SLAP Repair Rehabilitation Guidelines

SLAP Repair Rehabilitation Guidelines

Introduction

A SLAP lesion involves a tear in the Superior Labrum, Anterior to Posterior. The biceps tendon, attached to this area, is also impacted. Post-operative rehabilitation must balance protection of the repair with progressive restoration of function, prioritizing pain-free movement and careful neuromuscular re-education.

Rehabilitation Phases

Phase 1: 1–21 Days (Immediate Post-Op)

Goals:

1. Protect the repair:
   • Sling use at all times except for hygiene or exercises.
   • Teach dressing and personal hygiene techniques.
2. Pain and inflammation management:
   • Use NSAIDs, analgesics, ice, and maintain proper posture.
3. Controlled mobility:
   • Gradually increase AAROM and PROM for shoulder and elbow within pain limits.
   • Introduce pendulum exercises with good scapulohumeral rhythm (SHR).
4. Prevent muscle atrophy:
   • Pain-free, sub-maximal isometrics for rotator cuff (<30% MVC).
5. Promote sleeping comfort:
   • Use a pillow under the elbow while supine.

Precautions:

• Sling use for 4 weeks.
• Avoid:
  • Combined abduction and external rotation.
  • Resisted biceps activity.
  • Excessive extension or sudden movements.
  • Supporting body weight on hands.
  • Lifting objects.

Milestones at 3 Weeks:

• Pain and inflammation controlled.
• Return to pre-op sleep patterns.
• PROM:
  • Shoulder flexion to 90°.
  • External rotation to neutral.
  • Elbow ROM fully restored.

Phase 2: 22 Days – 6 Weeks

Goals:

1. Protect soft tissue healing without overload.
2. Restore shoulder PROM pain-free, avoiding combined abduction and external rotation.
3. Re-establish dynamic shoulder stability with AAROM → AROM progression.
4. Introduce elbow AAROM as tolerated.

Precautions:

• No lifting objects or excessive loading of the shoulder.
• Avoid repetitive or overhead activities.

Milestones at 6 Weeks:

• Full pre-op PROM except external rotation and abduction.
• Passive external rotation to 25% pre-op range.
• Good SHR during PROM.

Phase 3: 7–14 Weeks

Goals:

1. Achieve full PROM with end-range stretching as tolerated.
2. Restore AAROM → AROM with good SHR.
3. Gradually introduce shoulder strengthening:
   • Cuff strengthening: From maximal isometrics to isotonic exercises.
   • Scapular stabilization and proprioceptive exercises.
   • Gradual biceps strengthening (monitor closely).
4. Return to light functional activities and early-stage sport-specific exercises.

Precautions:

• Avoid heavy lifting and repetitive overhead tasks.

Milestones at 14 Weeks:

• Resolved pain and inflammation.
• AROM restored to 100% pre-op range with good SHR.
• Passive external rotation to 100% pre-op range.

Phase 4: 3–6 Months

Goals:

1. Maintain full PROM with capsular stretches if needed.
2. Advance shoulder and upper limb strengthening:
   • Proprioception and scapular stabilization.
   • Dynamic and rhythmic stabilization.
3. Gradually progress functional and sport-specific activities.
4. Full biceps strengthening.

Precautions:

• Avoid excessive or repetitive overhead loading.

Milestones at 6 Months:

• Full pain-free motion.
• Restored rotator cuff strength.

Phase 5: 6–9 Months

Goals:

1. Continue strengthening and neuromuscular training.
2. Gradual return to strenuous work and contact sports.

Contact for Assistance

• Consultant Secretary: 07810356433
• Physiotherapy Contacts:
  • Sulis Hospital: 01761 422388
  • Circle Health Group Bath Clinic: 01225 838767
  • St. Joseph: 01633 820321