SLAP Lesions

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SLAP ( Superior Labrum Anteriorly and Posteriorly ) Lesions
  • Compressive loading of the shoulder in the flexed abducted position (e.g. in a fall on the outstretched hand) can damage the superior labrum anteriorly and posteriorly (SLAP).
  • The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the ‘anchor’ of the biceps tendon to the labrum.

Four Main Types Are Described:

  1. Non-traumatic superior labral Degeneration, usually in older people and often asymptomatic;
  2. Avulsion of the superior part of the labrum – the commonest type
  3. A ‘Bucket handle’ tear of the superior labrum;
  4. As for type 3 with an extension into the tendon of long head of biceps.
• Further subtypes that include associated lesions have also been described. 

Clinical Features

  • There is usually a history of a fall on the arm.
  • As the initial acute symptoms settle, the patient continues to experience a painful ‘click’ on lifting the arm above shoulder height, together with loss of power when using the arm in that position.
  • He may also complain of an inability to throw.

  • O’Briens test:
    • →  The patient is instructed to flex the arm to 90 degrees with the elbow fully extended and then to adduct the arm 10–15 degrees medial to the sagittal plane.
    • →  The arm is then maximally internally rotated and the patient resists the examiner’s downward force.

    • →  The procedure is repeated in supination.
      Pain elicited by the first manoeuvre which is reduced or eliminated by the second signifies a positive test.

O’Briens test


Imaging


  • MRI is the modality of choice though the diagnosis is best confirmed by arthroscopic examination and at the same time the lesion is treated by debridement or repair.


Treatment

  • Very few patients with SLAP lesion injuries return to full capability without surgical intervention.
  • Arthroscopic repair of an isolated superior labral lesion is successful in the majority (91%) of pts.
  • However, the results in patients who participate in overhead sports are not as satisfactory as those in patients who are not involved in overhead sports. 


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