Shoulder pain after SLAP lesion repair

[marie]

I am a physio with a patient 5 months post SLAP lesion repair - SLAP tear. She had a very slow recovery with some neural involvement post surgery that has now been resolved. She has nearly full range apart from end range external rotation and end range flexion - really only lacking last few degrees of range. Her shoulder strength is a general 4+ and improving with her exercises. Good scapula stability. We are however struggling to clear her pain with shoulder flexion with her arm in internal rotation - pain starts at 30 degr flexion and gets worse if she pushes further into range. Flexion with her arm in neutral only has discomfort end range where she is still stiff. Flexion with her arm straight but internally rotated and flexion with her elbow in 90 flexion in internal rotation gives the same pain anterior on her shoulder
It might be a stupid question with a simple answer but I can't figure out why she has this pain and what to do to resolve it
Please help

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[physiobob]

I would want to ask the purpose for testing flexion in internal rotation? This is a position where you may get some anterior translation of the humeral head and also is more or a compressive position with respect to the coracoacromial arch further into range. How did she injury in the first place and what was the direction i.e. where was the labral tear? Was it more a Bankart lesion?

A touch more information would help us with ideas on this one.

[marie]

Hi Physiobob
It is not that I really test her in flexion internal rotation but this is the position that she still feels pain for instance if she lifts her arm to do her hair or make up etc or to take off a shirt over her head.
Her injury was in a self defence class where her arm got twisted in behind her back.
She had a typical SLAP lesion - anterior superior labral tear