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November 26, 2008

Travel Safe this Thanksgiving

Posted under: Welcome — Chelsea Mannella @ 2:16 pm

The National Crime Prevention Council (NCPC) has stated that travel safety has taken on a new meaning during these tough economic times. The organization best known for its icon, McGruff the Crime Dog, says opportunistic thieves may be looking for unprotected homes or pre-occupied travelers during the Thanksgiving holiday.

NCPC suggests following these safety tips to avoid problems during the start of the busiest travel season of the year.

Safety begins at home
• Make sure your house looks “lived-in” when you are away. Lock all doors and windows, and set household lights (inside and out) on timers.
• Trim your hedges and bushes so thieves do not have a place to hide out.
• Have a neighbor park a car in your driveway to make it appear as if someone is home.
• Invest in an alarm. An alarm system controls access points to your home and lets you know if someone has invaded your space.
• Ask a trusted neighbor or friend to watch your house and pick up your mail and newspapers while you are away.
• File a “travel plan.” Let someone know where you are going, the route you plan to take, and when you plan to arrive. If you deviate from that plan, let someone know.
Watch out for clever criminals
• Do not stop if your car is bumped from behind or if someone says there is something wrong with your car. Go to a service station or a well-lit, populated area and call for help.
• Fill the gas tank before dark and lock your car doors, and roll up your windows if you step away from the car for any reason.
• Never leave items of value such as cell phones, cameras, jewelry, or other expensive belongings visible in your car. Lock them in your trunk or take them with you.

Safety away from home
• Carry money separately from credit cards. Carry your purse close to your body or your wallet inside a coat or front trouser pocket.
• If you choose to shop on Black Friday, do not overburden yourself with packages to avoid being an easy target.
• Stick to well-lighted and well-traveled streets at all times.
• Select ATM machines in visible, well-lighted locations.
• Do not leave valuables in your hotel room. Most hotels have safes for guest use.
• Keep your hotel room door locked, even when you are inside.

National Crime Prevention Council

The National Crime Prevention Council (NCPC) is a private, nonprofit organization whose primary mission is to be the nation’s leader in helping people keep themselves, their families, and their communities safe from crime. NCPC manages public service advertising under the National Citizens’ Crime Prevention Campaign — symbolized by McGruff the Crime Dog(R) and his “Take A Bite Out Of Crime(R)” slogan — and acts as secretariat for the Crime Prevention Coalition of America, more than 400 national, federal, state, and local organizations representing thousands of constituents who are committed to preventing crime. NCPC is funded through a variety of government agencies, corporate and private foundations, and donations from private individuals. For more information on crime prevention issues, visit www.ncpc.org.

Happy Holidays from all of us here at Hickey Law Firm, P.A.

November 24, 2008

Cutting your mobile phone costs when travelling abroad

Posted under: Welcome — Chelsea Mannella @ 2:35 pm

Have you ever been horrified at the cost of using your mobile phone abroad and the fact that you have to pay to receive calls as well as make them! With a bit of planning you may be able to cut down your mobile phone costs. This blog tells you how.

Plan ahead:

It is like a lot of things in life, ‘failing to prepare is preparing to fail’, so if you are planning to use your mobile phone on holiday make sure you are fully equipped with the facts to ensure you don’t face a hefty bill!

Call charges:

Before departing on your holiday, make sure you know what your mobile phone provider charges for roaming in the country you are visiting. Some mobile phone operators charge flat rates for text messages and calls to the United States no matter what time of day it is or what foreign network you use. So when you arrive at your destination you can simply turn on your mobile phone on and use the network it automatically defaults to. Simple!

Certain networks however charge different call rates depending on which foreign network you use. It is therefore worthwhile finding out which foreign network is cheapest before you leave the country so that you can select it manually when you arrive at your destination.

Price comparison:

Getting an overview of what prices each mobile phone company charge is a good place to start and save money. The Internet is ideal for this. Another good way of keeping costs to a minimum is by using payphones for local calls and then buying an international card for calls back to the UK.

Text messaging:

It is best to try and limit the amount of text messages you send as the costs can mount up very quickly. The European Commission is proposing to reduce the cost of text messaging which may come into force next summer after it has been approved by Governments and the European Parliament.

SIM cards:

If you are going away for an extended period in one country, e.g. a Gap year, it might be worth considering buying a SIM card. You can buy an International one in the UK before you go or one at your destination.

Check your mobile phone works abroad:

The last thing you need is your phone not to work when you arrive at your destination. So well in advance of your departure date there are a few things you need to do. Firstly, check whether your mobile phone will work at your destination. Secondly, check with your mobile phone provider to make sure you can use your phone in the country you are visiting – not all networks allow you to roam anywhere. Thirdly, ask your mobile phone provider whether or not they have to activate your phone for use abroad. Finally, check the network coverage in the country you are visiting.

Travel adaptor and phone charger:

These are vital items to pack in your suitcase before you go, so you are not left in the middle of nowhere with a mobile phone with a flat battery!

November 19, 2008

Fever & Neurological Injury Link

Posted under: Injuries — Chelsea Mannella @ 2:09 pm

Combination of Fever, Neurological Injury Strongly Linked to Poorer Outcomes

Many studies associate fever with poor outcome in patients with neurological injury, but this relationship is blurred by divergence in populations and outcome measures.
In the most comprehensive meta-analysis to date, researchers have shown fever is strongly associated with worse outcomes in stroke and other types of neurological injury across multiple outcome measures.

Investigators at Massachusetts General Hospital, in Boston, analyzed data from 39 studies that included 14,431 patients with stroke and other brain injuries and found fever/elevated body temperature was consistently linked to poor outcomes regardless of the type of neurological injury or the outcome measured. “Whether a neurological injury is ischemic, hemorrhagic, or traumatic, or the outcome measured is clinical, functional, or economic, this study provides conclusive evidence that fever is consistently associated with poor outcomes,” said principal investigator David M. Greer.

The study was recently presented at the Neurocritical Care Society annual meeting and is published in the November issue of Stroke. Fever is a common condition in stroke and other types of brain injury, and previous research has shown a strong link to increased length of intensive care unit (ICU) and hospital stay, higher mortality, and worse overall outcomes.

However, said Dr. Greer, a direct causative link has been difficult to establish. “Historically, there has been a lot of research that has correlated fever in brain-injured patients — whether from stroke, traumatic brain injury, cardiac arrest, or subarachnoid hemorrhage — to poor outcomes. However, the wide variation in study populations and outcome measures in these studies have made it challenging to determine the true impact of high body temperatures in brain-injured patients,” he said.

To level the playing field, investigators incorporated all recent studies that addressed fever in brain-injured patients into a comprehensive meta-analysis to evaluate these disparate clinical findings. Researchers conducted a Medline search for articles published since January 1, 1995 and identified 1139 citations. Of these, they retained 39 studies with 67 tested hypotheses contrasting outcomes of fever/higher body temperature and normothermia/lower body temperature in patients with neurological injury.

Patients in the selected studies included individuals who had ischemic and hemorrhagic stroke and neurological ICU populations including traumatic brain injury (TBI) patients.
Outcome measures included clinical, functional, and economic outcomes as assessed by mortality, the Glasgow Outcome Scale (GOS), Barthel Index, modified Rankin Scale (mRS), Canadian Stroke Scale (CSS), ICU length of stay (LOS), and hospital LOS.

“Collectively, the meta-analyses presented a consistent result. In each of the 7 outcome measures evaluated, the meta-analysis indicated that fever/higher body temperature was significantly associated with worse outcome as indicated by higher mortality rate, greater disability, more dependence, worse functional outcome, greater severity, and longer stays in the hospitals and the ICU,” the authors write.

The investigators report the effect size of fever/higher body temperatures ranged from moderately small for the GOS to large for mRS, ICU LOS, and hospital LOS. In addition, in comparison with individuals with stroke or TBI who did not have fever/higher body temperatures, their counterparts with fever had a 1.3 to 3.2 times odds of a longer hospital LOS.

The results also suggest fever is associated with greater mortality and greater neurological dysfunction in patients with neurological injury. “It didn’t matter what measure we looked at, the outcomes were all significantly and consistently worse across the board in patients who were febrile,” said Dr. Greer. Whether fever actually causes worse outcomes or whether it is largely an effect of other causative factors is beyond the scope of this study. However, the investigators point out it is noteworthy that no other covariate examined “comes close to reaching the consistency of significance found with fever/higher body temperature.”

Although induced hypothermia is not standard medical practice in the management of all brain-injured patients, it is recommended by the American Heart Association in the treatment of resuscitated cardiac-arrest patients.

However, said Dr. Greer, although many in the neurocritical care community use hypothermia to treat neurologically injured patients, it remains an unproven therapy in this patient population. “At this point, induced hypothermia is not ready for prime time. We still can’t say conclusively that it improves outcomes for brain-injured patients. We suspect that it does, we see at the bedside that when we cool brain-injured patients their intracranial pressure comes down, but we still need hard scientific evidence,” he said.

According to Dr. Greer, the current findings point to a need for a major prospective, randomized study to confirm whether aggressive efforts to prevent and control fever in neurologically injured patients improves outcomes. Studies are currently ongoing for using induced hypothermia for such conditions as ischemic stroke and traumatic brain injury.

November 17, 2008

Government, Royal Caribbean sign US$122m Falmouth Port Deal

Posted under: Welcome — Chelsea Mannella @ 2:18 pm

Government and the Royal Caribbean Cruise Line (RCCL) signed a US $122-million contract for the development of a new cruise ship terminal on November 7th in Falmouth that promises significant increase in stopover visits to the north coast.

“They have guaranteed 400,000 visitors coming into the Falmouth port every year for the next 20 years,” said Prime Minister Bruce Golding, who signed the agreement along with Adam Goldstein, CEO of Royal Caribbean International.

The contract forms part of a US$224-million project that includes the establishment of themed retail shopping areas, entertainment facilities and restaurants in the Trelawney north coast town.

According to Golding, completion of the new pier and landside development is expected in May 2010 to coincide with the arrival of the Oasis of the Seas, the world’s largest cruise ship.

“Royal Caribbean has already started marketing Falmouth,” Golding said at the signing held at the Hilton hotel in Kingston. “We are going to have to do everything possible to assure that we meet the deadline,” he added. Transport & Works Minister Mike Henry, who also spoke at the signing, said that project would employ more than 700 workers during the construction phase and “hundreds others on a permanent basis afterwards”.

Under the contract, RCCL will be responsible for the landside development of sections of the town surrounding the pier that will retain the Georgian architectural ambiance for which Falmouth has been designated a world heritage site. “We have to recreate that as much as possible,” Golding remarked.

The RCCL chief said that he welcomed the opportunity to participate in the infrastructure development of the town, noting that Falmouth was ideally placed between the established ports of Montego Bay and Ocho Rios and would benefit the entire North coast.

“It’s a central location, we have an opportunity to make Falmouth and the north coast an even stronger attraction than it was before,” Goldstein said adding that the improvements around the pier would become a permanent tourist destination.

“When cruise ships are not there it will still be an attraction,” he added. At the same time Golding affirmed that environmental safeguards were observed and all of the issues addressed. “The project must become friendly to the ecology that we have there,” said the prime minister.

The multi-million-dollar pier works include dredging the Falmouth harbor, raising the elevation of low-lying areas and the building of a sea wall and promenade.

One thing to keep in mind about RCCL’s new investment is that Kingston is the most dangerous city in the Caribbean. Make sure to take more precautions here than you would elsewhere. The major problem facing most foreigners is mugging: Robbery is commonplace. If you are travelling in Kingston, stay with a group of people and if you do find yourself alone, return to your ship immediately. Make sure to get back to your ship, in order to depart on time to avoid being left behind by the cruise lines.

Traumatic Brain Injury “Happens to Families”

Posted under: Welcome — Chelsea Mannella @ 1:58 pm

Marilyn Shaver knows all too well how hard life becomes for someone who suffers from an acquired brain injury.

When her son Tim was 17, a serious ski accident changed his life forever. Now 31, his mother says his path has taken many difficult turns. “In the 14 years that have passed, he has fallen through the cracks in the system,” she said. “He‘s been in jail, he‘s been homeless, he‘s been inappropriately served in psychiatric institutions, and he’s received a patchwork of services.”

After much hard work and doubtless heartache, the family was finally able to find the right services for him. Now living in a facility where he can receive consistent 24-hour support, Tim has been able to make some “amazing gains” in the past few years, including participating in a drama group, Shaver said.

“But he‘s been through the gamut.” Experiences like Tim‘s are unfortunately all too common, says Ontario Alliance for Action on Brain Injury (OAABI) representative John Kumpf, who noted that nearly 500,000 people in Ontario are currently living with a brain injury-related disability.

“That‘s not including the families. One of the things I often say is brain injury doesn‘t happen to individuals – it happens to families,” said Kumpf. “It has a tremendous impact on families.”

The OAABI was in Thunder Bay on November 11, 2008 as part of a provincial tour to raise awareness among the public and policy-makers about the multitude of struggles faced by people affected by brain injuries. “If you‘re not aware of the challenges they face, it‘s hard to accommodate them. It‘s hard to have any empathy for them,” Kumpf said. Since brain injuries are a “very invisible disability,” it‘s easy for the condition to slip by unnoticed, undiagnosed and unsupported, he said, adding that no two brain injuries are alike.

“The range in brain injuries is substantial – that would include everything from concussions to severe brain injuries that leave people with physical, cognitive, emotional or behavioral disabilities,” said Kumpf. “There‘s no cookie-cutter response either, that‘s the other thing.”
See our website for information on what to do in the event of an accident involving traumatic brain injuries or death: www.hickeylawfirm.com. See also www.cruiseshipassault.com. The bottom line is get medical care immediately, take photos of the area where you were injured, get the names and contact information of witnesses, and report the accident at once. Also, CALL HICKEY LAW FIRM, P.A., TOLL FREE AT: 1.800.215.7117. Our consultations are always free. We work on a contingency fee basis; If we don’t recover, you don’t pay. Personal injury, wrongful death, sexual assaults, and medical malpractice. We have handled these types of claims for 28 years.

Divers Alert Network (DAN) to the Rescue

Posted under: Injuries — Chelsea Mannella @ 1:57 pm

I stumbled on this article on a Diver’s blog. The blogger explains accidents which he has experienced on dive excursions and how the Divers Alert Network has helped him these situations. It is great to know that there are communities of people that are taking preventative measures to ensure proper and timely medical treatment in the event of an injury.

See below for excerpts of the article:
(Also visit: http://blog.scubadiving.com/stephenfrink/DAN+To+The+Rescue+Again.aspx)

“From anywhere in the world, for any diving related emergency, my go-to guys are the Diver’s Alert Network.

The first thing I did was to pick up a sat phone and call DAN in Durham, North Carolina. It was two in the morning there, but the on-call physician Dan Nord (sorry to wake you Dan) talked to my guest, and then went the extra mile to seek out a cardiac consultation from his network of specialists. He called back in less than 20-minutes and we had reassurance that this was not a life-threatening cardiac event, and so long as he took it a little easy we could carry-on with the trip.

That episode along cost DAN insurance providers over $50,000, and that was back in mid-eighties dollars. I can easily envision a $200,000 tab for evacuation and treatment these days, and without that kind of an upper limit on a personal credit card, there is the very real possibility the airplane and doctors and chambers would simply not be available if they weren’t certain they would be paid. That’s the power of deep pockets and serious insurance. That’s the power of DAN.

For others who may ever have had need for emergency treatment, or even the reassurance of a free phone consultation far from home, the importance of DAN may not be readily apparent. But, of all the things we do as recreational divers, the small cost of DAN membership and insurance is the best bargain in our industry. Some may take it for granted, but not me. We require DAN insurance for all participants in our photo-tours, and most live-aboard worldwide want that same proof of recompression treatment and evacuation insurance for all their guests. Really, don’t leave home without it. Don’t even think about it. By the way, this year’s trip was aboard the Seven Seas, and it was awesome. Great boat, and great crew, with diverse and spectacular photo opportunities. In the end we had nothing to worry about, nothing worth being insured for. That’s the very best kind of insurance … the kind you don’t need.”

See our website for information on what to do in the event of an injury aboard: www.hickeylawfirm.com. See also www.cruiseshipassault.com. The bottom line is get medical care immediately, take photos of the area where you were injured, get the names and contact information of witnesses, and report the accident or incident at once. Also, CALL HICKEY LAW FIRM, P.A., TOLL FREE AT: 1.800.215.7117. Our consultations are always free. We work on a contingency fee basis; if we don’t recover, you don’t pay. Personal injury, wrongful death, sexual assaults, and medical malpractice. This all happens on cruise ships and we have handled these types of claims for 28 years.

Nissan’s “All-Around Collision Free” Vehicle

Posted under: Welcome — Chelsea Mannella @ 1:56 pm

Nissan Motor Co., Ltd. announced that it will demonstrate its advanced “All-Around Collision Free” prototype vehicle—complete with two all-new accident avoidance technologies—at the 15th World Congress on Intelligent Transport Systems (ITS). The ITS World Congress, to be held at New York City’s Jacob K. Javits Center, from Nov. 16 - 20, 2008, showcases future vehicle-to-vehicle and vehicle-to-infrastructure communications systems.

This is the first time the “All-Around Collision Free” prototype will be displayed in the United States and the world’s first demonstration of Back-up Collision Prevention (BCP). The prototype also incorporates Side Collision Prevention (SCP) and two current production technologies, Distance Control Assist (DCA) and Lane Departure Prevention (LDP).

The “All-Around Collision Free” prototype vehicle further extends Nissan’s “Safety Shield” concept to help protect the vehicle and its occupants from potential risks coming from multiple directions. Following is a brief overview of the key systems:
Side Collision Prevention: As the vehicle begins to change lanes, side-mounted sensors activate a warning if another vehicle is detected in the intended lane. A yaw mechanism is then activated through brake control of individual wheels on the opposite side of the vehicle, to help prevent a potential collision by moving the vehicle toward the center of the original lane of travel.

Back-up Collision Prevention: During a backing maneuver, such as backing out of a parking space, rear and side-mounted sensors detect objects in the path of the vehicle. If an object is detected, an alarm sounds and then the brakes are activated to help avoid a collision.

Distance Control Assist and Lane Departure Prevention: Distance Control Assist (DCA) detects the distance to objects in front of the vehicle. When the vehicle is approaching an object, DCA will display a warning symbol, sound an alarm, and move the accelerator pedal up against the driver’s foot. If the throttle is not being applied, DCA will gently apply the brakes to help encourage deceleration.

Lane Departure Prevention (LDP) assists with maintaining lane position by detecting lane markers and calculating position relative to them. If the vehicle approaches the lane markers, a warning illuminates and an alarm sounds. If the vehicle continues to travel toward the lane markers, the system activates the yaw mechanism (described in SCP above) to help move the vehicle toward the center of the lane.
Both the DCA and LDP systems complement the SCP and BCP to move toward an “All-Around Collision Free” prototype. These warning systems and preventive safety features are designed to help support the driver in an intuitive manner with minimal intervention.

About Nissan Safety Shield
As part of its commitment to continuously improve the safety of its vehicles, Nissan has developed and advanced many pre-crash and crash protection technologies. These innovations are part of Nissan’s “Safety Shield” concept: an advanced, proactive approach to safety issues based on the idea that advanced technology in vehicles helps protect people. This approach provides various measures to help the driver and passengers better avoid dangers in ways that are optimized to each of a wide range of circumstances that the vehicle may be in, from “risk has not yet appeared” to “post-crash.”

Video of these Safety Shield technologies in action is available at http://nissannews.com/show-video-gallery.do?method=view&cID=11&key= .

On a global level, Nissan is committed to building safe vehicles equipped with advanced safety technologies. In Japan, the company’s safety vision is to halve the number of traffic fatalities or serious injuries involving Nissan vehicles by 2015 compared with the level in 1995.

SOURCES:
http://www.NissanUSA.com

CRUISE LINES DESIGN THEIR OWN INTERIORS

Posted under: Injuries — Chelsea Mannella @ 1:55 pm

The cruise lines design the interiors of their ships. They have in house architects and engineers in their New Build Departments create designs right here in Miami, or they contract the design of certain areas out to design firms around the world.

These designs and plans are then sent to the ship yard for the building. The cruise lines even send designers, engineers, architects, and construction supervisors to the ship yards to oversee construction at various stages. These personnel usually live for a time, sometimes years, in the city in Europe where the ship is being built. Cruise ships typically are built in shipyards in Germany, Italy, and Finland.

These ships are completely custom made. The cruise line creates the plans and therefore the cruise ship. The ship is supposed to represent and to symbolize the brand of each cruise line. For Carnival, it is “the Fun Ships”. For Royal Caribbean, it is “way more than a cruise”. For Norwegian Cruise Lines, it is “Free styling”. For Celebrity, it is a more stately, art appreciating feel. For Disney, it is all about the fantasy.

Because the cruise lines have so much control over the design and construction of these ships, they have control over the safety of the ships. They choose where to have marble and where to have carpet. They also of course choose what to put on the marble at the factory and later of course on a regular maintenance basis.

See our website for information on what to do in the event of an injury on a cruise ship: www.hickeylawfirm.com. See also www.cruiseshipassault.com. The bottom line is get medical care immediately, take photos of the area where you were injured, get the names and contact information of witnesses, and report the accident or incident at once. Also, CALL HICKEY LAW FIRM, P.A., TOLL FREE AT: 1.800.215.7117. Our consultations are always free. We work on a contingency fee basis; if we don’t recover, you don’t pay. Personal injury, wrongful death, sexual assaults, and medical malpractice. This all happens on cruise ships and we have handled these types of claims for 28 years.

Looking Forward to a Future in which a Robot Helps Diagnosis Orthopedic Injuries

Posted under: Welcome — Chelsea Mannella @ 1:54 pm

The MRI and CT scan may one day have a robotic cousin capable of following and peering into patients as they move around. A University of Florida engineer has designed a robot to shadow and shoot X-ray video of sufferers of orthopedic injuries as they walk, climb stairs, stand up from a seated position or pursue other normal activities—and maybe even athletic ones like swinging a bat.

University of Florida mechanical and aerospace engineer Scott Banks’ goal is to augment static images of patients’ bones, muscles and joints with an interior view of these and other parts in action during normal physical activity. By merging such full-motion X-rays with computerized representations, orthopedic surgeons will make better diagnoses, suggest more appropriate treatments and get a clearer idea of post-operative successes and failures, he said.

“Our goal is come up with a way to observe and measure how joints are moving when people are actually using them,” Banks said. “We think this will be tremendously powerful, not only for research but also in the clinical setting as well.”

Complaints about orthopedic injuries are among the most common reasons people visit the doctor, according to the American Academy of Orthopedic Surgeons. More than 8 million people were hospitalized in 2003 for musculoskeletal conditions or injuries, which are estimated to cost the United States at least $215 billion annually.

Orthopedic surgeons have long diagnosed patients by touch or with static X-rays, MRI and CT scans. They also may use X-ray video, but current technologies provide only a tight view of a very limited range of motion in a controlled laboratory setting.

While all of these techniques can be effective, they do not work well with injuries that manifest themselves when a joint is in motion, Banks said. These include, for example, injuries to the patella, or kneecap, and injuries of the shoulder. Surgeons sometimes have to operate to diagnose these and other injuries, which can lead to unnecessary surgeries.

After operations, surgeons have few tools beyond the patient’s experience to tell them whether a procedure worked as intended and whether it will forestall additional joint damage.

Banks hopes his robot – actually, a system that uses two robots because one robot will be necessary to shoot the X-ray video and another to hold the image sensor — will lead to a radical improvement.

He has one working robot currently. The robot, which has a one-meter mechanical arm, is a commercial product normally used in robotically assisted surgeries and silicon chip manufacturing that Banks and his graduate students have re-engineered. The robot can shadow a person’s knee, shoulder or other joint with its hand as he or she moves.

In its completed form, the hand will hold lightweight equipment capable of shooting X-rays, while another robot will hold the sensor that captures images of the body as moving videos. Although the robots will be attached to a fixed base, there is room for a person to move around normally within their reach. And in the future, said Banks, “we could put these robots on wheels and they could follow you around.”

Mike Moser, a UF orthopedic surgeon working with Banks on the project, said he thinks the robot system would be very useful to surgeons.

“The biggest thing that this technology could offer in treating orthopedic injuries is that it has the ability to visualize joint motion dynamically, as it changes,” he said. “I think this would be good for many different conditions of the shoulder, knee, elbow and ankle. And I think it could be extrapolated to pretty much any orthopedic injury or condition.”

Although it is not yet available, this is something we have the pleasure of looking forward to in the future.

What Are SLAP Tears & How do They Occur in Shoulder Injuries

Posted under: Welcome — Chelsea Mannella @ 1:52 pm

A SLAP tear is an injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within.
A specific type of labral tear is called a SLAP tear; this stands for Superior Labrum from Anterior to Posterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum.

There are several injury mechanisms that are speculated to be responsible for creating a SLAP lesion. These mechanisms range from single traumatic events to repetitive microtraumatic injuries. Common reasons for a SLAP tear include:

• Fall onto an outstretched hand
• Repetitive overhead actions (throwing)
• Lifting a heavy object

The area of the labrum where the SLAP tear occurs is susceptible to injury because it is an area of relatively poor vascularity. Other parts of the labrum often heal more easily because the blood supply delivers a healing capacity to the area of the tear. In the area of SLAP tears this is not the case, and chronic shoulder pain can result.

Although everyone is different the most typical symptoms of a SLAP tear is a catching sensation and pain with movement. These are made worse by overhead activities such as throwing ironically the very activity that most likely caused the tear in the first incidence. Patients usually complain of pain at the back or deep within the shoulder. Patients find it hard to pinpoint symptoms to a specific isolated area, unless the biceps tendon is also involved.

How is a SLAP tear diagnosed?

Most patients with SLAP tears will respond to non surgical or conservative treatment. The most important factor after the initial injury is to rest to allow the injured tissue to cool down and for the inflammation to subside. This may alleviate symptoms and in many cases no further intervention will be needed.

If symptoms persist then other treatments are often tried other than surgery these treatments include:

• Physical therapy
• Anti-inflammatory medication
• Cortisone injections

If symptoms persist then arthroscopic surgery of the shoulder is a good idea. SLAP tears often occur along with other shoulder problems such as rotator cuff tears, and even shoulder arthritis. Arthroscopy the shoulder to be fully explored and any further surgery will then allow for all problems.

Common treatment options for SLAP tears are:

Debridement of the SLAP tear:
Debradment is shaving away the torn portion of the labrum in order to leave a smooth edge. This option is only suitable for very small tears that do not involve other tendons or factors in the shoulder.

Biceps tenodesis:
This cuts the biceps tendon from the labrum attachment and reinserts it in another area. This decreases the pull on the SLAP region and thus alleviates symptoms. This procedure is often performed on patients over 40 years of age or those patients with additional biceps tendonitis or tearing.

SLAP repair:
A SLAP repair done arthroscopically and re-attaches the torn labrum down to the shoulder socket. It is suitable for those patients with no other problems in the shoulder and for those who are very active. Once healed, the SLAP repair allows normal function to occur. The disadvantage is that the shoulder is prone to reoccurrence of the tear and both the debraidment and the SLAP repair should be accompanied with extensive physiotherapy

Your surgeon will go over these fully with you and discus which method is suitable for you.

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