[25], For patients older than 36 years there is a higher chance of failure. Am J Sports Med.,2014 ;42(6):1315-1322, WEBER S.C., Surgical management of the failed SLAP repair. A total of four types of superior labral lesions involving the biceps anchor have been identified. Glenoid neck preparation is with a tissue elevator, rasp, and/or shaver instrument. Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis. It also becomes more brittle with age, and can fray and tear as part of the aging process. In these situations, evaluating the patient’s history of repetitive overhead activity or general functional history will help isolate suspicion towards the superior labrum. Superior Scapes, Liverpool, New York. Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC. “Type II plus anterior shoulder instability.”. Surgical Trends in the Treatment of Superior Labrum Anterior and Posterior Lesions of the Shoulder: Analysis of Data From the American Board of Orthopaedic Surgery Certification Examination Database. When is surgery recommended? Brockmeier SF, Voos JE, Williams RJ, Altchek DW, Cordasco FA, Allen AA., Hospital for Special Surgery Sports Medicine and Shoulder Service. 2009 Oct-Dec; 43(4): 342–346, WILK K.E. The possibility of generalized hyperlaxity of tissues in all patients with instability should also be considered, and a Beighton score can easily be obtained. [17] Anatomical variations such as a Buford complex, a thickened middle glenohumeral ligament (MGHL), and absent anterosuperior labrum may be confused with a SLAP tear as well. Interestingly enough, the anterior aspect of the superior labrum and the labral region anterior to the LHBT origin have the highest density of these fibers.[32]. The shoulder labrum is a fibrocartilaginous rim attached to the margin of the glenoid cavity. They can extend into the tendon, involve the glenohumeral ligaments or extend into other quadrants of the labrum. Rowbotham EL, Grainger AJ. Unlike Bankart lesions and ALPSA lesions, they are uncommonly (20%) associated with shoulder instability 5. This rotator interval has a triangular shape in which the supraspinatus is superiorly located, the subscapularis inferiorly and the processus coracoideus medially. Fealy S, Rodeo SA, Dicarlo EF, O'Brien SJ. Physical Examination Pearls  Clinical and radiological outcomes of type 2 superior labral anterior posterior repairs in elite overhead athletes. Superior labrum-biceps tendon complex lesions of the shoulder. The shoulder joint is composed of the glenoid (the shallow shoulder "socket") and the head of the upper arm bone known as the humerus (the "ball"). Part II candidates. [9]Isolated SLAP lesions are uncommon. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. As with most shoulder conditions, the history including the exact mechanism of injury should be documented. So there are conflicting views in the literature about the repairs in the older patients.[27]. Neri BR, Vollmer EA, Kvitne RS. [11], When we consider some tests individually, one can consider the Speed’s test and O’Brien’s test helpful in the diagnosis of anterior lesions and the Jobes Relocation Test is often positive in a posterior lesion[6][23] According to Meserve et al, the O’Brien test is the most sensitive test (47%-78%) and the Speed’s test the most specific (67%-99%). While Snyder’s group reported that SLAP repairs represent about 3% of shoulder cases in a large tertiary referral center, ensuing studies from the first decade of the 2000s reported a consistent rise in the overall increased rate of SLAP repairs performed at many other institutions. Ilahi OA, Labbe MR, Cosculluela P. Variants of the anterosuperior glenoid labrum and associated pathology. To diagnose this condition it is important to use several different tests and not only one. The resulting tear of the labrum can then be debrided or fixed depending upon the severity of the tear. Also, a wide array of implant options are available depending on surgeon preference. Care must be taken to avoid iatrogenic nerve injury during decompression. At month 4 to 6, dependent on the type of sport practiced, patients should be able to start sport-specific training and gradually return to their former level of activity.[2]. SLAP lesions: anatomy, clinical presentation, MR imaging diagnosis and characterization. [15], SLAP tear itself accounts for 80–90% of labral pathology in stable shoulder but it’s only found in 6% on arthroscopy. El labrum glenoideo, recordemos, es un anillo de fibrocartílago que aumenta el diámetro efectivo de la glenoides respecto a la cabeza humeral. The authors noted that in cases of a positive peel-back sign (i.e., not present in normal shoulders during an arthroscopic examination), the biceps anchor assumes a more vertical and posterior angle that is dynamically visible. A total of four types of superior labral lesions involving the biceps anchor have been identified. Arthroscopic all-intra-articular decompression and labral repair of paralabral cyst in the shoulder. [21] Furthermore, SLAP tears account for approximately 1% to 3% of injuries presenting to sports medicine referral centers, and SLAP tears are present in approximately 6% of shoulder arthroscopy procedures.[2][21][22]. SLAP lesions of the shoulder. [9][11][13] It is important to keep in mind that while labral pathologies are frequently caused by overuse, the patient may also describe a single traumatic event. Stress distribution in the superior labrum during throwing motion. et al., The Diagnosis, Classification, and Treatment of SLAP Lesions. Strength, stability and motion are the components of shoulder function that should be focused on during rehabilitation. Anteroinferior labral tears decreased posterior stability and posterosuperior labral tears decreased anterior and anteroinferior stability, largely because of loss of the suction cup effect. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Tears of the glenoid labrum Some tests isolate the tension placed on the superior labrum by the biceps via provocative maneuvers in active and passive forms. External rotation must absolutely be avoided and abduction limited to 60°. The deltoid muscle often demonstrates atrophy in chronic dislocators. [3][4] further subdivided the SLAP classification schemes to ultimately delineate ten different types of SLAP tear patterns, including combined SLAP- and Bankart-type injuries seen in specific associative patterns. They can extend into the tendon, involve the glenohumeral ligamentsor extend into other quadrants of the labrum. [4] Other studies have shown rates between 6% and 26% at the time of arthroscopy. [24] As patients age, typically beyond 40 years of age, repair becomes consistently inferior to tenodesis or tenotomy. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. A positive test is noted if the patient reports pain over the bicipital groove and/or subluxation of the LHB tendon. ), which permits others to distribute the work, provided that the article is not altered or used commercially. National trends in the diagnosis and repair of SLAP lesions in the United States. SLAP lesions are considered as separate entities from other labral tears because the superior labrum is the attachment site of the long head biceps tendon. Oper Tech Sports Med, 2012;20 (1):46 – 56, MYERS J.B. et al., Sensorimotor deficits contributing to glenohumeral instability. A sublabral foramen with a cord-like middle glenohumeral ligament. Please enter a valid 5-digit Zip Code. Journal of Science and Medicine in Sport, 2014;17(5): 463–468, MAENHOUT A. et al., Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program. Presence of concomitant LHBT tendinitis or tendinosis: The odds ratio for revision surgery was 5.1 in the setting of LHBT tearing/fraying. [15] Additionally, we now recognize that SLAP lesions commonly occur in asymptomatic overhead athletes. There is an increasing body of literature evidence now recognizing that appropriate patient selection is critical. It is important to discuss the patients’ activities such as athletics, profession, and baseline activity level. Asymptomatic tears should be observed. Any evidence of significant muscular weakness may hint at an underlying associated neurologic deficit. A detailed sensory examination should take place in all acute and chronic instability patients. Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports. Sports Med Arthrosc.,2010;18:162-166. sensations of painful clicking and/or popping with shoulder movement, loss of glenohumeral internal rotation range of motion, loss of rotator cuff muscular strength and endurance, loss of scapular stabiliser muscle strength and endurance, inability to lie on the affected shoulder. Clinical testing for tears of the glenoid labrum. Original Editor - Kristin Sartore, Venugopal Pawar, Top Contributors - Venugopal Pawar, Lucinda hampton, Fasuba Ayobami, Kim Jackson, Rachael Lowe, Claire Knott, Amrita Patro, Wanda van Niekerk, Vasileios Tyros, Admin and WikiSysop. Clin Orthop Relat Res,2002; 400:98–104, HUIJBREGTS P.A., SLAP Lesions: Structure, Function, and Physical Therapy Diagnosis and Treatment. The patient lies supine on the exam table with his or her arms resting in full elevation with the forearm and hand supported by the table. Superior labrum anterior and posterior lesions of the shoulder: incidence rates, complications, and outcomes as reported by American Board of Orthopedic Surgery. Understanding the rigorous rehabilitation required from advanced procedures helps the patient understand what is expected on their road to recovery. [17], Beside biceps tears, other problems, such as bursitis and rotator cuff tears, are often identified, in combination with SLAP lesions,[18]According to Morgan CD et al., Rotator cuff tears were present in 31% of patients whit SLAP lesion and were found to be lesion-location specific.[19]. The long head of the biceps tendon attaches in the glenoid as part of the labrum at roughly 12:00. Resisted elbow flexion, resisted forearm supination. SLAP Tear of the Shoulder. http://creativecommons.org/licenses/by-nc-nd/4.0/ This means your labrum is. In the age category 60 years or older, circumferential lesions have been identified. Approximately 40% of the long head of biceps tendon (LHBT) attaches to the labrum. A SLAP lesion is mainly caused by a fall on an outstretched arm where there is an important superior compression on the labrum which causes a tear of the labrum. The ABOS database houses the collection of International Classification of Diseases, Tenth Revision (ICD-10), and CPT coding across eligible ABOS Part II candidates during their respective board collection periods. Glenohumeral internal rotation deficit (GIRD) is a common associated finding in throwing athletes. Patient complaint of pain is not a good gauge for progression. Rossy W, Sanchez G, Sanchez A, Provencher MT. Am J Sports Med., 2012;40(9):2105-2112, COOLS A .M. [26]Because of unsatisfactory results in older patients, Boileau et al., suggested arthroscopic biceps tenodesis in these patients. [10][11] Furthermore, the respective incidence rates for the clinical diagnosis of SLAP lesions and the incidence of SLAP repairs remain limited given the paucity of available high-quality studies reporting available epidemiologic data and surgical management trends. There is increasing evidence that SLAP tears are frequently present on MRI in asymptomatic overhead athletes. Nonoperative PT regimens focused on correcting for scapular dyskinesia and glenohumeral internal rotation deficit (GIRD).[49]. Yeh ML, Lintner D, Luo ZP. J. A tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion. AJSM 2013. SLAP stands for "superior labrum, anterior to posterior"—in other words, "the top part of the labrum, from the front to the back." It refers to the part of the labrum that is injured, or torn, in a SLAP injury. Describe treatment considerations for patients with superior labral anterior to posterior (SLAP) lesions. It can be caused by a forceful overhead motion, or when you try to catch something heavy. [27] It is the anatomic manifestation of a congenital failure of fusion of the labrum, which attaches to the glenoid with a smooth margin or a medial slip. Specific testing of the supraspinatus muscle can be difficult when passive ROM is limited. Snyder et al. Chronic anterior and posterior instability patients may also exhibit corresponding posterior and anterior acromial prominences, respectively. A standard detailed history is required, as with all patients presenting to the clinic. Superior labrum lesions, or frequently referred to as superior labrum anterior to posterior (SLAP) tears, are a subset of injuries of the labrum in the shoulder that occur in acute and chronic/degenerative settings. Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. Sometimes morphological varieties can be confused with pathological aspects and therefore diagnosis should be established following careful analysis of the case history and a physical examination. SLAP Lesions: Trends in Treatment. Other standard views include the axillary lateral view and “scapular Y”/outlet views. The arm is released from traction and brought into an abducted/externally rotated position. A 2017 level III case-control study highlighted the potential risk factors for revision surgery following SLAP repair, with the inclusion of nearly 5000 patients in the database query[58]. 1173185. The rotator cuff muscles are important as well to anchor the scapula and guide the movement. Essential to full recovery from a Type II SLAP ( S uperior L abral tear from A nterior to P osterior) Lesion is protection of the repaired labrum. Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) [5]In one study, half of the cases that had a SLAP lesion were 40 years old patients who showed signs and symptoms of instability after a history of acute trauma, repetitive injury, fall on an outstretched arm, or an injury from heavy lifting. - Clinical Presentation and Follow-up of Isolated SLAP Lesions of the Shoulder (SS-04) - Classification and Treatment: - labrum is assessed, including stability of the biceps labral attachment, as well as biceps tendon; - SLAP tears will show more than 5 mm of exposed superior glenoid bone and often a peel back sign; - peel back sign: Moreover, patients will often present with an MRI final report stating a SLAP tear was present on imaging. Cadaveric studies have demonstrated that SLAP tears are more likely to occur with the shoulder in a forward flexed position than positions in extension. Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction. Type II is the most common type and represents a detachment of the superior labrum and biceps from the glenoid rim. [9] The physical examination is also very important in determining the correct diagnosis[11], however physical examination should not be used in isolation because the literature does not confirm that special tests can accurately identify SLAP lesions. [15], According to William F.B., SLAP lesions had an association of 43% with the medial sheath lesion. [20], Erickson et al. SLAP lesions demonstrate a predilection for young laborers, overhead athletes, and middle-aged manual laborers. Compression-type injuries Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. The palm is on the anterior aspect of the contralateral shoulder, with the elbow flexed to 90 degrees. Return to play after Type II superior labral anterior-posterior lesion repairs in athletes: a systematic review. Rehabilitation after surgery is dependent upon several factors. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Describe interprofessional team strategies for improving care coordination and communication to advance the treatment of superior labrum lesions (SLAP tears) and improve outcomes. The recess/sulcus can be present during fetal development as early as 22 weeks of pregnancy, persisting throughout childhood and into adulthood. Ther., 2013; 8(5): 579-600, HURI G. et al, Treatment of superior labrum anterior posterior lesions: a literature review. Describe treatment considerations for patients with superior labral anterior to posterior (SLAP) lesions. What this means is that the labrum is torn at the superior (top) of the glenoid. Their findings show no difference between the two age groups. Initial evaluation of the shoulder typically starts with x-rays to rule out osseous pathology. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. Clinicians should keep in mind the utilization of MRA may promote the overdiagnosis of asymptomatic (or clinically irrelevant) SLAP lesions and thus exercise best clinical judgment in ordering specific advanced imaging modalities. Schwartzberg R, Reuss BL, Burkhart BG, Butterfield M, Wu JY, McLean KW. In the acute setting, traumatic injury can occur in traction/torsion and compressive/subluxation mechanisms. Connor PM, Banks DM, Tyson AB, Coumas JS, D'Alessandro DF. [1][2]  Snyder developed the initial 4-subtype classification of these lesions. O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. Gupta R, Kapoor L, Shagotar S. Arthroscopic decompression of paralabral cyst around suprascapular notch causing suprascapular neuropathy. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Int. 2022 Dec . [2]Regaining GIRD is a crucial aspect in the rehabilitation of SLAP lesions. Other authors supported the theory of an inferior traction mechanism on the basis of a sudden, traumatic, inferior pull on the arm or repetitive microtrauma from overhead sports activity with associated instability. Degenerative SLAP tears often affect overhead laborers with increasing degrees of association in patients over 40 years old[8], It is important to appreciate the limitations in our ability to accurately report the definitive epidemiological trends as the contemporary recognition and diagnosis of SLAP injuries remains debated. [23] Vangsness et al. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. [40]. Several authors recommend against repair in these populations.[23][31]. Demographic trends in arthroscopic SLAP repair in the United States. [39] Secondary to fraying related to Internal Shoulder Impingement. For the treatment of SLAP lesion one uses often a medical treatment where the surgeon uses advanced arthroscopic techniques. Unstable SLAP lesions are typically repaired with anchor fixation, and the extent of the injury typically determines the pattern of repair. Patients often complain of vague, deep shoulder pain and mechanical clicking with exacerbating activities. The rotator interval is an anatomic space between the Supraspinatus tendon, the Subscapularis tendon and the processus coracoideus. A tear of the labrum below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion. Provocative Examination Testing/Maneuver: You are not required to obtain permission to distribute this article, provided that you credit the author and journal. [18], Operative management varies widely depending on patient activity level and treatment goals. American journal of sports medicine,2009;37:2252-2258. Less common than SLAP Lesions. Assisted and passive techniques are used at 4 weeks post-operative to increase shoulder mobility. The examiner then applies terminal external rotation until resistance is appreciated. A positive test includes pain or a painful click on the anterior or posterior joint line. [53][54][55] A number of authors report good results in athletes, including those with sport-specific overhead demand requirements. and Maffet et al. As mentioned, this concept can also be applied to the young, athletic population as well. [38] Determining the onset of symptoms and mechanism (trauma, dislocation, or exacerbating maneuvers with overhead activity) can clue an examiner into labral pathology. Andrews JR, Carson WG, McLeod WD. Common SLAP-provoking sports include but are not limited to: Overhead sports (volleyball, baseball pitchers, javelin, swimming), History or current manual/physical laborer occupations, Atraumatic, insidious onset of anterior shoulder pain, Symptom exacerbation with overhead activities, Pain radiating down the anterior arm from the shoulder, Clicking or audible popping reported in the setting of proximal biceps instability. The labral insertion of LHBT is left unaffected. First described in the 1980s, extensive study has followed to elucidate appropriate evaluation and management. [7] Internal impingement can also result from rotator cuff tears via chronic posterosuperior or anterosuperior migration/subluxation of the humeral head.[8]. Andrews JR, Carson WG, McLeod WD. [2], After surgery, for 3 to 4 weeks, the shoulder of the patient is placed in a sling, which immobilises the shoulder in internal rotation and leads to general loss of motion and stiffness. The differential diagnosis for chronic shoulder pain includes several etiologies: Although Level I and II studies in the literature are lacking regarding outcomes following arthroscopic type II SLAP repairs, most studies report overall favorable results and good outcomes in the appropriately selected patients. Ther., 2013;8(5):617-629, CLAVERT P., Glenoid labrum pathology. The findings can be rather subtle, especially in obese patients. Performance of the test on the nonaffected shoulder should not elicit any pain. Results are widely varied in these athletes, demonstrating the return to the prior level of sport between 7% and 84%. Kuhn JE, Lindholm SR, Huston LJ, Soslowsky LJ, Blasier RB. Am J Sports Med., 2010;38:1456–1461, SACCOL M.F. [23][27] The most common complications after surgical fixation are residual pain and stiffness. The patient is eventually advanced to a strengthening phase, which includes trunk, core, rotator cuff, and scapular musculature. Gradually, active strengthening and improvement of neuromuscular control are undertaken from two to four weeks. In the chronic setting, degenerative changes within the shoulder may be present, and while testing of the superior labrum may be positive, it may not be the main cause of their symptoms. [5], There remains debate regarding whether the so-called peel-back mechanism versus the deceleration phase of throwing is most responsible for the pathologic forces driving SLAP tears in overhead athletes. [1], In various patient populations, internal impingement is also a culprit of SLAP tears. Superior labral anterior posterior (SLAP) lesions of the glenoid have proven difficult to diagnose clinically. In the acute traumatic setting, a fall onto an extended and abducted arm leads to a compressive and superior directed force from the humeral head into the superior labrum. Access free multiple choice questions on this topic. Injuries to the labrum in this region can result in labral symptoms, biceps symptoms or both. The cocking phase of throwing can place direct posterosuperior impingement on the superior labrum. Suprascapular nerve compression from a paralabral cyst may occur. This activity reviews the evaluation and treatment of SLAP tears and highlights the role of the interprofessional team in managing patients with this condition. Important variations in the normal anatomy of the labrum have been identified. Outcome of the isolated SLAP lesions and analysis of the results according to the injury mechanisms. Arthroscopy, 2010. The examiner places his or her hand over the patient’s elbow while instructing the patient to resist the examiner’s downward force applied to the arm. Contribution to the study of the pathogenesis of type II superior labrum anterior-posterior lesions: a cadaveric model of a fall on the outstretched hand. Physical examination is not easy because of the fact that SLAP lesions are often associated with other shoulder pathologies. This decreases the normal shoulder function. Next, the examiner applies a shear force through the shoulder joint by maintaining external rotation and horizontal abduction and lowering the arm from 120 to 60 degrees abduction. Smith R, Lombardo DJ, Petersen-Fitts GR, Frank C, Tenbrunsel T, Curtis G, Whaley J, Sabesan VJ. Weber SC, Martin DF, Seiler JG, Harrast JJ. [9], Postoperative rehabilitation for tenotomy and tenodesis of the biceps is typically included within the above protocols. [46]. Also, shoulder girdle proprioceptive training is beneficial to help prevent re-injury. Between week 4 and 8, internal and external rotation ROM are progressively increased to 90° of shoulder abduction. SLAP lesions represent a specific pattern of injury that involves the partial or complete detachment of the superior labrum and/or the biceps tendon. Forced shoulder abduction and elbow flexion, Type I – Fraying of the superior labrum with intact biceps anchor, Type II – Fraying of the superior labrum with detached biceps anchor, Type III – Bucket handle tear of the superior labrum with intact biceps anchor, Type IV – Bucket handle tear of the superior labrum with detached biceps anchor (remains attached to the torn labrum), Type VI – Type II + unstable flap either anteriorly or posteriorly, Type VII – Type II + anterior extension inferior to the MGHL, Type VIII – Type II + posterior labrum extension, Type X – Type II + reverse Bankart lesion, Other labral pathology and/or instability. Johannsen AM, Costouros JG. The involved shoulder is positioned at neutral, the elbow is flexed to 90 degrees, the forearm is supinated, and the patient makes a fist. Traumatic injuries commonly occur following acute, index events based on one of the following mechanisms:[2], Compared to the acute, traumatic SLAP injuries, the overhead athlete is more likely to present with attritional-based etiologies. Review the management options available for superior labrum lesions (SLAP tears). In SLAP repairs with unstable patterns, a more gradual approach is taken. Sling immobilization until 4 weeks postoperative, Early shoulder pendulum exercises, periscapular muscle activation exercises. Until now only one study looked at results from physical management on SLAP lesion. The avulsed area is now devoid of cartilage in the zone of injury. The specific etiology underlying the various SLAP tear presentations is multifactorial and remains a topic of debate and controversy. However, the ideal treatment of SLAP tears was never fully elucidated, and thus the increasing recognition of SLAP injuries brought about an increased incidence of SLAP repair rates across institutions. Gorantla K, Gill C, Wright RW. [27], Alpantaki et al. If one were to liken the glenoid to a clock face, these occur in the 10 o’clock to 2 o’clock position. Chronic instability patients will almost always exhibit at least a mild degree of asymmetry. Subsequently, Snyder et al defined the pattern of superior labral injury in 27 patients who were described as having superior labrum anterior posterior (SLAP) lesions. [12], Similarly, a 2012 study reported the rising incidence of arthroscopic SLAP repair rates within New York State from 2002 to 2010, noting a 464% increase in the number of SLAP repairs. Superior Labrum Anterior Posterior Lesions. [19], As our knowledge regarding the actual clinical significance of SLAP tear presentations continued to evolve from 2010 and beyond, the initial rise in the incidence rate of SLAP repairs performed reached its peak before subsequently declining over the last decade. Para ayudar a estabilizar el hombro, hay un anillo de tejido firme, llamado labrum, alrededor de la cavidad del hombro. Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: Effect of concomitant partial-thickness rotator cuff tears. [2][28]This way, physical treatment can be started sooner. By six to nine months, a gradual return to sport is undertaken dependent upon the painless progression of activity and clinical exam. Utilizing dedicated formal PT regimens can help ensure each “SLAP tear” diagnosis is most appropriately managed to help mitigate the risks of inferior patient outcomes. An interprofessional team approach involving clinicians (including PAs and NPs), therapists, and orthopedically-trained nurses will provide the best results.