A SLAP tear is an injury to a part of the shoulder known as the labrum. The shoulder joint comprises a ball and socket joint which is similar to the hip joint. But unlike the hip joint, the shoulder joint socket is very shallow making it inherently unstable.

Defining this Issue

This makes the shoulder susceptible to dislocation. This injury occurs when the ball moves out of the socket. The shoulder joint has a circular cartilage rim (labrum) which forms a cup for the humerus (end of the arm bone) to move within in order to make up for the shallowness of the socket. The labrum of the shoulder effectively offers depth to the shoulder socket.

A particular type of labrum injury or labral tear is known as a SLAP tear. The term SLAP is an acronym for Superior Labrum from Anterior to Posterior. This tear develops at the juncture where the tendon of the biceps muscle inserts on the labrum.

The accomplished Thomas and Bigler Knee and Shoulder Institute, led by committed board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and other neighborhoods and suburbs in this area of America.

SLAP Tear Symptoms

The common symptoms of a SLAP tear include pain and a catching sensation when there is movement in the shoulder, usually due to overhead motions such as throwing. Patients typically report deep pain within the shoulder or in the back of the shoulder joint.

In general, it is hard to identify the cause of these symptoms unless the biceps tendon is also affected. If the patient has a SLAP tear along with biceps tendonitis, they may report pain over the front part of the shoulder, where the biceps tendon is located.

SLAP Tear Diagnosis

An expert examiner will perform several tests to diagnose SLAP tears as a part of a shoulder physical examination. In addition, they may question the patient in detail to identify symptoms pointing to a SLAP tear.

A SLAP tear diagnosis can be challenging as these injuries are may not be apparent on MRI scans. They usually show up well on MRI scans when it is performed with an injection of contrast. The patient is injected with a fluid, known as gadolinium, in the shoulder to conduct a contrast MRI. This fluid highlights tears of normal structures including SLAP tears.

Upon injecting gadolinium contrast into the shoulder before the MRI scan, the sensitivity of an MRI (the percent of times the test will highlight the tear) increases remarkably. An imaging test will not display every SLAP tear. At times, a SLAP tear diagnosis is made during the surgery.

SLAP Tear Treatment

SLAP tear treatment often commences with basic steps to reduce the pain and regain shoulder strength. The patient will usually be advised to undergo nonsurgical treatments for at least three months as many patients are able to resume full athletic activities in this duration without any surgical intervention.

For patients who are unresponsive to these measures, a surgical treatment called SLAP repair is commonly recommended. Sometimes when the SLAP tear leads to nerve injury and weakness in the shoulder, the patient may have a more immediate need to go into surgery.

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and nearby areas across the landscape for orthopedic treatments.If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

A majority of SLAP (Superior Labrum Anterior and Posterior) tear patients will respond favorably to conservative non-surgical treatments.

Patients of SLAP tears will be advised to rest following the injury to enable the damaged tissue to recover. Resting for a period will enable the swelling to resolve and may help mitigate the symptoms.

Thomas and Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding communities.

Common Treatments

Treatments that are often used to address SLAP tears are as follows:

• Anti-inflammatory Drugs
• Physical Therapy
• Cortisone Injections

Patients with persistent symptoms despite these treatments may have to undergo arthroscopic surgery of the shoulder. There are multiple specific surgeries that may be undertaken.

It is vital to understand that SLAP tears usually develop along with other shoulder issues such as rotator cuff tears, and shoulder arthritis. For such patients, the surgical treatment will have to account for these conditions as well.

SLAP Tear Surgery

The main surgical options for the treatment of SLAP tears are as follows:

Debridement of the SLAP tear

In case a SLAP tear is debrided, the torn part of the labrum is trimmed away to develop a smooth edge. This treatment is appropriate only for minor tears that do not affect the biceps tendon. For the debridement surgery to be successful, the biceps tendon within the shoulder joint (known as the biceps anchor) should be stable.

In case the biceps anchor is not stable, merely debriding out the torn part of the labrum is not likely to address the symptoms of pain. Patients who undergo isolated debridement recover quicker than those who require surgical repair.

SLAP Repair

A SLAP repair refers to an arthroscopic procedure that utilizes sutures to rejoin the torn labrum to the shoulder socket. For patients who have an otherwise healthy shoulder but who want to remain active athletically, this procedure is most suitable.

In this procedure, the surgeon uses a surgical implant to reconnect the compromised labral tissue to the shoulder socket’s bone. Surgeons typically use a device known as a suture anchor for this surgery. The anchor is inserted into the bone, and then the sutures are wrapped around the labrum and tied firmly to the bone.

Biceps Tenodesis

This surgery involves cutting the biceps tendon in the area where it connects to the labrum and reinserting it in another site. The premise behind biceps tenodesis is that by reducing the forces that put a strain on the SLAP area, the symptoms will be resolved.  

In general, patients above 40 years of age or those with associated biceps tendonitis or tearing typically undergo a biceps tenodesis. This procedure can be performed by placing a tiny incision over the top portion of the shoulder, or arthroscopically.

The choice of technique to perform biceps tenodesis will depend mainly on the other conditions that are undergoing treatment within the shoulder joint.

Outcomes of Surgery

The outcomes of various surgical procedures have been reported in many scientific research studies. SLAP repair is the most frequently analyzed surgical procedure.

Over 90 percent of patients receiving an arthroscopic SLAP repair with modern suture anchors have reported good outcomes while over 85 percent are able to resume competitive sports activities.

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and nearby areas for orthopedic treatments.If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Many common shoulder conditions that are unresponsive to conservative therapy may require surgical treatment.

These surgical procedures can range from minimally invasive arthroscopic procedures involving a scope and surgical tools being inserted via keyhole incisions into the shoulder to traditional open surgeries.

Every shoulder surgery technique has its benefits, limitations, and appropriate uses. Thomas and Bigler Knee and Shoulder Institute, led by prudent board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding locations in The Silver State.

Arthroscopy for Impingement Syndrome

Impingement syndrome refers to rotator cuff tendonitis and bursitis. In this condition, the arthroscopic procedure is used to treat impingement (subacromial decompression). This surgery aims to increase the space between the rotator cuff and the shoulder’s top part (called the acromion).

In performing subacromial decompression, the surgeon may excise the bursa alone or some of the acromion undersurfaces. This will create space for the rotator cuff to move without getting impinged between the bone.

Arthroscopic SLAP Repair

A SLAP tear refers to an injury to the rim of cartilage encircling the shoulder socket or the labrum.

An arthroscopic procedure may be performed to restore the labrum back to its appropriate position at the shoulder socket’s rim. The surgeon will fix the bone to the cartilage with sutures after the repositioning. The patient may require additional surgery if the damage encompasses the biceps tendon.

Arthroscopy for Shoulder Dislocation

A shoulder dislocation injury involves the ball of the shoulder joint moving out of the socket.

The damage typically occurs at the labrum in young athletes. A surgery known as a Bankart repair can reattach the labrum to the joint capsule in place to treat this condition.

Multidirectional instability is a condition involving the generalized laxity of the shoulder ligaments. This makes the shoulder joint prone to moving n and out of the socket quite readily. In such cases, the joint capsule is tightened surgically.

Arthroscopy for Frozen Shoulder

The capsule surrounding the shoulder joint becomes constricted and tight in a condition known as frozen shoulder. The objective of the surgery is to make the contracted tissue looser and enable the shoulder to move smoothly.

The surgeon achieves this by cutting the capsule around the ball of the shoulder. This is a technically challenging procedure as space within the joint is very tight.

Rotator Cuff Repairs

The surgery aims to identify the damaged area of the rotator cuff and to clean and reconnect any damaged or torn tendons. After locating the healthy tissue, the surgeon will employ multiple techniques to treat the tendon without stretching the remaining tissues excessively.

Acromioclavicular (AC) Joint Repairs

The acromioclavicular joint, commonly called the AC joint, is the point at the end of the collarbone (clavicle) and acromion. Various problems can develop at the AC joint. The patient may undergo an open surgery to remove the end of the clavicle and widen the AC joint space.

In general, shoulder separation can be addressed nonsurgically. However, severe cases may warrant surgical intervention to reconstruct or repair the ligaments that support the end of the collarbone.

Kind board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and other towns and cities in this region of the southwest for orthopedic treatments. If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Radial tunnel syndrome is also known as a radial nerve entrapment. This condition refers to radial nerve compression or restriction in the tunnel that it passes through.

Rotation of the wrist/lower arm rather than repetitive movement such as in tennis elbow is usually the reason for this elbow injury. However, the symptoms of radial tunnel syndrome and tennis elbow can sometimes be quite similar.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding locations in The Silver State.

Radial Tunnel Symptoms

Radial nerve entrapment symptoms are similar to those associated with tennis elbow. Therefore, it may be challenging to identify which of these two conditions is leading to the pain in the elbow.

Other symptoms of this condition are tingling or pins and needles in the hand and outer forearm.

The patient may experience tenderness in the upper forearm muscles with the maximum tenderness occurring around four to six cm down from the lateral epicondyle. In case of tennis elbow, the point of maximum tenderness is right underneath the bone. This condition may also cause wrist pain which may radiate towards the upper arm.

Radial nerve entrapment can be diagnosed with a specific test which reproduces pain on turning the palm of the hand up and extending the middle finger against resistance or resisted supination.

The radial nerve bifurcates into two branches at the elbow, namely the posterior interosseous nerve (PI nerve) and superficial radial nerve. Radial tunnel syndrome occurs when the PI nerve in the forearm gets compressed. This compression of the PI nerve can occur at various locations in the upper forearm and elbow.

This condition frequently occurs in those who turn the hand over or pronate and supinate the arm in a repetitive manner. On the other hand, tennis elbow typically manifests due to repetitive wrist extension or bending of the wrist backwards.

Treatment

Radial nerve entrapment treatment comprises a combination of rest and discontinuing any repetitive wrist motion. The application of ice therapy to the forearm and elbow may also offer relief from the symptoms.

Ice and Compression

The patient should apply the principles of P.R.I.C.E. (Protection, Rest, Ice, Compression, and Elevation) in the initial 72 hours following the injury. The application of a cold compression wrap should not be done for over 15 minutes as the injured tissues are located close to the skin and do not require a longer application.

Protection

If the patient wears specialist elbow support, it can reduce the pressure on the tendon expediting the healing process. This involves the application of compression around the injured site creating pressure on the compromised tendon. Change in the way forces are transferred through the tendon allows the injured tissues to rest.

Rest

The most crucial part of the treatment and usually the most challenging is allowing the injured tendons to rest. In case the patient continues the offending activities with the painful elbow, it will not recover fast and become chronic and hard to treat.

The doctor may prescribe anti-inflammatory meds, and a professional therapist may perform soft tissue massage to free the supinator muscle which typically causes the entrapment.

The patient may also undergo neural stretches within the physical therapy treatment. If the condition is persistent or severe, the patient may require surgical intervention to decompress the nerve which usually resolves the condition.

But if the patient requires surgery, they may take around eight weeks to recover. Kind board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada, and other towns and cities in this region of the southwest.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Tennis elbow, also known as lateral epicondylitis or extensor tendinopathy, is a common term used to describe pain in the outer elbow.

It usually occurs because of tendon swelling or degeneration in the area where the extensor muscles insert into the elbow. Tennis elbow may develop due to sports such as tennis or other activities that strain the muscles of the elbow.

Not Just in Tennis Players

This condition, contrary to its name, does not manifest only in tennis players. It also affects people engaged in other sports or recreational activities involving repetitive stress on the muscles surrounding the elbow, such as decorating or heavy lifting.

It can be challenging to treat a tennis elbow, particularly if it becomes chronic. Therefore, it is essential to get it medically assessed at the earliest. This condition can develop gradually (chronic) or over a few days or weeks or quite suddenly (acute).

Thomas & Bigler Knee & Shoulder Institute, led by caring board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding communities in this region of The Battle Born State.

Symptoms

The primary symptom is pain around one to two cm below the bony part located on the outside of the elbow (lateral epicondyle).

The patient may also experience weakness in the muscles around the wrist and forearm rendering it challenging to perform routine activities due to weakness in gripping objects such as opening a door handles or holding a racket. A professional therapist or doctor may conduct various assessment tests to diagnose tennis elbow.

Types of Tennis Elbow

Acute Injuries

Acute injuries occur suddenly after an activity such as using a poor technique to hit a backhand shot. The extensor muscles behind the forearm (wrist extensors) suddenly become overloaded. This causes micro tears of the tendon where it inserts into the elbow.

Chronic Injuries

Chronic injuries develop gradually over a few days or weeks. It is usually preceded by bouts of intense exercise or activity that the patient is not accustomed to, such as lifting heavy furniture while moving.

Treatment

Tennis elbow treatment involves measures to reduce pain and swelling through rest and application of ice or cold therapy. Gradually, the load through the elbow is increased via exercises to a level where the patient can resume routine training and competition.

A doctor or professional therapist may prescribe drugs such as Ibuprofen to mitigate the symptoms in the initial stages.

Exercises

Stretching and strengthening exercises form the basis of the rehabilitation program and are vital to recovery. The patient should perform these exercises as soon as the pain reduces and continue until and beyond the level of full fitness.

The most important part of the rehab program is wrist extension stretches and exercises. These aim to slowly increase the load transferred through the tendon and its extension while remaining within the limits of pain. Static exercises (also called isometric) are done initially.

These involve muscle contraction without actually causing movement in the wrist. These exercises should only commence after the initial swelling and pain have subsided.

Surgery

When it comes to surgical intervention, golfer’s elbow and tennis elbow are treated similarly. Most tennis elbow cases are unresponsive to conservative treatments involving ice, rest, ultrasound, and at times, a steroid injection.

But if the patient requires surgery, they may take around eight weeks to recover. Devoted board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada, and other suburbs and cities in the southeast part of Nevada.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Injuries of the arm and elbow are classified into lateral elbow pain (on the outer side of the elbow), medial elbow pain (inside the elbow), posterior elbow pain (at the back portion of the elbow), acute elbow injuries (sudden pain), forearm pain and upper arm injuries.

The most common reason for pain on the outside of the elbow is the Tennis elbow.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding locations.

Lateral Elbow Pain

Tennis elbow, medically known as lateral epicondylitis, is a commonly used term to describe pain on the outside of the elbow. But various other causes lead to lateral elbow pain. These reasons should be considered along with acute elbow injuries such as fractures and ligament sprains.

Tennis elbow

Tennis elbow is a commonly used term to describe outer elbow pain. It frequently occurs due to tendon swelling or degeneration in the wrist extensor muscles as they connect with the elbow.

Radial Tunnel Syndrome

Radial tunnel syndrome, also known as radial nerve entrapment, occurs when the radial nerve gets restricted or compressed within the tunnel that it passes through.

Medial Elbow Pain

Medial elbow pain occurs in the inside of the elbow. In general, the onset of the pain is gradual and due to overuse. However, it can also happen because of an acute injury, especially in throwers. The most common name given to this condition is thrower’s elbow or golfer’s elbow. It refers to the swelling or degeneration of the flexor tendon.

Golfer’s elbow

Golfer’s elbow (medial epicondylitis) is an injury brought about by overuse similar to the tennis elbow. However, it leads to pain on the inside of the elbow rather than the outside.

Medial Elbow Ligament Sprain

This condition happens due to a tear to the medial collateral ligament (MCL) located on the inside portion of the elbow. It may occur unexpectedly due to an impact, accident, or even repetitive overuse due to, say, poor throwing technique.

Posterior Elbow Pain

This pain occurs at the back of the elbow and may be acute. It can manifest suddenly or slowly over time. The patient may experience a chronic elbow injury after an acute injury which has not been addressed appropriately or remains unhealed.

Elbow Bursitis – Students Elbow

Elbow bursitis (also called students elbow or olecranon bursitis) leads to swelling of the bursa. The bursa protects the bone at the back of the elbow.

Olecranon Fracture

The olecranon process refers to the bony prominence at the back of the elbow on the ulna forearm bone. This fracture typically occurs due to a direct fall or impact on a bent elbow.  

Forearm Pain

Forearm pain can be acute (sudden onset) and may involve radius or ulna bone fractures. Nerve impingements or overuse of the wrist can cause the gradual onset of forearm pain.

Upper Arm Pain

A common upper arm injury is a fractured humerus (broken bone). But bicep and tricep strain may also occur.  Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada, and nearby areas.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Tennis elbow or lateral epicondylitis is the most frequent reason behind pain in the outside of the elbow. But there are various other causes for the occurrence of lateral elbow pain.

These causes should be considered along with acute elbow injuries such as fractures and sprains. Possible reasons for outside elbow pain may include radial tunnel syndrome, bursitis, referred pain, synovitis, and osteochondritis dissecans.

Thomas & Bigler Knee & Shoulder Institute, led by reliable board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding locations in The Sagebrush State.

Tennis Elbow

Tennis elbow, also known as lateral epicondylitis or extensor tendinopathy, is a common term to describe pain in the outer elbow. It usually occurs due to tendon swelling or degeneration where the wrist extensor muscles insert into the elbow. Sports such as tennis as well as other activities that strain the elbow muscles can cause this condition.

Radial Tunnel Syndrome

Radial tunnel syndrome (radial nerve entrapment) occurs when the radial nerve gets restricted or compressed in the tunnel that it goes through. This injury usually happens due to rotation of the lower arm/wrist rather than repetitive use as in the case of tennis elbow. However, symptoms of both types of injuries may be similar.

Osteochondritis Dissecans

Osteochondritis Dissecans refers to a piece of cartilage and, at times, the underlying bone within a joint. This condition occurs commonly in teens as the ends of the bones are not yet completely hardened. Throwing sports cause and aggravate this injury. Therefore, discontinuing this activity for a period can help address the pain.

Elbow Synovitis

Elbow synovitis is the swelling of the synovial membrane which surrounds the elbow joint. The symptoms are a pain in the elbow joint and redness over the site. But usually, another condition causes synovitis such as joint injury or cancer. Due to this reason, synovitis can signal a grave problem and it is vital to receive medical advice for this condition.

Radiohumeral Bursitis

Symptoms of radiohumeral bursitis can be similar to those of tennis elbow.  Radiohumeral Bursitis refers to the swelling of the bursa (tiny sack of fluid located between the tendon and bone to help lubricate the area).

This injury can occur due to a direct blow to the arm or joint. The common symptoms associated with this injury are inflammation, elbow pain, and limited movement.

When should you consult a Doctor?

Most elbow and injuries can be treated at home, especially if they are minor. But in case the patient experiences the following symptoms, they should consult a doctor:

• Severe upper arm, forearm, or elbow pain, especially after a fall.
• Severe edema (swelling) around the injury.
• A discernible “crack” sound from the forearm or upper arm after a fall.
• A sensation when the bone at the elbow moves out of its joint (dislocates). This injury commonly occurs in young kids (see above).
• Changes in hand or arm sensations, such as experiencing paresthesia (“pins and needles”) or anesthesia (“loss of feeling”) in the hand.
• Inability to undertake or manage routine tasks after the first 72 hours.

Successful board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada, and nearby areas across the landscape.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.