SLAP lesions can be described as a tear in the superior anterior and posterior portion of the labrum. The lesions that specifically extends to the bicep tendon which attaches to the anterior superior portion of the labrum. SLAP lesions may be brought on in individuals with repetitive overhead stress and is thought to be a continually progression of impingement syndrome. Acute trauma such as falls may also be a cause pf the SLAP lesions. Inferior traction injuries of the humorous can also cause a SLAP lesion. Finally, SLAP lesions are common among throwing activities or overhead athletic activities that requires the bicep to aid in deceleration of the shoulder or conversely the stress being placed on the labrum in late cocking phase.
SLAP lesions are categorized in to four groups:
Fraying labrum, biceps remains intact
Tear of superior labrum, bicep tendon torn away from glenoid
Bucket handle tear of the labrum, Bicep labrum is intact
Bucket handle tear of the labrum, Bicep attachment is affected
Types I and III are typically treated with conservative treatment. Types II and IV are treated through appropriate surgical techniques.
Type II lesions are the most common. Differential diagnosis is difficult to determine. Slap lessions are also many times associated with Bankhart lesions.
If untreated, SLAP lesions may progress further down its continuum. Untreated SLAP lesions with bicep involvement can lead to instability and Bankhart lesions as the bicep acts a stabilizer of the GH joint during dynamic activities. Furthermore, if untreated, SLAP lesions can lead to further progression of rotator cuff pathologies secondary to compensatory patterns, repetitive microtraumas to corresponding tissues.
As noted above differential diagnosis is difficult. Apprehension test, O’ Brien’s and relocation tests are sensitive tests used to rule out SLAP lesions. Speeds, Biceps load test II and Yargason’s test are specificity tests to rule in. 2 sensitive tests and 1 specific test can be used to confidently diagnose a SLAP lesion. MRIs and MRAs are the most common clear identifiable test for SLAP lesion inclusion.
During conservative management, treatment should focus on rotator cuff, shoulder girdle strengthening, restoring normal ROM. An extra emphasis should be placed on regaining GIRD, the use of posterior capsule stretching.
Following surgical intervention be sure to follow the MD specific protocol. Typically, the individual will sleep in an immobilizer for 4 weeks. Isometrics for may begin in weeks 3-4, but no isolated bicep strengthening is to be performed.