A SLAP lesion of the shoulder is a specific type of shoulder labral tear. Generally, problematic SLAP tears occur in young people involved in throwing sports or after trauma such as a fall. So how do we manage people with a SLAP lesion of the shoulder?

What is a SLAP tear? 

picture of shoulder with circle around superior labrum

 

SLAP stands for superior labrum anterior to posterior. A SLAP labral tear occurs at the top of the shoulder joint where the biceps tendon inserts into the labrum. As a result, the labrum attaches to the edge of the socket and makes the socket deeper. Tears of the labrum can occur due to trauma, such as a dislocation or ageing.

How do you get a SLAP lesion of shoulder?

A SLAP tear can occur from one of the following conditions:

  • A fall onto the outstretched hand, forcing the arm backward above the head
  • lifting heavy objects
  • overuse tear due to excessive throwing in sports such as tennis or baseball

SLAP lesion of shoulder diagnosis 

male tennis player serving

 

Generally, shoulder SLAP tears are diagnosed on a careful clinical assessment and imaging.

Typically, a SLAP tear causes a catching pain sensation in the shoulder, particularly with throwing. Pain can radiate into the back of the shoulder. If the biceps tendon is involved, pain can localise to the front of the shoulder.

The examination can often give clues as to whether you have a shoulder SLAP tear. Specific tests such as the O’Brien or Crank tests are thought to be good at detecting a SLAP tear. Nevertheless, no one specific test is accurate in diagnosing a SLAP tear.

Moreover, imaging may also be inaccurate in diagnosing a SLAP tear. Usually, X-ray and ultrasound are normal. However, an MRI scan can show a tear of the top of the labrum and thickening and swelling of the biceps tendon.

How do you know a SLAP tear is the cause of your shoulder pain? 

Other conditions, such as rotator cuff tendonitis and shoulder joint arthritis, mimic a SLAP tear. Also, just because you have a SLAP tear on MRI doesn’t mean you have pain coming from the tear. Many people above the age of 35 years have a SLAP tear on imaging, even without shoulder pain.

Treatment of SLAP lesion of shoulder

Picture of slap tear

 

 

Overall, the treatment of a shoulder SLAP lesion differs according to age and activity.

Generally, SLAP tears in older people are due to aging and are often not the cause of shoulder symptoms. However, recent studies suggest that anyone over 45 has a 50% chance of having a SLAP tear on an MRI, even without pain.

However, SLAP tears are more likely to cause pain in younger athletes. Therefore, we start with simple treatments such as ibuprofen tablets and physiotherapy. In cases that fail rehab, injections or surgery may be an option.

Usually, an injection aims to relieve pain and allow the person to progress in rehab. Injection options include cortisone or PRP. Usually, cortisone injections are the preferred option. Injections should be done under ultrasound guidance to increase accuracy and effectiveness.

We should only consider surgery in cases that fail all other treatments. Options for surgery include biceps tendonesis or a SLAP repair. Doctors generally do surgery with keyhole to prevent unnecessary damage to the deltoid muscle.

SLAP repair vs. biceps tendonesis 

There are advantages and disadvantages to both procedures. In a SLAP tear, we restore the normal anatomy and function of the shoulder. However, the healing may be unpredictable and often longer. In biceps tendonesis, recovery is quicker, and the rehab is not as extensive. Also, the results of surgery are a little more predictable.

Recent evidence suggests that SLAP repairs and biceps tendonesis are not as effective as once thought. A recent study found that surgery for SLAP tears has the same outcomes as a ‘placebo’ surgery. Therefore, we should be careful about SLAP surgery, particularly in older patients (above 40 years).

Final word from Sportdoctorlondon about SLAP lesion of the shoulder

SLAP tears are common on MRI but do not necessarily cause shoulder pain. Generally, you should avoid surgery unless you’ve failed simple treatment.

Related conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.