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Physiotherapy and Chiropractic – Why We Prep Your Joints during Treatment
March 31, 2024
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SLAP lesion injury with Shoulder “Popping”

After a shoulder injury, you are left with pain and a "popping" sensation.

Your Heavy Toolbox or grocery bag was wedged in the back of the car, so you yanked it out. Or maybe you just experienced a car accident with your arm braced against the steering wheel when you were suddenly driven forward and back. You felt a twinge or maybe a snap in your shoulder, and now your shoulder pops when you reach overhead. Do you have a rotator cuff tear? Or potentially this could be a SLAP lesion injury causing shoulder “popping”. Most often, these SLAP lesions occur due to repetitive overhead exertion, quickly lifting a heavy object, or a fall onto an outstretched arm. It’s important to note that repetitive stresses can, over time, wear down the labrum and set you up for a tear. So, while this can happen to anyone, a tennis player injured with a SLAP lesion after a car accident might not surprise you hugely.

What is a SLAP Lesion?

A SLAP (Superior Labrum Anterior to Posterior) lesion injures the ring of cartilage, the labrum, that lines and deepens the shoulder socket, helping to stabilize the joint. In a SLAP lesion, the labrum tears away from its attachment to the socket part of the shoulder blade, the glenoid. SLAP lesions can be notoriously difficult to diagnose and occasionally challenging to manage. This is often a diagnosis that gets missed before a patient gets to us, that we we end up spotting.

SLAP lesions often occur in overhead athletes like tennis players, swimmers or baseball pitchers due to the repetitive overhead motions that place stress on the shoulder joint. However, they can also happen due to acute trauma like a fall on an outstretched arm. In a SLAP lesion injury the shoulder popping – which is truly more of a “clunk” – acts as a potential indicator of instability. We see a number of these injuries at Blue Heron Chiropractic.

Diagnosing SLAP Lesions

To diagnose a SLAP lesion, we first ask about your symptoms: Pain, catching, or popping sensations in the shoulder, especially with overhead activities. In the physical exam, we check for tenderness and pain, range of motion, and perform specific tests to assess labral integrity. We likely order imaging tests too. An MRI (Magnetic Resonance Imaging) scan usually provides the best way to visualize a SLAP lesion and confirm the diagnosis.

Your Treatment Options

Typically, after positively visualizing a SLAP lesion, we refer you to an Orthopedic Surgeon (different from an Orthopedist) for an opinion as to whether you are a surgical candidate. If you are surgical, that provider handles that portion of your injury, then refers you back to us for rehabilitative physiotherapy. In the meantime, we take care of everything else at Blue Heron Chiropractic if you are non-surgical.

Non-Surgical Treatment:

  • Rest and activity modification: We help you identify and avoid activities that aggravate your symptoms. If you need work restrictions, we guide you.
  • Anti-inflammatory medication: OTC supplements reduce pain and inflammation unless you already have a prescription that worked for you.
  • Chiropractic adjusting: While not focusing on your shoulder specifically, we likely support your shoulder blade in moving freely your upper back. We will help adjust your spine so your shoulder rotation posture supports functional healing of this injury. We can adjust the shoulder in the future, after the lesion has recovered or been repaired.
  • Physical therapies: We customize specific physiotherapy exercises to improve strength, flexibility, and stability of your shoulder joint. We may use electrical stimulation, therapeutic ultrasound, Graston Technique myofascial release, or even ESWT shockwave therapies.
  • We can discuss referral for corticosteroid injections: Injections into your shoulder joint can provide temporary relief in some cases. We do our best to avoid you requiring this.

Non-surgical treatment is often recommended for partial SLAP tears or cases where symptoms are not severe. However, if conservative measures fail to provide relief or with a complete tear of the labrum, we refer you back to the surgical option. In the meantime, we are helping you manage and coordinate this process.

The Surgical Referral

Sometimes with a SLAP lesion, there is no way for your shoulder to heal without surgical correction:

  • Arthroscopic SLAP repair: Performed by an orthopedic surgeon on referral, this minimally invasive procedure makes small incisions and uses tiny instruments to reattach your torn labrum to the glenoid using anchors or sutures.
  • Biceps tenodesis or tenotomy: In some cases, the long head of your biceps tendon may need release or relocation to relieve pain and improve shoulder function.

The surgeon will explain the options. After surgery, a period of immobilization proves required, followed by a structured rehabilitation program. This helps you regain strength, range of motion, and function in your shoulder. This is where we come into play again at Blue Heron.

We discuss your specific situation and preferences to determine the most appropriate course of treatment for your SLAP lesion. With proper management, many patients achieve a good outcome and return to their regular activities.

At the same time, often these SLAP injuries overlap with others like neck strain with whiplash. We help you understand and navigate how to fit all these challenges, treatment plans, exercises and appointments together. Then, when you recover, we check and optimize your functional status going into the future.

Let’s diagnose that shoulder injury – set up an appointment today!

Want more chiropractic reading? Try our prior blog on Physiotherapy with Chiropractic, or the earlier one on Neuromuscular Re-Education. Did you miss the one on Radial ESWT Shock Wave therapy?

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