SLAP Lesion

FAQs on SLAP Lesion and Tears

 

SLAP lesion is the most common shoulder injury impacting baseball, football, basketball, and volleyball players across the United States. First used in 1985 to describe shoulder injuries in baseball players, SLAP tears in the labrum causing discomfort and throbbing ache and become potent enough to sap capacity, weaken the shoulder, and end career of athletes prematurely. There are a number of pain management options, surgical and non-surgical, available to treat the injury successfully.

What is a SLAP lesion?

The word SLAP is used in medical annals to refer to “superior labrum from anterior to posterior,” which can be translated into “top part of labrum, from front to back.” When an injury impacts the top part of the labrum, SLAP tears appear in the front and the back of the area where it connects with bicep muscles.

The shoulder joint is like a “ball-and-socket structure.” Labrum is the cuff-shaped cartilage, a dense but elastic tissue, which keeps the two bony structures, ball (arm bone) and socket (glenoid cavity), attached with each other and facilitates the movement of the arm. The shallow character of the glenoid cavity aided by the unstable nature of shoulder joint makes bicep muscles tendons susceptible to injury and appearance of tears or SLAP lesions in their front or back area.

What are the symptoms of SLAP lesion?

  • Catching feeling with or without pain as you move your shoulder
  • Throbbing pain in the shoulder or its back side
  • Pain in the front shoulder area when SLAP tears spread into bicep tendons
  • Pain during overhead activities
  • Locking or popping sensation in the shoulder
  • Dull ache pain in the shoulder
  • Pain when lifting something or keeping the shoulder in certain postures
  • Feeling of weakness in the shoulder
  • Reduced shoulder mobility and capacity to throw
  • Shoulder pain while sleeping
  • Stress or force leads to shoulder impingement and locking feeling

What causes SLAP lesions?

You are at the risk of suffering from potential SLAP lesions whenever subject to

  • Acute trauma impacting the shoulder
  • Repetitive shoulder motion causing stress and strain
  • Slip and fall or motor accidents
  • Outstretched arm injury or dislocation of shoulder
  • Moving the arm hurriedly or forcefully above the shoulder
  • Sudden traction or pull on the shoulder
  • Repeated overhead activities
  • Degenerative factors affecting the labrum
  • Heavy lifts or falling on the shoulder
  • Forced pulling, forcefully extending the arm, or similar activities
  • Rotator cuff injury

Who are at the risk of SLAP lesions?

Those involved in overhead throwing, lifting, or contact sports are at increased risk of the injury.

How is SLAP lesion diagnosed?

The most effective way to diagnose SLAP lesions is physical examination. Doctors ask patients to perform certain activities in front of them. They are observed for various symptoms and SLAP tears are identified based on that. Contrast MRI may be suggested when symptoms overlap with other types of shoulder injuries.

What are the treatment methods available for SLAP lesions?

  • Painkiller Drugs: Those with SLAP lesions are prescribed NSAID medications as the first line of treatment and to relieve the pain. However, when the pain becomes chronic, these drugs have limited effect.
  • Physical Therapy: Ice, heat therapy, acupuncture, and adequate rest help overcome swelling and small tears in the SLAP area.
  • Surgical Intervention: There are three primary surgical options for SLAP lesion surgery.
  • Arthroscopic surgery: A tiny incision is made and repair and reattachment surgery is performed using a small camera-like device.
  • Debridement surgery: In case of minor SLAP lesions, the torn part is knocked off or trimmed to ensure smooth edge on the labrum.
  • Biceps tenodesis surgery: It restructures the connection between the labrum and biceps tendon through surgery so that the force on the SLAP area is reduced allowing smoother shoulder movement.
  • Pain Management Injections

Pain injections have gained ground in the recent years as an effective mode to treat SLAP lesion pain condition. According to the American Journal of Sports Medicine, about a third of SLAP tear surgeries need to be redone. The database of the American Board of Orthopedic Surgery also supports similar findings. On the other hand, pain injections offer pain relief for months while allowing the body to overcome swelling and accelerate its own healing and repairing mechanism.

  • Anesthetic injections containing anesthetic medication numbs the area and reduces pain sensation considerably.
  • Corticosteroid injections with steroid medications inhibit inflammation and pain.
  • Hyaluronic acid injections not only lessen pain, but also encourage swift healing of SLAP lesions.
  • PRP injections (prolotherapy) with platelet rich plasma or stem cells, derived from our body, assist the natural healing process of the body and repairing of tears and ensure full recovery.

References

Weber, SC, et al. Superior Labrum Anterior and Posterior Lesions of the Shoulder: Incidence Rates, Complications, and Outcomes as Reported by American Board of Orthopedic Surgery Part II Candidates. Am J Sports Med. 2012 May 24.

Park S, Glousman RE. Outcomes of revision arthroscopic type II superior labral anterior posterior repairs.Am J Sports Med. 2011 Jun;39(6):1290-4. Epub 2011 Mar 25.

CHRISTOPHER C. DODSON, MD. SLAP Lesions: An Update on Recognition and Treatment

, Journal of Orthopaedic & Sports Physical Therapy, vol 39 (2), feb 2009

Parentis MA, Mohr KJ, ElAttrache NS. Disorders of the superior labrum: review and treatment guidelines. Clin Orthop Relat Res. Jul 2002;(400):77-87

Swaringen JC, Mell AG, Langenderfer J, et al. Electromyographic analysis of physical examination tests for type II superior labrum anterior-posterior lesions. J Shoulder Elbow Surg. Sep-Oct 2006;15(5):576-9

Huang H, Zheng X, Li P, Shen H. Arthroscopic reconstruction of shoulder’s labrum with extensive tears. Int J Surg. 2013;11(9):876-81.

Waterman BR, Cameron KL, Hsiao M, Langston JR, Clark NJ, Owens BD. Trends in the diagnosis of SLAP lesions in the US military. Knee Surg Sports Traumatol Arthrosc. Dec 10 2013

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