp. 1144-1147.
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