SLAP/Bankart Lesion

Repair and Rehabilitatio

nRielly Byrd Laura Wind

Bankart Lesions• Usually occur from

traumatic detachments of glenoid labrum, result of reoccurring anterior dislocations 1

• Lead to anterior instability involving avulsions of glenoid labrum and ligamentous structures attaching inferiorly 2

SLAP Lesions• Superior Labral

Anterior Posterior• Bicep tendon• Can be acute

trauma or overuse with repetitive shoulder movements. 3

Bankart Lesion Types a. Bankart Lesion-

Complete detachment of the anteroinferior labrum ligament complex from the glenoid

b. Bony/Osseous Bankart Lesion-Bony fragment avulsed from anteroinferior glenoid with ligament structure1

Bony Lesion

SLAP Lesion Types• Type 1- Frayed or degenerative labrum but still attached. • Type 2- Fraying with detachment of the superior labrum

and biceps tendon from the glenoid. • Type 3- A bucket handle tear from the labrum with biceps

intact.• Type 4- A bucket handle tear from the labrum that extends

through the biceps tendon. 4, 5, 6

Surgical RepairSLAP Lesion Bankart Lesion

• Debride fraying tissue to prevent tear

• Secure loose labrum to the socket*

• Repair or remove torn labral tissue

• Remove labral tear/ repair biceps tendon

• Arthroscopically

• Reattach/secure loose labrum to the socket*

• Open or arthroscopically 6,7,8,9

Guidelines for Rehabilitation Post

Surgery• Time for full recovery=6-12 months• Repair should be protected for 6 weeks• Sling for 48-72 hours, continue as needed during

day, worn at night 6 weeks• Do not wet incision• NO active shoulder motion 4 weeks, all planes• NO active IR 6 weeks• ER limited during early rehabilitation• Accelerating program may lead to recurrent

problems• Patient education is key! 10,11

Timeline/Goals: Post Op

Weeks 9-24:• Normalize

strength, endurance, power, & stability

• Sport specific exercises

• Goals are dependent on patient’s activity 7

Weeks 0-6: • Protect repair• Scapular

exercises/ active motion in uninvolved joints

• Submax isometric strengthening of shoulder & elbow

Weeks 6-9:• Initiate rotator

cuffs/scapular neuromuscular control

• Strengthening in elevation activities (limit weight bearing activity)

Guidelines for Non-Operative

Rehabilitation• The mechanism of injury is important to determine

the appropriate rehabilitation guidelines. 2

• Time for full recovery is usually no longer than 6 months. 12

• Using NSAIDS, Posterior Capsular stretching, and strengthening program. 12

• Focus on functional stability, neuromuscular control, proprioception, plyometric, eccentric and scapular stability. 5, 13

Timeline/Goals: Non-operative

• Phase 1• Decrease pain and

inflammationo Modalities (ice,

electric stimulation)

o NSAIDS • Re-establish

functional ROM• Re-establish

muscular balance

Phase 2• Normalize

arthrokinematics• Improve strength• Improve

neuromuscular control

• Enhance

proprioception 14

Timeline/Goals:Non-Operative cont.

• Phase 3

• Enhance dynamic stabilization

• Improve strength endurance

• Improve neuromuscular control

Phase 4• Maintain level of

power, strength, endurance, and agility

• Progress activity level to prepare for full functional return

to sport or activity 14

ROM/Stretching• Pendulums (4 ways)• Scapular Mobility• Passive ER, IR, Flexion • Active Flexion using Stick• Pulleys• Table Slides• Cross body Stretch 10,15

Strengthening• Isometric IR*, ER, Flexion, Extension, • Ball Squeeze• Row • Prone Extension, Horizontal Abduction,

Scaption• Bicep Curls• Wrist (4-ways)• Gripping exercise• Serratus Press• Body Blade• Wall Push-ups• Diagonals10,11,15

Cardiovascular/Proprioception

• Arm Circlesa. Eyes Closed b. Plyoball• Diagonals

(Perturbations)• Planka. Eyes Closedb. On Bosuc. Perturbationsd. 1-Arm 10,11,15

• Bike• Elliptical• Treadmill• Swimming*• UBE• Stairmaster

Speed, Power, Agility• Overhead Throw• Medicine Ball Underhand• Vertical Toss• Medicine Ball Chest Pass• Side Arm Throw• Over hand throw 1 Arm• Clap Push Up• Ladder Drills• Step Up in Push-Up Position10,15

Back to Throwing Progression

• Phase 1• throwing at 50%• -20 throws from 20ft (warm

up)• -35 throws from 30-40ft• -20 throws from 20ft (cool

down)

Phase 2 • throwing at 50%• -10 throws from 20ft (warm

up)• -10 throws from 30-40ft • -35 throws from 50ft• -10 throws from 20-30ft (cool

down)

Phase 3• throwing at 60%• -10 throws fro 30ft (warm up)• -10 throws from 40-45ft• -35 throws from 60-70ft• -10 throws form 30ft (cool

down)

Phase 4• throwing at 60%• -10 throws at 40ft (warm up)• -10 throws at 50-60ft• -20 throws at 70-80ft• -10 throws at 50-60ft at 70%• 10 throws at 40ft (cool

Phase 5• throwing at 70%

• -10 throws from 40ft (warm up)

• -10 throws from 50-60ft• -30 throws from 80-90ft • -20 throws from 50-60ft at

75%• -10 throws from 40 (cool

down)

 

Phase 6• throwing at 75%• -10 throws from 40ft (warm

up)• -10 throws from 60ft• -20 throws from 100-110ft• -20 throws from 80ft at 80%• -10 throws from 40ft (cool

down) 16,17

Back to Throwing Progression Cont.

• Phase 8• throwing at 80%• -10 throws from 40ft

(warm up)• -10 throws from 60-

80ft• -20 throws from 120-

150ft• -20 throws from 60ft

at 90%• -10 throws from 40ft

(cool down)•  Phase 9• Throwing off the

mound• -Fastballs only• -Work on spot location

• -50%-90% velocity• -Game scenarios• -Pitch count >90

• Phase 10• Bullpen workout• -Throwing all pitches• - Game scenarios• - 100% velocity• - Pitch count >90-110

•  Phase 11• Competitive RTP-

game setting• - Athlete feels

confident and ready 3

• -120 pitches/3 innings 16, 17

References1. Lasanianos, N.G., Kanakaris, N.K., and Giannoudis, P.V. (2014), Bankart Lesions

and Bankart Variable Lesions. Trauma and Orthopaedic Classifications. 37-40.2. Wilk, K.E. and Macrina, L.C. (2013), Nonoperative and Postoperative

Rehabilitation for Glenohumeral Instability. Clinic of Sports Medicine. 32, 865-914.

3. Horsley, I.G., Herrington, L.C., and Rolf, C. (2010), Does a SLAP Lesion Affect Shoulder Muscle Recruitment as Measured by EMG Activity During a Rugby Tackle? Journal of Orthopedic Surgery and Research. 5(12), 1-10.

4. University of Wisconsin Sports Medicine. Accessed September 7, 2015. Rehabilitation Guidelines For SLAP Lesion Repair. UW Health. 1- 6.

5. Wilk, K.E., Reinold, M.M., Dugas, J.R., Arrigo, C.A., Moser, M.W., and Andrews, J.R. (2005), Current Concepts in the Recognition and Treatment of Superior Labral (SLAP) Lesions. Journal of Orthopedic and Sports Physical Therapy. 35(5), 273-292.

6. Dodson, C.C. and Altchek, D.W. (2009), SLAP Lesions: An Update on Recognition and Treatment. Journal of Orthopedic and Sports Physical Therapy. 39(2), 71-80.

7. Gaunt, B.W., Shaffer, M.A., Sauers, E.L., Michener, L.A., McCluckey III, G.M., and Thigpen, C.A. (2010), The American Society of Shoulder and Elbow Therapists’ Consensus Rehabilitation Guideline for Arthroscopic Anterior Capsulolabral Repair of the 155-Shoulder. Journal of Orthopedic and Sports Physical Therapy. 40(3), 155-168.

8. Cho, H.L., Lee, C.K., Hwang, T.H., Suh, K.T., and Park, J.W. (2009), Arthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results. Clinics in Orthopedic Surgery. 2, 39-46.

References Continued9. Chang, D., Mohana-Borges, A., Borso, M., and Chung, C.B. (2008), SLAP Lesions: Anatomy, Clinical Presentation, MR Imaging Diagnosis and Characterization. European Journal of Radiology. 68, 72-87.10. Vanderbilt Sports Medicine Knee Center and Shoulder Center. Accessed September 7, 2015. Bankart Repair Protocol. Vanderbilt Sports Medicine. 1-6.11. Beth Israel Deaconess Medical Center. Accessed September 7, 2015. Sports Medicine and Shoulder Surgery. Medsport: Ann Arbor, Michigan and Vanderbilt Sports Medicine Nashville, TN. 1-4.12. Edwards, S.L., Lee, J.A., Bell, J.E., Packer, J.D., Ahmad, C.S., Levine, W.N., Bigliani, L.U., and Blaine, T.A. (2010), Nonoperative Treatment of Superior Labrum Anterior Posterior Tears: Improvements in Pain, Function, and Quality of Life. The American Journal of Sports Medicine. 38(7), 1455-1461.13. Hayes K, Callanan M, Walton J, Paxinos A, Murrell GA. Shoulder Instability: Management and Rehabilitation. Journal of Orthopaedic & Sports Physical Therapy. 2002;32:497-50914. Rockford Orthopedic. Accessed September 7, 2015. (2012), Conservative Bankart Lesion. Therapy Department. 1-4.15. South Shore Hospital, Orthopedic, Spine, and Sports Therapy. Accessed November 5, 2015. SLAP Repair Protocol. South Shore Orthopedics. 1-9.16. Lugo, R., Kung, P., and Ma, C.B. (2008), Shoulder Biomechanics. European Journal of Radiology. 68, 16-24.17. Augustsson, S.R., Klintberg, I.H., Svantesson, U., and Sernert, N. (2012), Clinical Evaluation of Muscle Function, Quality of Life, and Functional Capacity after Shoulder Surgery. Advances in Physiotherapy. 14, 29-37.