Slap tear

So after 3 or so months of pain following a shoulder dislocation at the climbing gym i finally decided to head to a dr. to see if there was anything wrong. After multiple visits to the orthopedist and mri facility they diagnosed me with a type 3 slap tear and i will be undergoing arthroscopic surgery on april 6th to repair it. not having climbed for nearly 2 months now and not for the foreseeable future I am starting to get a little bit stir crazy. Has anyone had this surgery before? What am I in for as far as recovery and getting back to climbing? Any tips, info, support, ideas would be greatly appreciated!

I had a SLAP tear a few years ago and got the surgery. If I remember right, I was beginning to climb about 4 months out and was back to may former level at about 5-6 months. Definitely keep up on the PT and let the therapist know your goals. Also, it has been suggested that shoulder instability can lead to SLAP tears, so make sure you get a good PT who will not only treat with a SLAP protocol, but will also look at your movement patterns to truly dicharge you safely to climbing. I have a few suggestions for PTs if you are not stuck in a HMO.

I just had the surgery about 3 months ago. In December I dislocated my shoulder skiing, and it appeared I tore the labrum pretty badly, so I decided to get the surgery right away. It is notoriously difficult to assess the exact nature of the tear on an MRI from what I've heard,but it is likely that you also have a bankart tear, which is the labral tear associated with a dislocation, along with a slap tear(just a different part of the labrum), which just means the labrum is probably pretty well torn, though they don't know for sure until they do surgery. As suspected, mine had a big tear (both slap and bankart) and required 5 "anchors". While everyone responds to surgery and pain differently, I must warn you that in my case, the recovery was quite difficult. The second I woke up from the surgery, the pain was pretty intense, and for the first 3-4 days, I had to hit the pain pills every 4 hours, or else I was in a world of hurt. For reference, I've had an arthroscopic knee surgery, a mangled wrist that required several pins, and a major knee surgery, and honestly the initial pain for the shoulder surgery was significantly worse than any of those. Don't worry though, after the first 5 days, for me at least, the pain dropped off significantly. It also didn't help that on the 4th day of recovery I had to fly across the country to go back to school! As far as recovery, you'll probably be in a sling for 4ish weeks depending on your doc. I was in one for 3.5 weeks and started pt at 4 weeks. My arm felt like a useless thing hanging off my body until 6 weeks, which is when they generally start some strengthening. Stick to the strengthening religiously, and the shoulder will start feeling much better very quickly. I'm at 11 weeks and can do 20ish pushups, range of motion is good, and there is no pain. I went to the climbing gym yesterday for the first time and climbed a bunch of easy routes(5.7-5.10a), slab to slightly overhanging. I was definitely compensating, but the shoulder had no pain or soreness afterwards. Sorry for the long response, it is still very fresh in my mind. Hang in there and good luck with the recovery,

Eric

Hey thanks for the info guys. Any suggestions on PT's who have worked with climbers before would be greatly appreciated!
Thanks.

i had a slap repair, it was a full 6 months of recovery but now the shoulder feels stronger and more stable than it had the two years prior to the surgery. as already stated get a good PT and keep going until you are 100%.

Could others specify more about their symptoms with the SLAP tear? I was diagnosed with a posterior labral tear and partial tear of the supraspinatus tendon in my left shoulder in January. Both of the surgeons I have seen (and they both come highly recommended) have said they are not sure that either of the tears is what is causing my pain. They think it is possible the tears were there for quite a while and I have other stuff going on that is contributing to the pain. All of the clinical exams I have had by the surgeons, their fellows and two different PTs have not shown any demonstrable loss of strength in the rotator cuff or weakness and sharp pain that would be associated with a labral tear. In fact, I really cannot elicit any sharp pain from the tear - its all more of a dull constant ache that is worse in the morning and worse after activity. I do have some significant scapular winging going on which could be making my shoulder less stable but again I don't have the classic signs of a labral tear upon examination.
I'm trying to get an idea of others' symptoms and whether they were the kind of thing were surgery was necessary immediately. My pain has been pretty debilitating for what the docs think is a small/mild labral tear. Sleeping sucks and any form of exercise -- even hiking or biking - is painful and results in inflammation and swelling the following day.

Its totally possible that the tear is alot larger than the MRI showed but I also feel like I am in a disproportionate amount of pain given that others are climbing, running, etc with tears in their shoulders even if they do eventually need surgery.

Sorry to hear that you're having to have a surgical fix done. Give me a shout if you'd like to talk shop. I've been climbing for 12+yrs and worked on all kinds of beat up shoulders, including doing surgical rehab.
Climbing injuries and performance is the primary focus of my practice.

I have no idea about your personality but if you start going nuts just try and find some aspect of climbing that you can focus on that doesn't overtax your shoulder. Rushing to get back to climbing at your previous limit isn't worth the risk of screwing things up... I've seen this too and it definitely sucks to create another injury on top of one that's just been repaired.
Good luck w/ the whole process of getting back to the rock.
BA

In 2008 I subluxed my shoulder snowboarding, then dislocated it climbing. I was a grad student at U. Colorado AMC in Aurora so I went to the UC Hospital on campus to have it checked out. Turns out their Sports medicine department is top notch. I had Dr. Eric McCarty who is the does all the shoulder work for the UC Boulder teams and I think some of the pro teams here too. He is awesome.
uch.edu/conditions/bones-jo…

He also suggested a PT (at UCH) who specializes in shoulder work, Greg Young. He really knew his stuff.
I had huge tearing of the labrum and also a partial bicep tendon tear.
Rehab sucked, but is really important. Work hard on it, but don't do anything stupid too early and screw all up again. It took me a year or 2 to get back to orginal climbing form. But the shoulder feels great now. Plus, I'm climbing smarter. Keeping the shoulder tucked in and not just letting it fully extend out.
I would definitely recommend Dr. McCarty and Greg Young at UC Hospital as your team.
Good luck, hope this helped.

If the surgeon is half decent then you will be fine. It is a minior surgery at this point compared to what you could face if you do not get it fixed now. Do your PT and count your blessing that it is not a lot worse. I truely wish I had gotten my shoulder fixed the first time it came out. As another word of advice, I would probably give your shoulder 3 to 6 months of good rehad before you start climbing hard again. Good luck!

All, thanks for your insight and stories. In 2002 I tore the labrum in my left shoulder and had arthroscopic surgery to repair the tear. The recovery was challenging and post recovery I tore the long head of my biceps tendon in the same arm. Much to my dismay, I was recently diagnosed with a lengthy SLAP tear in my right shoulder (the good one) due to slip in the climbing gym. I am trying to avoid surgery this go round and was wondering if anyone out there has been diagnosed with a torn labrum and avoided surgery through PT. Specifically, have you been able to get back to climbing at your pre-injury levels. Thanks.

Jon,

Non-operative success can depend on the extent of the injury, but the worst prognostic factor for you is that climbing is an overhead sport. My surgeon told me that if I was not a climber, he probably would not have suggested surgery for me. This is also supported by much of the research out there that essentially says minor SLAP tears don't really need surgery, unless you are an overhead athelete. In fact, a new case series supports this (look up Edwards SL, et al. if you are interested) but there is other evidence out there, too. I would suggest trying PT, from a good PT, for a little while, as I am always a little apprehensive when it comes to cutting into my body. If anything, the PT may be able so suggest a good surgeon in your area, instead of just going to some random one.

Has anyone heard of Dr. Eric Stahl at Panorama Orthopedics in Golden? He just did a friend of mine's surgery and she is doing quite well. He is pretty progressive in terms of rehab and post-op protocol and generally has his patients out of a sling in 2-4 weeks as opposed to 4-6.
I have seen both Eric McCarty at CU Sports Med and Dr. Millet at Steadman Hawkins and liked both of them but am just trying to shop around a little and figure out who to do my surgery with this summer.
Thanks.

hey amy,
i havent heard of dr. stahl at panorama, but i have been seeing dr. gottlob at panorama and he will actually be doing my surgery tomorrow AHHHHH. He seems very knowledgeable and has lots of experience doing them. As far as recovery time ive been told it really depends on the amount of damage that is found once they go in. Dr. Gottlob told me 1-4 weeks in a sling depending on what he finds. I guess i will keep you updated on how everything is going after the surgery tomorrow.
I am still interested in hearing about other's rehab experiences and perhaps a good therapist who has worked with climbers?

Dr. McCarty did my surgery and rehab next door at Boulder Sports Med, yhat shoulder is now my strong one. For me the recovery was long which may or may not have been a function of my age (50) at the time of surgery. Probably close to a year before the arm / shoulder was back up to pre-surgery strength.

Dr. Stahl is excellent! From personal experience he repaired my mother's rotator cuff tear and she had a fantastic outcome - she also worked her butt off in PT afterward. He did 2 knee surgeries for me and I also did great. Professionally as a PT, I have seen lots of Dr. Stahl's patients post-op (both shoulders and knees) and they always did well - no complications. He was on the French national alpine ski team in his younger days, so he completely 'gets' athletes, which is always really nice when you are a patient who is also an athlete. He also is a surgeon who is very willing to recommend against surgery if he feels a conservative approach (PT) will work, which is also nice. Some surgeons are willing to cut on everyone who walks in the door.

He has been listed as a top doc in 5280 as well which is largely based on feedback from other physicians. Can't say enough good things about him!

Erika

Erik,

Thanks for the info and the article. The article provides some interesting information about SLAP tears and treatment. One of the surgeons that I have seen raised the concept of biceps tenodesis in addition to the labral repair to move the biceps tendon off the labrum. Have you, or anyone else, heard of this procedure either in lieu of or in addition to a SLAP repair? Thanks.

Amy - I am not sure you will find any surgeon who is more aggressive than 6 weeks in a sling post-op.... it all depends on what they find and have to do once they get in there. There are limitations for tissue healing times (minimum 4-6 wks) and sometimes that is just what you have to deal with. Having to deal with recovering from shoulder surgery and caring for an infant simultaneously might be unrealistic. The worst case would be to have surgery and then mess it up by doing too much too soon. I hope you are able to get some good answers so you can make the best decision for your long-term health.

If they have to do any tendon repair, that 6 weeks passive movement is pretty standard unfortunately. Shoulder surgery (tendon repair at least) is one of the most difficult rehabs as far as orthopedic surgeries go because of that initial 6 weeks where you can't really do anything active.

I am recovering from an elbow reconstruction right now, and I am not allowed to use my hand for 6 weeks because I had 2 tendon reconstructions as well as the ligament, and I can't risk tearing the tendon repair. It is a pain for sure, and I can't imagine having to care for an infant at the same time. I don't think I would be able to do it quite honestly, especially the 1st 2 weeks where pain was a serious issue. Is there any way you can put it off for awhile? You are in a super tough situation for sure.

Good luck with whatever decision you make!

Erika

I was diagnosed with a SLAP tear 2 years ago after a humerus fracture from snowboarding. 7 months in PT, allowed me avoid the surgery, but I am forever in need of keeping up exercising my shoulder blades to compensate the torn labrum. Whenever I get sloppy and lazy, the pain in the shoulder returns... The recovery was long - while in PT I climbed 5.6s and 5.7s forever. My footwork got really good though! I occasionally back off climbs where the move is a potential shoulder ripper if my feet came off. So in retrospect, I should have gotten a surgery...

I am sure this is incredibly stressful, especially during a time that is supposed to be exciting! The ligament laxity + fluid from pregnancy could absolutely be aggravating things - I wonder if any of your PTs suggested taping for stability/pain relief to help get you through these last couple of months? Once you have your baby you will be in a much better position to figure out what you can/should do, and it is true that a lot of the pain might resolve. I know a great PT in Golden (Tina Cuka at Physiotherapy right off 93 & Washington). She is who I am working with for my rehab and she is also affiliate faculty in the PT school at Regis where I teach. You might be able to do a 1-2 time consult and learn how to tape, manage pain. Definitely avoid all of those exercises if they are increasing pain, you are obviously way too flared up to be strengthening right now. I feel for you..... but hang in there!

Thanks Erika for your suggestions.

I actually have tried taping -- two different PTs have taped my shoulders and it may have helped a little but not enough to make all that much difference. I just cannot understand why my shoulders decided to fall apart when I was pregnant of all times -- I have never had any problems with them prior to pregnancy despite all the sports I've done over the years. The various PTs and doctors I've consulted have essentially said that it just seemed that there were tears in both shoulders before that were never symptomatic but that the weight and postural changes (i.e, more weight on the chest) combined with the ligament/joint laxity just pushed things over the edge to the point where the tears started to produce pain. I had been very active through the first 6 months of my pregnancy (yoga, backcountry sking, running, etc) but if I had ever known this was going to happen I would have sat on my butt for the entire 9 months!

Thanks also for the PT recommendation. I am in Boulder but if I decide to do my surgery with Dr. Stahl than I will look into Tina for sure.