1. SLAP/Bankart
Lesion Repair
and
Rehabilitation
Rielly Byrd
Laura Wind

2. Bankart Lesions
• Usually occur from
traumatic detachments of
glenoid labrum, result of
reoccurring anterior
dislocations 1
• Lead to anterior instability
involving avulsions of
glenoid labrum and
ligamentous structures
attaching inferiorly 2

3. SLAP Lesions
• Superior Labral
Anterior Posterior
• Bicep tendon
• Can be acute
trauma or overuse
with repetitive
shoulder
movements. 3

4. Bankart Lesion Types
a. Bankart Lesion- Complete
detachment of the
anteroinferior labrum
ligament complex from
the glenoid
b. Bony/Osseous Bankart
Lesion-Bony fragment
avulsed from
anteroinferior glenoid with
ligament structure1
Bony
Lesion

5. SLAP Lesion Types
• Type 1- Frayed or degenerative labrum but still attached.
• Type 2- Fraying with detachment of the superior labrum and
biceps tendon from the glenoid.
• Type 3- A bucket handle tear from the labrum with biceps
intact.
• Type 4- A bucket handle tear from the labrum that extends
through the biceps tendon. 4, 5, 6

6. Surgical Repair
SLAP Lesion Bankart Lesion
• Debride fraying tissue to
prevent tear
• Secure loose labrum to
the socket*
• Repair or remove torn
labral tissue
• Remove labral tear/
repair biceps tendon
• Arthroscopically
• Reattach/secure loose
labrum to the socket*
• Open or arthroscopically
6,7,8,9

7. Guidelines for Rehabilitation
Post Surgery
• Time for full recovery=6-12 months
• Repair should be protected for 6 weeks
• Sling for 48-72 hours, continue as needed during day,
worn at night 6 weeks
• Do not wet incision
• NO active shoulder motion 4 weeks, all planes
• NO active IR 6 weeks
• ER limited during early rehabilitation
• Accelerating program may lead to recurrent problems
• Patient education is key! 10,11

8. Timeline/Goals: Post Op
Weeks 9-24:
• Normalize strength,
endurance, power, &
stability
• Sport specific
exercises
• Goals are dependent
on patient’s activity 7
Weeks 0-6:
• Protect repair
• Scapular
exercises/ active
motion in
uninvolved joints
• Submax isometric
strengthening of
shoulder & elbow
Weeks 6-9:
• Initiate rotator
cuffs/scapular
neuromuscular
control
• Strengthening in
elevation activities
(limit weight bearing
activity)

9. Guidelines for Non-
Operative Rehabilitation
• The mechanism of injury is important to determine the
appropriate rehabilitation guidelines. 2
• Time for full recovery is usually no longer than 6 months.
12
• Using NSAIDS, Posterior Capsular stretching, and
strengthening program. 12
• Focus on functional stability, neuromuscular control,
proprioception, plyometric, eccentric and scapular
stability. 5, 13

10. Timeline/Goals:
Non-operative
• Phase 1
• Decrease pain and
inflammation
o Modalities (ice,
electric
stimulation)
o NSAIDS
• Re-establish
functional ROM
• Re-establish
muscular balance
Phase 2
• Normalize
arthrokinematics
• Improve strength
• Improve
neuromuscular
control
• Enhance
proprioception 14

11. Timeline/Goals:
Non-Operative cont.
• Phase 3
• Enhance dynamic
stabilization
• Improve strength
endurance
• Improve
neuromuscular
control
Phase 4
• Maintain level of
power, strength,
endurance, and
agility
• Progress activity
level to prepare for
full functional
return to sport or
activity 14

12. ROM/Stretching
• Pendulums (4 ways)
• Scapular Mobility
• Passive ER, IR, Flexion
• Active Flexion using Stick
• Pulleys
• Table Slides
• Cross body Stretch 10,15

13. Strengthening
• Isometric IR*, ER, Flexion, Extension,
• Ball Squeeze
• Row
• Prone Extension, Horizontal Abduction,
Scaption
• Bicep Curls
• Wrist (4-ways)
• Gripping exercise
• Serratus Press
• Body Blade
• Wall Push-ups
• Diagonals10,11,15

14. Cardiovascular/Proprioception
• Arm Circles
a. Eyes Closed
b. Plyoball
• Diagonals (Perturbation
• Plank
a. Eyes Closed
b. On Bosu
c. Perturbations
d. 1-Arm 10,11,15
• Bike
• Elliptical
• Treadmill
• Swimming*
• UBE
• Stairmaster

15. Speed, Power, Agility
• Overhead Throw
• Medicine Ball Underhand
• Vertical Toss
• Medicine Ball Chest Pass
• Side Arm Throw
• Over hand throw 1 Arm
• Clap Push Up
• Ladder Drills
• Step Up in Push-Up Position
10,15

16. Back to Throwing
Progression
• Phase 1
• throwing at 50%
• -20 throws from 20ft (warm up)
• -35 throws from 30-40ft
• -20 throws from 20ft (cool down)
Phase 2
• throwing at 50%
• -10 throws from 20ft (warm up)
• -10 throws from 30-40ft
• -35 throws from 50ft
• -10 throws from 20-30ft (cool
down)
Phase 3
• throwing at 60%
• -10 throws fro 30ft (warm up)
• -10 throws from 40-45ft
• -35 throws from 60-70ft
• -10 throws form 30ft (cool down)
Phase 4
• throwing at 60%
• -10 throws at 40ft (warm up)
• -10 throws at 50-60ft
• -20 throws at 70-80ft
• -10 throws at 50-60ft at 70%
• 10 throws at 40ft (cool
Phase 5
• throwing at 70%
• -10 throws from 40ft (warm up)
• -10 throws from 50-60ft
• -30 throws from 80-90ft
• -20 throws from 50-60ft at 75%
• -10 throws from 40 (cool down)
Phase 6
• throwing at 75%
• -10 throws from 40ft (warm up)
• -10 throws from 60ft
• -20 throws from 100-110ft
• -20 throws from 80ft at 80%
• -10 throws from 40ft (cool down)
16,17

17. Back to Throwing
Progression Cont.
• Phase 8
• throwing at 80%
• -10 throws from 40ft
(warm up)
• -10 throws from 60-80ft
• -20 throws from 120-150ft
• -20 throws from 60ft at
90%
• -10 throws from 40ft (cool
down)
• Phase 9
• Throwing off the mound
• -Fastballs only
• -Work on spot location
• -50%-90% velocity
• -Game scenarios
• -Pitch count >90
• Phase 10
• Bullpen workout
• -Throwing all pitches
• - Game scenarios
• - 100% velocity
• - Pitch count >90-110
• Phase 11
• Competitive RTP- game
setting
• - Athlete feels confident
and ready 3
• -120 pitches/3 innings 16,
17

18. References
1. Lasanianos, N.G., Kanakaris, N.K., and Giannoudis, P.V. (2014), Bankart Lesions and
Bankart Variable Lesions. Trauma and Orthopaedic Classifications. 37-40.
2. Wilk, K.E. and Macrina, L.C. (2013), Nonoperative and Postoperative Rehabilitation for
Glenohumeral Instability. Clinic of Sports Medicine. 32, 865-914.
3. Horsley, I.G., Herrington, L.C., and Rolf, C. (2010), Does a SLAP Lesion Affect Shoulder
Muscle Recruitment as Measured by EMG Activity During a Rugby Tackle? Journal of
Orthopedic Surgery and Research. 5(12), 1-10.
4. University of Wisconsin Sports Medicine. Accessed September 7, 2015. Rehabilitation
Guidelines For SLAP Lesion Repair. UW Health. 1- 6.
5. Wilk, K.E., Reinold, M.M., Dugas, J.R., Arrigo, C.A., Moser, M.W., and Andrews, J.R.
(2005), Current Concepts in the Recognition and Treatment of Superior Labral (SLAP)
Lesions. Journal of Orthopedic and Sports Physical Therapy. 35(5), 273-292.
6. Dodson, C.C. and Altchek, D.W. (2009), SLAP Lesions: An Update on Recognition and
Treatment. Journal of Orthopedic and Sports Physical Therapy. 39(2), 71-80.
7. Gaunt, B.W., Shaffer, M.A., Sauers, E.L., Michener, L.A., McCluckey III, G.M., and
Thigpen, C.A. (2010), The American Society of Shoulder and Elbow Therapists’
Consensus Rehabilitation Guideline for Arthroscopic Anterior Capsulolabral Repair of the
155-Shoulder. Journal of Orthopedic and Sports Physical Therapy. 40(3), 155-168.
8. Cho, H.L., Lee, C.K., Hwang, T.H., Suh, K.T., and Park, J.W. (2009), Arthroscopic Repair
of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results.
Clinics in Orthopedic Surgery. 2, 39-46.

19. References Continued
9. Chang, D., Mohana-Borges, A., Borso, M., and Chung, C.B. (2008), SLAP Lesions: Anatomy,
Clinical Presentation, MR Imaging Diagnosis and Characterization. European Journal of
Radiology. 68, 72-87.
10. Vanderbilt Sports Medicine Knee Center and Shoulder Center. Accessed September 7,
2015. Bankart Repair Protocol. Vanderbilt Sports Medicine. 1-6.
11. Beth Israel Deaconess Medical Center. Accessed September 7, 2015. Sports Medicine and
Shoulder Surgery. Medsport: Ann Arbor, Michigan and Vanderbilt Sports Medicine Nashville,
TN. 1-4.
12. Edwards, S.L., Lee, J.A., Bell, J.E., Packer, J.D., Ahmad, C.S., Levine, W.N., Bigliani, L.U.,
and Blaine, T.A. (2010), Nonoperative Treatment of Superior Labrum Anterior Posterior Tears:
Improvements in Pain, Function, and Quality of Life. The American Journal of Sports Medicine.
38(7), 1455-1461.
13. Hayes K, Callanan M, Walton J, Paxinos A, Murrell GA. Shoulder Instability: Management
and Rehabilitation. Journal of Orthopaedic & Sports Physical Therapy. 2002;32:497-509
14. Rockford Orthopedic. Accessed September 7, 2015. (2012), Conservative Bankart Lesion.
Therapy Department. 1-4.
15. South Shore Hospital, Orthopedic, Spine, and Sports Therapy. Accessed November 5,
2015. SLAP Repair Protocol. South Shore Orthopedics. 1-9.
16. Lugo, R., Kung, P., and Ma, C.B. (2008), Shoulder Biomechanics. European Journal of
Radiology. 68, 16-24.
17. Augustsson, S.R., Klintberg, I.H., Svantesson, U., and Sernert, N. (2012), Clinical
Evaluation of Muscle Function, Quality of Life, and Functional Capacity after Shoulder Surgery.
Advances in Physiotherapy. 14, 29-37.