Damage to the Bankart of the shoulder joint: symptoms, causes, methods of treatment and rehabilitation. SLAP injury of the shoulder joint Etiology of development and pathogenesis of the disease

Biceps tendon injuries are a common occurrence in athletes or people over 40 years of age. SLAP damage to the shoulder joint occurs under mechanical stress, which is accompanied by prolonged aching pain. Often these signs are confused with other diseases, so the timely diagnosis of any damage is especially important in order to conduct the correct therapy and eliminate unpleasant symptoms.

Characteristic

The human shoulder joint is the most mobile. Any movements or manipulations can lead to injuries of the tendons or muscle tissue, thereby complicating the condition of the shoulder as a whole, and hence the patient's life. SLAP syndrome - damage to the original structure and shape of the lip that surrounds the glenoid cavity, up to its rupture. This leads to a significant decrease in depth, which causes instability and looseness of the joint and possible. The process affects the biceps (a long tendon), as a result of which the volume of active and less mobile manipulations in the shoulder is noticeably limited.

Etiology and pathogenesis

The articular structure of the shoulder in structure is one of the most complex, consisting of the clavicle, scapula and, the head of which is placed in the scapular cavity. The lip, which forms an anatomically matching shape for the bone, is often damaged in various ways, resulting in impaired mechanical movement. The joint is surrounded by a capsule, a dense connective tissue. The articular lip is restrained between the head of the humerus and the glenoid during manipulation. This is faced by people whose work and life was associated with hard work and physical exertion.

The causes of this condition are often various lesions and injuries of the shoulder that have not been treated or have not been noticed. Often the condition is caused by a fall on a straight arm. In athletes, this damage is common in throwing sports, swimming and other disciplines where there is a constant load on the shoulder joint. Shoulder dislocations and subluxations lead to SLAP syndrome. In addition, congenital pathology and low strength of lip tissues can provoke an ailment. Tissues in which degenerative-dystrophic processes are already taking place are often affected.

Symptoms of a Slap Injury to the Shoulder

After injuries and bruises, the patient feels explicable pain in the shoulder area. The amplitude of movements is significantly reduced, a crunch appears. Signs of SLAP damage:

• a definable feeling of subluxation;
• discomfort in the shoulder area during rest or sleep;
• pain does not stop after injections of corticosteroid drugs;
• discomfort when touched;
• radiating pain in the limb and scapula.

The primary manifestations of the pathological process are similar to signs of other diseases, therefore, self-medication without an established diagnosis is prohibited.

Diagnostics

The study will establish the presence of damage to the bone and cartilage tissue.

Given that the characteristic features of the pathology are similar to other injuries of the shoulder, it becomes difficult to diagnose the disease. The doctor conducts an examination and anamnesis to exclude probable joint diseases. After that, the patient undergoes a series of studies using arthroscopy and x-rays, tests are prescribed. SLAP shoulder injury has a classification by types, which are established depending on the changes taking place, which is presented in the table:

Shoulder arthrosis is a chronic progressive disease characterized by degenerative-dystrophic changes in the shoulder joint. As a result of the gradual destruction of cartilage tissue, the joint ceases to perform its function.

Who is most likely to develop the disease (risk factors)
Symptoms
How does a doctor distinguish this disease from other diseases?
Treatment: pills, physiotherapy, surgical treatment + interesting video!

Osteoarthritis of the shoulder (also sometimes referred to as "chondrosis of the shoulder joint") usually develops in people over 45 years of age. At this age, degenerative changes in the body begin, the aging process develops, which affects the state of many tissues and organs, or, in simple terms, salt deposition begins. In this case, they speak of primary arthrosis.

If osteoarthritis develops as a result of a previous injury, then it is called secondary post-traumatic arthrosis of the shoulder joint. Secondary osteoarthritis can occur at any age.

An important role in the development of the disease is played by lifestyle, the specifics of the profession, nutrition. The gradual destruction of the articular cartilage is due to microtraumatization of its surface and impaired production of intraarticular fluid. As a result of synovial fluid deficiency and changes in its composition, cartilage tissue does not receive sufficient nutrition.

Joint movements are accompanied by friction. This leads to the development of a dystrophic process in the cartilaginous tissue and its gradual destruction. The degenerative process passes to the bones. Osteoporosis develops, bone outgrowths (osteophytes) appear, the joint is deformed.

Risk factors for developing this disease:

• hereditary predisposition;
• congenital malformation of the shoulder joint;
• hereditary diseases of the osteoarticular apparatus;
• elderly age;
• excess body weight, leading to increased load;
• endocrine diseases;
• work associated with a long load on the shoulder;
• injuries (bruises, dislocations, fractures in the joint area);
• shoulder arthritis of various etiologies.

Symptoms

Shoulder osteoarthritis in the initial stages is manifested by discomfort or pain in the joint in certain positions of the body. When moving in the joint, a crunch is sometimes heard - in other words, the shoulder joint crunches.

After a while, the pain gradually subsides, but then the disease begins to progress. Pain in the shoulder becomes more intense and occurs more often. They can be constant, aching, their intensity varies depending on weather conditions and physical activity. Sometimes shoulder arthrosis is manifested by sharp pains in the shoulder or shoulder blade in response to physical activity.

Localization of pain may be different. Sometimes he suffers from pain all over his shoulder and even his arm, his elbow aches. Pain in the muscles of the neck and back on the side of the lesion may also bother. In some cases, only the area of ​​\u200b\u200bthe shoulder joint hurts.

With further progression of the disease, morning stiffness and limitation of mobility join. The pain syndrome becomes constant. The function of the joint is lost, the range of motion decreases. At first, the patient can raise his arm only 900, over time, the difficulty of movement progresses. Other symptoms include a slight swelling in the joint area, usually it appears after hypothermia or prolonged exercise.

How does a doctor distinguish this disease from other diseases?

Some diseases can have symptoms similar to shoulder arthrosis. The doctor must differentiate osteoarthritis of the shoulder with the following diseases:

• shoulder arthritis (rheumatoid, reactive, psoriatic);
• gout, or gouty arthritis;
• pyrophosphate arthropathy.

To exclude these diseases, it is necessary to study the symptoms and conduct a laboratory and instrumental examination (general blood count, biochemical analysis of blood and synovial fluid, radiography, ultrasound of the shoulder joint).

With arthritis, morning stiffness is longer than with arthrosis (more than 30 minutes), inflammatory changes are present in the blood and joint fluid.

On the radiograph, shoulder arthrosis is characterized by osteophytes, uneven narrowing of the joint space, in the later stages - a significant deformation of the articular joint, which is not typical for arthritis. In rheumatoid arthritis, specific antibodies called rheumatoid factor are found in the blood. Arthritis in psoriasis is often accompanied by skin rashes.

With gout and pyrophosphate arthropathy, corresponding changes in the composition of the blood are observed, indicating a metabolic disorder (increased content of uric acid salts, etc.).

Treatment

Treatment of shoulder arthrosis involves conservative and surgical methods.

1. Drug therapy

In the treatment of shoulder arthrosis, the following groups of drugs are used:

• non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, aertal, meloxicam) inside and in the form of local agents - ointments and gels;
• chondroprotectors (preparations of cartilage tissue components - rumalon, structum, chondroitin sulfate);
• muscle relaxants to relieve muscle spasm (mydocalm);
• drugs that improve microcirculation;
• anesthetics.

The goal of drug therapy for arthrosis is to eliminate pain and improve the nutrition of cartilage tissue.

Important: the effect of drug therapy becomes noticeable only with prolonged and regular use of prescribed drugs. Therefore, the recommendations of the doctor must be strictly followed regardless of the presence of symptoms!

2. Physiotherapeutic methods

With osteoarthritis of the shoulder, a good effect is observed from ultrasound and microwave therapy. Thermal applications, electrophoresis with anesthetics, and local barotherapy are also used.

An important place in the treatment of shoulder arthrosis is occupied by physiotherapy exercises and massage. With the help of a set of exercises, the muscles around the joint are strengthened, and the load on it is reduced.

In addition, adequate physical activity improves blood circulation in the joint and promotes the production of joint fluid, which provides nutrition to the cartilage. Massage has a similar effect. For more information about this, see the article Therapeutic exercises for shoulder arthrosis.

With osteoarthritis, which is also mistakenly called osteochondrosis of the shoulder joint, spa treatment is also very useful, combining various physiotherapeutic methods.

3. Surgical treatment

Surgical treatment of arthrosis is radical. The operation consists in replacing the articular surface of the scapula and the epiphysis of the humerus with metal prostheses. Since conservative therapy can only slow down the development of arthrosis, shoulder arthroplasty is a good option, especially in the later stages of the disease.

But in old age, there are often contraindications to surgery due to various chronic diseases. Therefore, in such cases, preference is given to medical treatment.

Caution: Shoulder arthrosis is a serious condition that can lead to disability. Proper and timely treatment can slow down the progression of the disease, so when the first symptoms appear, you should immediately consult a doctor.

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Shoulder Impingement Syndrome

A sharp pain in the shoulder joint after an unsuccessful movement or lifting too heavy a thing is, as many believe, not a slight sprain of the joint, but, quite possibly, something more serious. We are talking about such a disease as impingement syndrome of the shoulder joint. Of course, fleeting pain can also be the result of a small sprain, but the best option in this case is to go to the doctor, who can determine the source and cause of the sharp pain.

In order not to accidentally underestimate the seriousness of the disease, which can lead to negative consequences, we invite you to read this article, where you can find out what this disease is, why it appears, how to treat it and whether it can be avoided.

What is this disease

The shoulder joint is a complex system in which each component interacts with others. The movable base formed by the humerus, scapula and clavicle has great mechanical capabilities. Through the tendons, it connects to the subscapularis, small round, as well as supra- and subclavian muscles. All of them are in close interaction with each other, thanks to the rotator cuff, formed from a series of tendons. It is between them and the process of the scapula, called the acromion, that friction occurs, which causes severe pain. This syndrome is called impingement.

Causes of the syndrome

When a person raises his hands up, the tendons and articular bag located between the head of the humerus and the acromion are compressed in his body. If this process is simply called impeachment, then there is also a clinical form of this disease. It is typical for those people whose labor or other forms of activity involve a long fixed position of the hands in an upright position (athletes, painters, plasterers, etc.).

Formally, this disease can provoke any condition that somehow causes a decrease in the space between the tendons of the cuff and the acromion, for example:

• adhesive capsulitis;
• development of calcification of the tendon of the periosteal muscle;
• the presence of cervical osteochondrosis;
• neuropathy of the suprascapular nerve;
• chronic stage of cholecystitis;
• various deviations from the normal functioning of the joints;
• the presence of arthrosis of the shoulder and acromioclavicular joint.

At the same time, pain sensations appear exclusively in a certain range, if you raise or lower your hands below 30-60 degrees, then the pain becomes minimal or disappears altogether.

Stages of the disease

First stage. There are pains in the shoulder joint as a result of physical exertion. In this case, after some time, the patient may experience severe swelling and internal hemorrhages.

Second stage. It is characterized by the appearance of fibrosis and tendinitis. With them, there is a significant thickening of the tendons of the rotator cuff, which occurs as a result of constant inflammation and is a consequence of the fact that mechanically the shoulder begins to move incorrectly. At this stage, patients are shown surgical treatment.

Third stage. It is considered the most neglected. It is characterized by tendon and rotator cuff rupture, bone spur growth. As a result, the shoulder rotators are weakened and the centralization of the head of the shoulder is disturbed. Inflammations begin to be cyclical, which is the main reason for the destabilization of the shoulder joint.

Diagnosis of the syndrome

The syndrome is characterized by severe pain in the front and outer part of the shoulder with partial (in some cases complete) dysfunction of the joint. Almost immediately, asynchrony in the abduction of the shoulders back begins to appear (pain does not allow the affected shoulder to be abducted further than the healthy one).

At the initial stage of diagnosis, the doctor finds out from the patient the conditions of his work, since impeachment is considered mainly an occupational disease. For a more detailed identification of the source of pain, an examination method such as radiography is prescribed. If the doctor fails to identify the source of pain, then it is very likely that he will consider it necessary to additionally send the patient for an MRI. With this method, soft tissue and bone can be visualized in detail, which will allow you to know if the rotator cuff has been torn. If the source of pain is not found, then an anesthetic is injected, which indicates the cause of pain.

Treatment of the syndrome

Treatment of impingement syndrome proceeds in two stages:

1. Conservative (early stages of the disease).
2. Surgical (if the conservative did not have the desired effect).

Conservative methods include taking drugs such as xefocam or voltaren (the dosage is prescribed by a specialist depending on the severity of the disease). If the pain is very severe, diprospan is prescribed. The task of the drug is to reduce swelling and inflammation, the injection is made directly into the acromion. Along with taking medications, physical exercises and gymnastics are performed.

If the medication does not help, an operation is prescribed - subacromial decompression of the shoulder. With it, the gap between the acromion and the rotator cuff is artificially increased, while removing the bone spikes. In some cases, it may be necessary to remove part of the acromion.

Disease prevention

To avoid the occurrence of impingement syndrome, it is necessary to minimize the fixed vertical position of the hands. If, due to the nature of the profession or, if necessary, a sports load, this cannot be avoided, then you need to give a break to the joints. Hands should be in a lowered and relaxed state, this position must be alternated with loads.

When the first pains appear, you need to try to independently carry out exercises to relieve tension in the muscles. If the effect was not achieved, and the pain intensified, it is necessary to urgently consult a doctor who, based on a differential analysis, will be able to make an accurate diagnosis, determine the stage of the disease and, in accordance with the data obtained, prescribe a competent, effective and effective treatment.

When a person has the development of damage and inflammation of the soft tissues and tendons surrounding the shoulder joint, after undergoing a diagnosis, the doctor can diagnose "humeroscapular periarthrosis", or "shoulder joint impingement syndrome". As a result of such a disease, there is no damage to the bones that form the joint of the shoulder. But with a large amount of movement, injuries can occur that cause inflammatory and cicatricial changes in the joint capsule.

Shoulder syndrome, or impingement syndrome of the shoulder joint, can be diagnosed at an early stage of its development. This may be a pain syndrome and a decrease in the amount of mobility in the department. If you do not start treatment in a timely manner, you can come to a complete restriction of movement in the shoulder area. What causes such a disease, and whether it is possible to get rid of it, we will analyze in more detail.

Sources of the disease

Why brachialgia occurs, or periarthrosis of the shoulder joint, has not been fully investigated. The science of neurology identifies predisposing factors to the development of the disease:

1. As a result of damage to the shoulder joint.
2. With uneven muscle tension.
3. With a hernia of the intervertebral discs of the neck.
4. The presence of damage at the level of genetics.
5. With impaired metabolism.
6. With osteochondrosis of the neck and chest.
7. Menopause.
8. The presence of left-sided periarthrosis after a pathology such as myocardial infarction.
9. The presence of right-sided periarthrosis after liver disease.
10. After removal of the breast.

Stages of the disease

Without taking into account the fact that the shoulder syndrome (brachialgia, or periarthrosis) causes inflammation, thickening or reduction in the volume of the shoulder joint bag, developing at any stage of its process, the following can be distinguished:

1 stage

In other words, frozen shoulder syndrome, which is accompanied by sudden pain in the affected area, with an increase at night or at rest. It should also be noted that the increase in pain occurs when turning the shoulder in the direction of the lesion. At rest, the humeroscapular pain syndrome is more pronounced than when performing movements. This stage has a duration of no more than nine months and is completely cured with conservative treatment.

2 stage

In other words, periarthrosis, which is accompanied by a less limited pain syndrome, but a simultaneous manifestation of limited movements in the affected area. With muscle atrophic changes in the shoulder girdle, the possibility of circular movements of the shoulder is limited. Periarthrosis of the brachial plexus at this stage has a duration of no more than nine months. Removal of symptoms and elimination of the disease is observed with an integrated approach: physiotherapy exercises, physiotherapy and drug treatment.

3 stage

In a word, humeroscapular periarthrosis, which is accompanied by an almost complete loss of pain and a sharp progression of mobility limitation, including complete blockage of the affected area. Periarthrosis at this stage has a duration of no more than two years. Left untreated or insufficiently effective treatment of the disease at this stage leads to sclerosing capsulitis.

General symptoms of the disease

Neurology highlights the symptoms of a disease such as periarthrosis of the shoulder joint (brachialgia):

1. Limitation of joint mobility and pain syndrome during its movement.
2. The occurrence of synovitis and contracture of the muscles that surround the shoulder joint.
3. Symptoms of shortening of the hand, which occurs mainly in people whose comorbidities are diabetes mellitus, thyroid disease.

If the first symptoms and signs of brachial plexus pathology occur, it is better to consult a doctor to avoid further complications.

A special form of humeroscapular periarthritis is Steinbroker's syndrome, which causes a person's sharp pain in the shoulder and pronounced trophic changes in the hand. In other words, Steinbroker's syndrome is the occurrence of cold edema, cyanosis, muscle atrophy, osteoporosis.

Shoulder-hand syndrome may also develop, which is a consequence of shoulder pathology. In this case, a person develops a gradually increasing persistent painful restriction of shoulder mobility. In some cases, signs of osteoarthritis can be diagnosed. Over time, the pain syndrome goes away, but the restriction of mobility still increases.

Tunnel signs of neuropathy are one of the leading mechanisms of periarthrosis of the shoulder joint. In this case, tunnel signs are eliminated by blockade of the nerve or its neurolysis. The causes of tunnel signs lie in the trauma of the shoulder, which is accompanied by inflammation, the presence of a tumor or nerve compression.

Diagnostics

The brachial plexus is diagnosed by a neurologist. In this case, the doctor determines the degree of movement of the shoulder joint, taking into account which treatment is prescribed.

The first stage of the disease of the brachial plexus does not reveal any structural changes in the X-ray and MRI images. When diagnosing the disease in subsequent stages, x-rays show signs of concomitant arthrosis.

Treatment of the disease

After diagnosing a lesion in periarthrosis of the brachial plexus, the doctor must prescribe treatment, which, first of all, is aimed at eliminating the cause that caused it.

In case of violation of the blood supply, agents are prescribed that improve microcirculation and have an angioprotective effect. In the case when periarthrosis has become a consequence of the pathology of the spine, manual therapy is performed.

In order to alleviate the symptoms of brachial plexus disease and restore the mobility of the affected joint, the following treatment is carried out:

• taking medications;
• introduction of injections into the periarticular areas;
• doing gymnastics.

To reduce the severity of pain, you can take non-steroidal drugs. When such drugs are inactive, injections containing corticosteroids are prescribed. But we must remember that this is only the treatment of symptoms, which does not eliminate the cause of the disease itself.

Therapeutic and physical training complex for periarthrosis of the brachial plexus is carried out during the period of remission of the disease. At the same time, the loads are carried out slowly, avoiding jerks, otherwise pain syndrome may occur, and recovery will come much later.

The most important rule for performing physical education in case of brachial plexus disease is that exercises are carried out only in the presence of a doctor and with his help. Large loads in this case can only aggravate the course of the disease and cause negative consequences.

Injuries to the biceps tendon at the site of attachment to the superior labrum can be chronic and often present with mild symptoms. This type of injury was described in throwing athletes in 1985.

Preoperative diagnosis of SLAP lesions and differentiation of normal anatomy variants is a challenging task. To these difficulties are added normal age-related changes in the articular lip.

There are various mechanisms of SLAP damage. They may be associated with a fall onto an outstretched arm, abrupt forced abduction, and external rotation of the shoulder, as a result of a sharp jerk of the outstretched arm (for example, a dog leash).

SLAP damage most commonly found on the dominant limb in men over 40 years of age who have experienced overhead work or throwing for many years. Another group includes patients with trauma or instability of the shoulder joint.

Patient complaints

The most common complaints from patients are anterior shoulder pain, clicking and crackling in the shoulder joint, and impaired function (including decreased speed and strength). Throwing athletes have symptoms that appear suddenly or are present for a long time. Against the background of pain, when trying to perform active actions above the level of the head, the patient may experience a decrease in the energy of the throw.

Clinical examination

For detection of SLAP damage There are several clinical stress tests.

O'Brien test- the arm is given a position of adduction of 10 ° -15 ° and anterior flexion of 90 °. By turning the first finger down, the patient with outstretched hand resists the pressure exerted by the researcher in the area of ​​the wrist joint from top to bottom. The arm is then fully supinated and the examiner again applies pressure to the patient's wrist, which the patient resists. It is considered positive when pain in the shoulder joint, appearing in the position of pronation of the forearm, decreases with its supination, suggesting SLAP - damage.

Pain in the acromioclavicular joint on palpation indicates pathological changes in the acromioclavicular joint.

If there is tendinitis of the biceps tendon, it is determinedSpeed's test- with a fully supinated forearm and shoulder abduction up to 90 °, an attempt to anterior flexion with overcoming resistance causes pain in the region of the intertubercular sulcus.

Restriction of internal rotation compared to the opposite shoulder suggests thickening of the posterior capsule. If internal rotation restriction is not relieved by physiotherapy, then it suggests the presence of a SLAP injury.

Provocative tests often do not give unambiguous results and are not diagnostically independent. Despite doubts about their reliability, these tests are of value in the clinical examination of the shoulder joint.

Diagnosis of the articular lip

To identify concomitant pathological changes in the bones, it is necessary to performstandard radiography.

MRIallows to clarify the anatomy of the articular lip, and the interpretation of the results by a specialist in radiation diagnostics of diseases of the musculoskeletal system increases the reliability of the method. MRI should be used as an auxiliary diagnostic method and no isolated conclusions can be drawn from the results of this study.

Even among experts, there is no consensus on the issue of diagnosing SLAP damage.Arthroscopyis still considered as one of the main methods for diagnosing such conditions.

SLAP injury classification

With the development of arthroscopic equipment and techniques, the differentiation of SLAP injuries from normal anatomical structures has improved.

1 type -this is the result of normal age-related degenerative changes and a decrease in blood supply, which is expressed by defibration of the inner edge of the upper part of the articular lip.

type 2is the most common and clinically significant type. It occurs as a result of separation of the upper part of the articular lip at the site of attachment of the tendon of the biceps muscle from the supraarticular tubercle. Burkhart and Morgan described three subtypes: anterior, posterior, and combined.

3 type- rupture of the upper part of the articular lip, like a watering can handle, usually extends from front to back in the area of ​​​​attachment of the tendon of the biceps of the shoulder.

4 type- rupture of the articular lip like the handle of a watering can, with the transition to the biceps tendon, which leads to splitting in the area of ​​its attachment. Weber subdivided this type into:

• 4A type– there is a non-blood-supplied portion of the handle of the watering can.
• 4V type- there is a splitting upwards into the biceps tendon with signs of maintaining blood supply.

Subsequently, the classification was expanded to include SLAP injuries associated with shoulder instability:

5 type- Bankart injury that extends to the area of ​​attachment of the biceps tendon.

6 type– anterior and posterior labral flap with biceps elevation characteristic of type 2.

7 type- separation of the biceps at the site of attachment with the spread to the middle glenohumeral ligament.

8 type -represented by type 2 with the greatest distribution to the back of the glenoid labrum.

9 type- represented by type 2 with a circumferential rupture of the articular lip.

10 type- represented by type 2 with a posterior inferior compartment of the articular lip.

Importantly, with the exception of cases of shoulder instability, the number of SLAP injuries is low.

Treatment of SLAP injuries

Start off SLAP injury treatment follows from conservative measures, which consist in creating rest conditions and taking anti-inflammatory drugs, exercises to stretch the muscles and strengthen them in conditions of a specific imbalance.

The main task of the initial stage of physiotherapy treatment is stretching the posterior part of the capsule.

Surgeryshown if conservative measures have not had an effect within three months. Prior to the intervention, a set of measures should be performed aimed at stretching the muscles and restoring the full range of motion.

Surgery - . Basically, there are 3 types of operations.

1. ABOUT processing of the bed of the articular lip in the area of ​​damage and anchor fixation of SLAP using anchor threads.
2. Those tendon node of the long head of the biceps muscle. Tenodesis can be intra-articular or extra-articular using various implants - interference screws, anchors.
3. Tenotomy of the tendon of the long head of the biceps muscle. In this case, the tendon simply intersects in the area of ​​attachment to the articular lip.

Preoperative planning is an important stage of treatment. The choice of operation for each case is strictly individual.

Rehabilitation after SLAP injury treatment

A support bandage is applied to ensure comfort for three weeks. Three weeks later, pendulum exercises, movements in the elbow joint are allowed (except for flexion in the horizontal plane). After 6 weeks, exercises to strengthen the rotator cuff, biceps and deltoid muscles and stabilize the scapula are allowed. Exercises to stretch the posterior part of the capsule continue until complete recovery.

Damage to the tendon of the biceps muscle in the area of ​​its transition to the glenoid lip is a fairly common occurrence. However, this pathology is very difficult to diagnose and very often detected directly during surgery. Often, normal wear and tear in this area, which occurs in patients after 40 years of age, can be mistakenly regarded as damage.

With persistent pain, limitation of movement, and the presence of clicks in the shoulder joint, especially if the patient has previously played sports related to swimming or throwing, SLAP damage can be suspected.

ANATOMY OF THE SHOULDER JOINT

The shoulder joint is made up of three bones: the clavicle, scapula and humerus. The head of the humerus is placed in a cavity of the scapula, small in comparison with its size.

Along the edges of the articular cavity is surrounded by a soft tissue lip, it increases the depth of the articular cavity, which allows it to more closely match the head of the humerus in shape.

The joint is also surrounded by a dense connective tissue called a capsule. A strong capsule, strong ligaments, tendons and muscles surrounding the joint keep the head of the humerus in the center of the glenoid cavity.

The rotator cuff is formed from the tendons of four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) and connects the humerus to the scapula.

Tendons connect muscles to bones. The muscle moves the bone by pulling on the tendon. The tendons of the rotator cuff help raise and rotate the arm. Also, the rotator cuff centers the head of the humerus in the center of the articular platform of the scapula (glenoid) during movements.

The articular lip can be pinched between the head of the humerus and the glenoid during movement. As a result, the upper sections of the articular lip begin to come off. Over time, the size of the damage increases, the torn lip can move into the joint cavity and be infringed between the head of the humerus and the glenoid (SLAP injury).

The result is pain on movement. Also, when the articular lip is torn off, stability in the joint decreases.

CAUSES OF SLAP DAMAGE

Upper labrum injuries are often caused by direct trauma, such as a fall onto an outstretched arm. Often, during long-term throwing sports or weightlifting, gradual damage to the articular lip can occur. In some cases, SLAP injury can be the result of a shoulder dislocation.

SYMPTOMS OF SLAP

The main symptoms of SLAP injury are pain in the anterior sections of the shoulder, clicks and crackles during movements in the shoulder joint. Against the background of pain, a decrease in the volume of active movements, especially above the head, progresses, and then stiffness in the joint develops. With damage to the labrum, some patients may feel instability in the shoulder joint, with some movements.

SLAP DIAGNOSIS

A physician may suspect labral injury based on the history and physical examination. During a clinical examination, the doctor conducts special stress tests, revealing symptoms characteristic of this disease. MRI and radiography of the shoulder joint are not highly sensitive to damage to the articular labrum.

In this connection, the diagnosis of damage to the articular lip is much more difficult. Arthroscopy may be used to confirm the diagnosis. An arthroscope is a small optical device connected to a video camera and a monitor, which is inserted into the joint cavity through a skin puncture.

During the operation, you can examine the joint cavity, diagnose damage to the articular lip and perform reconstruction.

SLAP DAMAGE TREATMENT

Treatment usually begins with conservative measures. The main goal is to reduce pain and inflammation in the joint. Priority is also therapy, mainly physiotherapy exercises aimed at preventing stiffness in the joint. Your doctor may prescribe cortisone injections into your joint. Cortisone is a very strong anti-inflammatory drug that, when injected into the joint, significantly reduces pain. However, it is worth noting that pain relief is only temporary. If within 3-4 months conservative treatment is not effective, the pain syndrome is not stopped, and the range of motion in the joint progressively decreases, surgery may be considered.

For the surgical treatment of labral injuries, including SLAP injuries, arthroscopy is currently used.

If the area of ​​the damaged lip is small and does not affect its entire thickness, the lip is not infringed between the head and the glenoid during movements, debridement can be limited. Debridement is performed with special arthroscopic mechanical instruments or with the help of cold plasma (cold plasma ablation). As a result of debridement, irregularities are smoothed out, as well as areas of disintegration of the articular lip. With debridement, it is possible to resect marginal and partially torn fragments of the articular lip and biceps tendon, which, when moving in the shoulder joint, “wear” the articular cartilage and contribute to chronic inflammation.

If the gap of the glenoid lip is significant, and instability is determined in the shoulder joint, its refixation may be required, rather than simple removal.

During arthroscopy, the site of damage is visualized, channels are drilled in the bone in the projection of separation, and special anchor fixators (anchors) are inserted into them, to which the articular lip is fixed with heavy-duty threads. The operation may require several anchors.

Anchor fixators (anchors) can be made of metal or a special absorbable material. After some time, the articular lip adheres to the bone. Anchor latches do not need to be removed later.

In some cases, with significant damage to the biceps tendon, its tenodesis is performed.

Tenodesis is the operation of cutting off the tendon of the biceps from the scapula and fixing it in a new place in the region of the proximal humerus.

With tenodesis, the relief of the muscles of the shoulder does not suffer. The operation leads to a sharp decrease in pain in the shoulder joint.

There are many techniques for arthroscopic biceps tendon tenodesis.

To fix the tendon to the bone, anchor fixators (anchors) or special screws can be used.

The advantage of arthroscopic tenodesis is to reduce the degree of damage to the intact tissues surrounding the joint, which leads to faster healing and recovery.

REHABILITATION AFTER OPERATION

After the operation of tenodesis and refixation of the articular lip, a special orthotic bandage is prescribed, most often passive movements in the elbow and shoulder joint are resolved immediately after the operation.

However, active movements of the operated hand are limited to one and a half months after the operation. More aggressive rehabilitation may result in avulsion of the biceps tendon and labrum from its reattachment site to the bone. You can usually return to sports 4-6 months after surgery.

The debridement operation involves a more active rehabilitation that begins immediately after the operation. Sutures from the skin after arthroscopic operations on the shoulder joint are usually removed on the 10th day.

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In our clinic, we widely use arthroscopy and other minimally invasive methods for treating shoulder joint pathology. Operations are carried out on cutting-edge medical equipment using high-quality and proven consumables, fixators and implants from major global manufacturers.

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Arthroscopic SLAP reconstruction — 79,000 rubles

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*

Arthroscopic tenodesis of the biceps tendon — 49,000 rubles

• Clinic stay
• Anesthesia
• Operation: Arthroscopy of the shoulder joint with biceps tenodesis
• Consumables
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* Analyzes for the operation are not included in the price

Intra- and periarticular administration, "blockade" with glucocorticoids (without the cost of the drug) - 1000 rubles

• Local anesthesia
• Local administration of a glucocorticoid solution (Diprospan)

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• Clinical examination after surgery
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One of the most common injuries of the upper extremities is a Bankart injury of the shoulder joint.

With proper treatment and a full course of rehabilitation in the first year, you can fully restore the functions of the hand and return to a full life. Let's consider this problem in more detail.

The shoulder joint differs from other joints in its structure, especially considering its size. It consists of two main parts: the scapular cavity and the head of the humerus. In shape, it resembles a ball, and quite large in size.

The ratio of the dimensions of the head of the shoulder and the articular cavity is unequal - the bone enters it by about 25 - 30%. The rest would have remained free, which would have made the joint extremely unstable if not for a special system of cartilage, joints and ligaments.

Along the edge of the cavity there is a cartilaginous outgrowth, the so-called articular lip, which additionally fixes the head.

There is also a system of muscle tendons:

• small round;
• scapular;
• infraspinatus;
• supraspinatus.

All together forms a strong joint capsule and a stable system that ensures safe movement of the hand. If damage to the rotator cuff of the shoulder joint occurs, the lifting and abduction of the limb, its rotation, and force tension will become inaccessible.

This anatomical complex is carefully thought out by nature itself, but still it remains vulnerable, so Bankart's injuries are quite common.

Causes of damage

SLAP injury to the shoulder joint can be provoked mainly by external factors, although some internal processes can also contribute to this.

The risk of injury increases in such cases:

• osteoporosis;
• tendinitis;
• arthritis.

The main reasons for the violation of the integrity of the articular cuff are:

• sharp hand movements with a large amplitude of its abduction or rotation;
• falling on a straightened limb;
• exposure to intense load, for example, when lifting a load sharply;
• a blow to the shoulder of great force.

The risk group includes people whose profession or hobbies are associated with a long stay of hands in a position above their head, rotational movements or jerks. For example, a labral tear is a common injury among athletes: shot putters, golfers, tennis players, etc.

As a result of such an impact, a partial tear or complete separation of the articular lip occurs. As a result, the shoulder joint loses stability, which is expressed in a significant increase in the likelihood of dislocation, cracks and fractures of the articulation elements. It is dislocations that in most cases accompany SLAP injury.

Symptoms and signs

The main signs that characterize damage to the rotator cuff of the shoulder joint are pain and impaired motor ability. The intensity of their manifestation depends on the severity of the injury.

General symptoms are expressed as follows:

• pain aggravated by movement of the limb;
• puffiness;
• characteristic clicks when trying to bend the arm;
• a noticeable decrease in the strength and mobility of the injured hand;
• inability to make retracting movements;
• when trying to implement a rotational movement, a dislocation is highly likely;
• loss of working capacity.

Important! With a slight tear in the tissues, the symptoms may be mild, so the person may not pay attention to them. However, if appropriate measures are not taken and the damage is allowed to become obsolete, negative consequences may occur, in particular, the preservation of articular instability.

Types of damage

There is a classification of injuries of the shoulder joint of this type.

There are three types of Bankart injury:

1. Classic type. The pain manifests itself from the moment of injury, hand movements are difficult. It is characterized by a complete separation of the articular lip at the junction with the scapular cavity. The moment of receiving damage is accompanied by a special click.
2. Second type. In this case, the damage is minor, a complete rupture does not occur, so the discomfort in the joint is not so pronounced. This leads to ignoring the problem, which in the end can provoke the development of serious complications.
3. Extreme type. This is a particularly severe type of injury, since the rupture of the articular lip is accompanied by cracks or fractures of the bone. The victim needs immediate medical attention.

The degree of damage and the intensity of the expression of symptoms are directly related to the presence of a particular type of shoulder injury. Treatment is selected accordingly.

Diagnostic measures

Even an experienced doctor will not be able to make an accurate diagnosis without hardware studies. Although the symptoms are very specific, some types of damage can be similar to other diseases. If dislocation is present, it is important to examine the soft tissue and bone for associated injuries.

It is possible to assess the condition of the shoulder joint using special motor tests, but in any case, additional diagnostics are required.

The most informative research methods include:

1. MRI. This diagnostic option allows you to consider structural changes in all tissues of the joint, including cartilage and tendons, muscles and bones. Any type of damage in all elements of the articulation and adjacent structures will not remain without the doctor's attention.
2. CT. Computed tomography in this case is performed using a contrast agent. It is preliminarily poured into the joint cavity, due to which the ruptures of the capsule become more visualized.
3. Arthroscopy. Through small incisions in the shoulder, a miniature camera, the arthroscope, is inserted into the joint cavity. First, a saline solution is pumped inside to open the capsule in order to more clearly examine the condition of the tissues. The image from the camera is displayed on the monitor.

Radiography in this case is ineffective, since it allows you to consider only the displacement and violation of the integrity of bone formations. After finding out the type of injury and all the necessary related aspects, appropriate treatment is prescribed.

Treatment Methods

In most cases, surgical methods of treatment are used to eliminate Bankart injuries. Conservative therapy is possible only with minor tears.

Instructions for this approach include the following activities:

1. Immobilization. It is necessary to completely immobilize the injured limb to avoid further damage.
2. Taking medication. Painkillers and non-steroidal anti-inflammatory drugs are used. Additionally, chondroprotectors and vitamin-mineral complexes are recommended.
3. Physiotherapy. Various procedures, the price of which is quite affordable, stimulate regenerative processes, relieve pain and improve blood circulation.
4. Folk remedies. They are used only as ancillary measures to relieve symptoms and speed up recovery.
5. exercise therapy. After fusion of the articular lip, it is necessary to carefully develop the limb, gradually increasing the load and range of motion.

Surgical intervention

Shoulder injuries with a torn rotator cuff most often require surgical repair. Surgery is performed in the least traumatic way - through arthroscopy.

With chronic injuries, first of all, it is necessary to clean the edges of the gap, so to speak, to refresh the wound. To restore the integrity of the articular lip, special anchors are required to secure it around the scapular cavity. Holes are carefully drilled in its bottom, where the fixing elements are inserted. With their help, the lip is pulled up to the bone and stitched.

Such measures provide optimal conditions for the fusion of damaged tissues. Threads for suturing are used both from titanium alloys and polylactic acid. The dimensions of the clamps in diameter are on average 1.2 - 3.5 mm.

Rehabilitation

The rehabilitation period takes an average of 3-6 months. In severe cases, recovery can take more than 1 year. To make the process as easy and fast as possible, certain rules must be followed. First of all, the limb is immobilized with the help of special orthoses. At the doctor's prescription, you need to attend physiotherapy procedures.

Of particular importance is exercise therapy.

The load on the shoulder joint is distributed into 3 stages, for which the following exercises are used:

After 3 months, with positive dynamics, the introduction of the usual load with weight lifting is allowed.

Prevention

In order to prevent injury to the limb in the area of ​​the rotator cuff and to avoid recurrence in case of damage to the articular lip earlier, it is necessary to take care of the prevention of such problems.

To do this, you must follow the following recommendations:

• correctly group in case of a fall, the hand put forward is almost always injured in the joints;
• perform sports exercises correctly;
• avoid sudden hand movements, especially with a load on the shoulder joint;
• do not overload the limb;
• Seek immediate medical attention after an injury or if you develop suspicious symptoms.

For more information about Bankart's shoulder injury, watch the video in this article.