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?
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 tears due to excessive throwing in sports such as tennis or baseball
SLAP Lesion of Shoulder Diagnosis
Generally, shoulder SLAP tears are diagnosed with careful clinical assessment and imaging.
Typically, a SLAP tear causes a sensation of catching pain in the Shoulder, mainly when 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 indicate whether you have a shoulder SLAP tear. Specific tests like the O’Brien or Crank tests are considered good at detecting a SLAP tear. Nevertheless, no particular 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 at 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
Overall, treating 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. We start with simple treatments such as ibuprofen tablets and physiotherapy. In cases that fail rehab, injections or surgery may be an option.
An injection usually aims to relieve pain and allow the person to progress in rehab. Injection options include cortisone or PRP. Cortisone injections are generally the preferred option. Injections should be done under ultrasound guidance.
We should only consider surgery in cases that fail all other treatments. Options for surgery include biceps tendonesis or a SLAP repair. Doctors generally perform surgery through a keyhole to prevent unnecessary damage to the deltoid muscle.
SLAP repair vs. biceps tendonesis surgery: which is better?
Both procedures have advantages and disadvantages. In a SLAP repair, we restore the normal anatomy and function of the shoulder. However, the healing may be unpredictable and often take longer. In biceps tendonesis, the biceps tendon is cut and attached to the intertubercular groove. Recovery is quicker, and the results of this surgery are a little more predictable.
Recent evidence suggests that SLAP repairs and biceps tendonesis are less effective than 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 the age of 35).
Other frequently asked questions about a SLAP tear of Shoulder
What does SLAP stand for?
SLAP stands for the site of the labral tear in the shoulder. The SLAP is situated at the top part of the shoulder cartilage: Superior Labral Anterior to Posterior (SLAP).
Do SLAP tears need surgery?
It depends on the person who has the SLAP tear. A SLAP tear can cause shoulder instability in young throwing athletes, leading to recurrent pain and clicking. If rehab fails to relieve pain in these cases, we recommend surgery. In older patients (greater than 35), SLAP tears are part of the aging process and often not the cause of pain. In older patients, we rarely recommend surgery.
Final word from Sportdoctorlondon about SLAP lesion of the Shoulder
SLAP lesions are common on MRI but do not necessarily cause shoulder pain. These injuries can cause instability in younger throwing athletes leading to pain and clicking. Generally, athletes should avoid surgery unless they have failed a comprehensive rehab programme.
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