SLAP Lesion
What is a SLAP lesion?
What is a SLAP lesion?
SLAP is an acronym for “Superior Labrum from Anterior to Posterior” which means that there is a tear in the upper region of the labrum from anterior to posterior. These injuries are relatively rare, occurring more frequently in pitchers such as in baseball or rugby. However, it can also occur when there is a “pull” on the arm.
Injury mechanism and risk factors
Injury mechanism and risk factors
SLAP lesions occur because the tendon of the long portion of the biceps brachii muscle is inserted into the upper region of the labrum and, therefore, whenever this tendon is stretched, there is potential for injury to the labrum and its insertion into the upper region of the glenoid.
Injuries can occur in two different ways: an injury associated with repeated movements in which this tendon is “stretched”, as in throwers and swimmers; or a sudden injury, such as a fall with the arm extended or a longitudinal “pull” of the upper limb, which causes this tendon to be “teared” at its insertion in the glenoid labrum.
Signs and Symptoms of SLAP Injury
Signs and Symptoms of SLAP Injury
Pain in the anterior region of the shoulder that radiates down the arm to the elbow, especially when it is raised above 90°.
Diagnosis SLAP lesion
Diagnosis SLAP lesion
Physical examination
Physical examination
Although no single test is sufficient to make a diagnosis, there are several that help us guide clinical practice:
- Positive Palm-up test
- O’Brien’s test
- Yergason
X-ray
X-ray
It does not allow diagnosis, but it does allow other causes of pain to be ruled out, such as fractures, osteoarthritis and tumor lesions.
Magnetic Resonance Imaging or Arthro-resonance Imaging
Magnetic Resonance Imaging or Arthro-resonance Imaging
Excellent examination for diagnosing SLAP lesions, making it possible to identify the lesion.
SLAP Injury Treatment
SLAP Injury Treatment
Decision
Decision
Snyder described 4 types of injury, through their visualization by arthroscopy.
- SLAP lesion type I: Fringed (no rupture or displacement)
- SLAP type II lesion: labral detachment. It is the most frequent (55%)
- SLAP lesion type III: longitudinal intrasubstance tear (basket wing).
- SLAP lesion Type IV: longitudinal tear with extension to the long portion of the biceps brachii (basket wing with LPB)
Conservative
Conservative
When to perform? In type I SLAP lesions and most type II SLAP lesions.
Treatment options?
Treatment options?
Physiatric rehabilitation with the aim of strengthening the muscles of the rotator cuff and the stabilizers of the shoulder blade.
Surgical
Surgical
When to perform? In SLAP type III and IV lesions and in SLAP type II lesions in young individuals, especially if they have not improved with conservative treatment.
Procedure/technique – Arthroscopy-assisted tenodesis/fixation of the long portion of the subpectoral biceps.
Postoperative
Postoperative
The patient may be discharged on the day of surgery or the following day.
- Use of brachial suspensory for a period of 2 to 4 weeks.
- Surgical stitches must be removed after 2 weeks.
- You can start passive mobility exercises the day after surgery.
When to seek an Orthopedic Specialist?
When to seek an Orthopedic Specialist?
Shoulder pain that persists despite treatment with pain medication.