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Check out this excerpt from the 86th ChiroUp protocol- SLAP lesion (References removed for readability):

The acronym “SLAP” stands for Superior Labrum Anterior Posterior, and is used to describe a tear or detachment of the shoulder’s superior glenoid labrum; generally originating at the anchor site for the long head of the biceps tendon and extending into anterior or posterior portions of the labrum. This pathology is fairly common, in fact up to 1/4 of patients undergoing shoulder arthroscopy for any diagnosis will demonstrate a SLAP lesion.

The labrum, a circumferential rim of fibrocartilage that surrounds the entire perimeter of the glenoid fossa, shares some similar characteristics with the knee’s meniscus. The inferior labrum is typically tightly attached to the bony glenoid rim, while the superior labrum is more “meniscus like” with a less secure union. At its superior surface, the long head of the biceps tendon converges with the labrum. This provides an anchor for approximately 50% of the fibers that form the long head of the biceps tendon; the remaining fibers originate from the supraglenoid tubercle of the humerus and surrounding structures.

SLAP lesions are common in athletic populations, particularly those requiring overhead motions that encourage the biceps to “pull” the labrum from its underlying bony attachment. Interestingly, the long head of the biceps has a dichotomous relationship with the labrum. In healthy shoulders, the long head of the biceps stabilizes the shoulder by generating compressive forces that limit translation, thereby, protecting the shoulder from anterior subluxation. The biceps also depresses the humeral head to protect the labrum and subacromial contents during arm elevation. Conversely, repetitive contraction of the biceps may trigger avulsion of its labral anchor – becoming progressively more problematic as the tear progresses.

Chronic SLAP lesions do not typically occur in the absence of concurrent shoulder pathology; in fact, only 28% of SLAP tears are isolated problems. Chronic etiologies are often associated with rotator cuff dysfunction. Weakened and irritated rotator cuff tendons lose their ability to depress the humeral head within the glenoid cavity during arm elevation. Loss of this protective mechanism allows unchecked superior migration of the humeral head; and over time has the ability to “lift” the labrum from its attachment. Not surprisingly, a high percentage (29-45%) of patients with SLAP lesions demonstrate concomitant rotator cuff pathology.

No single orthopedic maneuver has been shown to reliably predict a SLAP tear. Nevertheless, the literature is replete with no less than two-dozen tests designed to help establish a diagnosis. The ChiroUp team has whittled this list down into 6 practical options (click to view video demonstrations):

Biceps Load Test II
Compression Rotation Test
Crank Test
O’Brien’s Test
Pronated Load Test
Resisted Supination External Rotation Test

Log into ChiroUP to check out the full protocol, containing loads of more practical advice on SLAP lesions, or any of the other 85 conditions- then practice with confidence, knowing that your “best practice” management is supported by more than 5000 references and expert peer reviews.

About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman


Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.

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