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.
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 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.
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)
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. Check out this short video where Dr Steele describes 3 of the most useful tests to help diagnose SLAP lesions.
In the video, Dr Steele mentions “functional pathology” that leads to shoulder problems. Watch this ChiroUp Clinical Excellence tutorial for a refresher on the shoulder’s most common functional deficit- Scapular Dyskinesis.
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, recommends a 6-12 week course of conservative management prior to considering surgical intervention. (1-3)
The preceding information was taken from the ChiroUp protocol for SLAP lesion. Visit ChiroUp.com to view the entire protocol (including the 57 supporting references) or any of the other 90+ condition protocols filled with up-to-date, evidence-based assessment and management tools.
Patient Education: https://www.dropbox.com/s/
- 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
- Dodson CC, Altchek DW. SLAP Lesions: An Update on Recognition and Treatment. JOSPT February 2009, Volume 39 Number 2
- Franceschi F, Longo UG, Ruzzini L, et al. No advantages in repairing a type II su- perior 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.
About the Author
Dr. Brandon Steele
Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.
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