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

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. Incidentally, the long head of the biceps has a dichotomous relationship with the labrum. In healthy shoulders, the biceps’ long head 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 preserve the labrum and subacromial contents during arm elevation. Conversely, the biceps’ repetitive contraction may trigger the avulsion of its labral anchor – becoming progressively more problematic as the tear progresses.

SLAP lesion complaints can vary from asymptomatic to disabling. Symptomatic patients often describe:

  • A deep, vague, non-specific shoulder pain that is provoked by overhead and cross-body activity
  • Weakness and stiffness
  • Discomfort may limit athletic performance, particularly in overhead athletes who may complain of a “dead arm.”
  • Complaints of popping, clicking, grinding, or catching are common.
  • Patients with more advanced lesions are likely to report symptoms associated with instability; i.e. (pinching, slipping, apprehension, or “looseness”- especially during overhead activity)

The presence of a SLAP lesion does not automatically necessitate surgical intervention. Most clinicians view this structural abnormality with the same skepticism as “disc lesion,” “meniscus tear,” or “rotator cuff tear”- wherein the imaged defect is not necessarily the primary contributor to the patient’s complaint. Most experts, including the American Academy of Orthopedic Surgeons, recommend a 6-12 week course of conservative management before considering surgical intervention. (1-3)

A recent publication by DeFazio et al. 2021 also highlights two important risk factors for patients that do undergo surgical intervention. The first is that these post-surgical patients require rehabilitation to improve shoulder and scapular stability. Otherwise, 10% of patients require a second surgery due to re-tearing on the labrum. Secondly, smoking increases the risk of re-tear due to the diminished capacity of the tissue to heal. (4) 

While the questions remain the same, sometimes the answers evolve with new information! 

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References
  1. Mileski RA, Snyder SJ. Superior labral lesions in the shoulder: pathoanatomy and surgical management. J Am Acad Orthop Surg. 1998 Mar-Apr. 6(2):121-31
  2. Dodson CC, Altchek DW. SLAP Lesions: An Update on Recognition and Treatment. JOSPT February 2009, Volume 39 Number 2
  3. Franceschi F, Longo UG, Ruzzini L, et al. No advantages in repairing a type II superior labrum anterior and posterior (SLAP) lesion when associated with rotator cuff repair in patients over age 50: a randomized controlled trial. Am J Sports Med 2008;36(2):247–53.
  4. DeFazio, M.W., Özkan, S., Wagner, E.R. et al. Isolated type II SLAP tears undergo reoperation more frequently. Knee Surg Sports Traumatol Arthrosc (2021). Link

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