What is SLAP Lesion?

  • SLAP Lesion is the abbreviation of Superior Labrum from Anterior to Posterior tears in the shoulder joint labrum.
  • It may occur as isolated lesion or it can be associated with:
    1. Internal impingement of the shoulder.
    2. Rotator cuff tears (usually articular sided tears).
    3. Shoulder Instability (may be subtle)
  • Most common occurs in a Throwing Athlete (repetitive overhead activities).
  • It comprise approximately 5% of all shoulder injuries.
See Also: 
- Rotator Cuff of the Shoulder
- Anterior Shoulder Instability

SLAP lesion Classification (Expanded Snyder classification)

TypeDescriptionTreatment
IBiceps fraying, intact anchor on superior labrumArthroscopic debridement
IIDetachment of biceps anchorRepair versus tenotomy/
tenodesis
IIIBucket-handle superior labral tear; biceps intactArthroscopic debridement
IVBucket-handle tear of superior labrum into
biceps
– <30% of tendon involvement: debridement
– > 30%: repair or debridement and/or tenodesis of tendon
VLabral tear + SLAP lesionStabilization of both
VISuperior flap tear Debridement
VIICapsular injury + SLAP lesionRepair and stabilization
Expanded Snyder classification of SLAP lesion

Type II is the most common (IIA is anterior, IIB is posterior, IIC is anterior and posterior).

Physical Examination:

There is no single physical examination maneuver specific for SLAP tear, some tests may rise suspicious of SLAP tear:

  1. O’Brien Test
  2. Compression-rotation test
  3. Speed test
  4. Dynamic labral shear test
  5. Kibler anterior slide test
  6. Crank test
  7. Kim biceps load test

See Also: Shoulder Special Tests

Imaging:

  • MR arthrography is the modality of choice.
  • A paralabral cyst is indicative of a SLAP tear (or posterior labral tear).
    • Cyst may extend to spinoglenoid notch and compress the suprascapular nerve, leading to infraspinatus wasting.

SLAP Tear Treatment

Nonoperative Treatment:

  • Nonoperative treatment should be tried in all patients.

Treatments include:

  1. Rotator cuff muscles strengthening and scapular stabilization.
  2. Throwers benefit from stretching of the posterior capsule.
  3. Intraarticular injections.

Operative Treatment:

Surgical technique is selected based on the type of SLAP tear as mentioned in the table above.

  • Some suggests that patients older than 40 years with obvious biceps pathology and degenerative labral changes are best treated with débridement and tenotomy/tenodesis.

If concomitant rotator cuff tear presents, recent studies have found no advantage to repairing SLAP at time of rotator cuff repair as it may result in increased rate of shoulder stiffness if SLAP tears is repaired.
Recent studies have suggested biceps tenotomy should be performed at the time of rotator cuff repair.

Postoperative Rehabilitation

  • Relatively high incidence of postoperative stiffness, so motion is begun early ( Pendulums are initiated immediately).
  • Passive and active assisted exercises are begun 7 to 10 days postoperatively.
  • Patient should avoid resistive biceps exercises and external rotation with the arm in 90 degrees of abduction.

Complications

  • Shoulder stiffness is common after SLAP tear repair.
  • Stiffness should be initially managed with physical therapy. If symptoms persist, arthroscopic capsular release may be performed.
  • Persistent symptoms, articular cartilage injury, and loose or prominent hardware are other frequent complications following SLAP tears repair.