particularly so if there is an associated rotator cuff injury. In such circumstances, it is suggested that labral debridement and biceps tenotomy is preferred. SLAP (Superior Labral Tear, Anterior to Posterior) Type 1 Fraying of Superior Labrum Biceps Anchor Intact Type 2 Superior Labrum detached Detachment of the Biceps Anchor Type 3 Bucket Handle type tear of Superior Labrum Biceps Anchor INTACT Type 4 Bucket Handle tear of Superior Labrum Extension of tear in Biceps Tendon Part of Biceps Anchor still INTACT Procedure Following inspection and determination of the extent of injury, the basic labrum repair is as follows. The glenoid and labrum are roughened to increase contact surface area and promote re-growth. Locations for the bone anchors are selected based on number and severity of tear. A severe tear involving both SLAP and Bankart lesions may require seven anchors. Simple tears may only require one. The glenoid is drilled for the anchor implantation. Anchors are inserted in the glenoid. The suture component of the implant is tied through the labrum and knotted such that the labrum is in tight contact with the glenoid surface. Surgical rehabilitation Surgical rehabilitation is vital, progressive and supervised. The first phase focuses on early motion and usually occupies post-surgical weeks one through three. Passive range of motion is restored in the shoulder, elbow, forearm, and wrist joints. However, while manual resistance exercises for scapular protraction, elbow extension, and pronation and supination are encouraged, elbow flexion resistance is avoided because of the biceps contraction that it generates and the need to protect the labral repair for at least six weeks. A sling may be worn, as needed, for comfort. Phase 2, occupying weeks 4 through 6, involves progression of strength and range of motion, attempting to achieve progressive abduction and external rotation in the shoulder joint. Phase 3, usually weeks 6 through 10, permits elbow flexion resistive exercises, now allowing the biceps to come into play on the assumption that the labrum will have healed sufficiently to avoid injury. Thereafter, isokinetic exercises may be commenced from weeks 10 through 12 to 16, for advanced strengthening leading to return to full activity based on post surgical evaluation, strength, and functional range of motion. The periods of isokinetics through final clearance are sometimes referred to as phases four and five. References External links Dislocations, sprains and strains Shoulder Lesion