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Old 07-22-2009, 02:38 PM   #1
Bill Rogers
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Should I do SLAP surgery?

Unfortunately I didn't realize until recently just how serious SLAP tear surgery really is. I had no idea that it required screws, anchors, etc. and that I'd probably need numerous months of physical therapy. I was told about suchuring to anchor the tear but not that we had to do more invasive surgery. Not good!!! I had one doctor look at my x-rays and MRI and said that there might be a tear but he would definitely suggest not having surgery since my shoulder is much too stable. He didn't know what this huge bump was on my shoulder right at the joint (everyone has a bump, mine is like twice the size easily), which the other doctor said was arthritis and needed a "right distal cavicle excision" if that makes sense. Apparently the bones were rubbing against each other and they would shave them down so they don't rub any more.

My problem occurs when I raise my hand above my head and play basketball. It's really not bad except on occasion it will hurt. Right now I have plenty of strength in my shoulder and on occasion I'll wince from not even doing anything but the motion of my arm when performing aerobics - rare but it happens. Don't really do much overhead throwing but I did notice some zip missing when I was trying to pitch a baseball. Otherwise it is stable although picking up my arm I feel rubbing of bones or something. It could be only the arthritis.

Otherwise, I have no pain at all. I was told my slap tear is on the borderline, nothing really definite to have surgery and sometimes it's more about placement than about how large the tear. Right now I'm quite worried that if I do the surgery, it will be brutal with minimal benefits. I think I should do the excission and get rid of the bump but that's all. SLAP tear... nothing I can do without risk of really marginal benefits.

I know you haven't seen my xrays or mri but I'm curious as to experiences here. Would be grateful for them.
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Old 07-22-2009, 06:19 PM   #2
Steven Low
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Re: Should I do SLAP surgery?

Quote:
He didn't know what this huge bump was on my shoulder right at the joint (everyone has a bump, mine is like twice the size easily), which the other doctor said was arthritis and needed a "right distal cavicle excision" if that makes sense. Apparently the bones were rubbing against each other and they would shave them down so they don't rub any more.
If it doesn't hurt then it's not really arthritic yet... why have a surgery when you don't have any problems yet?


As for the SLAP tear that's really up to you.

If you don't use the ROM where there's pain much then it may not be a good idea to do get the surgery.... but if you plan on being active and moving heavy weight as well as keep on playing sports with that ROM then it may be a good idea to do the surgery.

You can always postpone it until it gets worse (if it does at all) if you want unless there's a time limit like there is... but that's generally with tendon tears IIRC.
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Old 07-23-2009, 03:14 AM   #3
Everett Steinbarger
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Re: Should I do SLAP surgery?

Steven, good advice.

I waited 16 years to fix my SLAP tear. It never was bad enough to do anything about until later in life. I did it when I was 17, benchpressing, had it repaired 6 years ago. The year before it had to be repaired my strength started falling off slowly, regardless of what I did. Then about 6 months before it had to be repaired it got really painful. I couldn't sleep at night.

If you can hold off any surgery and still perform and sleep, I say do that.

As far as doing a distal clavicle resection based on films, regardless of whether or not the patient is symptomatic.........
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Old 07-23-2009, 10:18 AM   #4
Tom Nguyen
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Re: Should I do SLAP surgery?

The distal clavicle resection is the mumford procedure. It is done when you have severe AC joint degenerative changes (particularly hypertrophic ACDJD - like what you are describing, big ball a the AC joint). Like you said, it is usually done when symptomatic as it can cause chronic rotator cuff impingement. The rotator cuff tendons attaches to the humeral head. On the way there, they are positioned under the AC joint. When the AC joint develops hypertrophic changes, it can press on the rotator cuff eventually leading to tears.

Curious if your MRI was an MR Arthrogram or regular MR?? did they inject contrast into your shoulder prior to the MR? SLAP tears are pretty difficult to evaluate on non-arthrogram MRI...
good luck
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Old 07-23-2009, 10:18 AM   #5
Andy Shirley
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Re: Should I do SLAP surgery?

I've had both done(L labral repair and L distal claviculectomy), and night pain was the deciding for me: I couldn't sleep. Recovery wasn't too bad.
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Old 07-23-2009, 06:05 PM   #6
Bill Rogers
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Re: Should I do SLAP surgery?

Thanks guys! I can definitely sleep, no problem. I think I tore it when I was trying to throw a baseball hard 2 years ago. I felt a twinge in my shoulder and my fingers were numb.

Honestly, it's just sometimes this sharp pain in the shoulder like a stinger. The bump for the arthritis is pretty large. It's noticeable enough that if you pull down a t-shirt tight, you can easily see it. It's noticeable to me just wearing a shirt. They said something like the end of one of the bones was totally worn out now. It would seem that it definitely needs to be "shaven down" as they said. I don't know how painful that is but it must be way less of a problem than the slap fix.

Honestly, the slap fixing is what worries me. My friend asks why I should go in twice - he's an ortho. He is going to take a look at my shoulder and see whether it's as bad as I say but he thinks no way do a slap tear unless it's really, really bad. I'm also 45. If it gets worse I don't know if it's worth fixing... at 50? Or 55? With those screws and all the pain I hear, it sounds much worse than my ACL reconstruction. That was bad... but 2-3 screws? Also there is the question of shoulder tightness from what I hear.

My MRI was I think the one with the dye. It was very difficult for them to see it. One doctor said no, the other said it's definitely there but in my case it is always 50-50 whether they choose to do anything. Those that do are usually football players who are young and really need the ROM. I'll look for the report of my MRI and xray and post shortly. Thanks
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Old 07-23-2009, 10:08 PM   #7
Steven Low
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Re: Should I do SLAP surgery?

You can't really feel the screws or anything. People who get their RC anchored back may have much better ROM and strength after because they went without repair for a while or had a preexisting half torn one for a while.

Really depends on your surgeon and PT how good of an experience you have (besides your own diet, recovery,etc.). But yeah, anchors aren't a big a deal honestly.
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Old 07-23-2009, 11:10 PM   #8
Bryan Stell
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Re: Should I do SLAP surgery?

You don't always need such an extensive surgery for SLAP tears. I had mine repaired arthoscopically. I have had no further problems with the labrum and fully recommend it. I tried to deal with the tear for months and it just degenerated and grew progressively weaker. I am much better post surgery than I was or would have been without it. In fact, i would have been a depressed cripple with out it.
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Old 07-24-2009, 04:47 AM   #9
Bill Rogers
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Re: Should I do SLAP surgery?

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Originally Posted by Bryan Stell View Post
You don't always need such an extensive surgery for SLAP tears. I had mine repaired arthoscopically. I have had no further problems with the labrum and fully recommend it. I tried to deal with the tear for months and it just degenerated and grew progressively weaker. I am much better post surgery than I was or would have been without it. In fact, i would have been a depressed cripple with out it.
How large of a tear did you have? How old were you?

I'm realizing that I can do all the things that most of you were not able to do. I can easily shower, sleep and more. I have some weakness in the arm but the thing bothering me most is the clavicle bump that is much more pronounced and may or may not have anything to do with the tear. I can't say that other than the occasional pain that the tear has changed my life at all. I'm not a depressed cripple but I do remember what it was like with my ACL.

From what I read about arthroscopic surgery, it's still a matter of drilling holes and screwing in anchors. Invasive surgery like that has repercussions and I'm 45. Reading people's experiences, all of them have expressed real pain for weeks or months. I went through an ACL reconstruction. The first 2 weeks were extremely uncomfortable and the rest weren't so easy the first 4 months. Then the getting back to normal took at least another 4 months. With the shoulder, I hear it can be worse because the surgery provides much more unpredictable results with the negative of a stiffer shoulder without very aggressive rehab and even then there is no guarantee.

All things considered, I'd love to fix the tear but I'm getting the feedback that I'll see a very marginal improvement, if any at all. The amount of pain involved isn't worth it and it's not like fixing a tear in paper with scotch tape now will prevent anything in the future. It's a hard decision but it seems like it might not be the wisest thing.
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Old 07-24-2009, 10:19 AM   #10
Steven Low
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Re: Should I do SLAP surgery?

Shrug. It's ultimately up to you.

If you don't want to do it then don't do it.
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