Slap Lesion

What Is A SLAP Lesion?

A superior labral anterior posterior (SLAP) lesion, also known as a SLAP tear, occurs when the cartilage that surrounds the shoulder joint becomes torn. Prevalence rates of SLAP lesions have been reported to occur in between 3.9 and 11.8% of adults. The shoulder is characterized as a ball and socket joint. The shoulder itself is comprised of three different bones, including the humerus (bone of the upper arm), scapula (shoulder blade), and clavicle (collarbone). At the shoulder, the head of the humerus fits into a rounded socket that is formed by the scapula. Around the outside of the joint lies a strong, fibrous layer of tissue known as the labrum. The labrum’s function is to provide a pocket for the humerus bone to rest, to stabilize the joint, and to act as an attachment point for other ligaments and tendons within the shoulder.

The symptoms of a SLAP lesion can be difficult to link directly to the condition. Many patients will complain of non-specific pain within the shoulder, typically when making overhead or cross-body movements with the arms.

Other common symptoms of a SLAP lesion include:

• Sensations of popping, grinding, locking, or catching in the shoulder joint
• Pain with movement of the shoulder joint
• Pain upon holding the shoulder in a particular position
• Reductions in shoulder strength
• The sensation that the joint has popped out of place
• Joint instability
• Limited range of motion

Causes of SLAP Lesions

A SLAP lesion can occur as the result of blunt trauma sustained to the shoulder or by repetitive movements that place strain on the underlying structures of the area. Diagnosing SLAP lesions can be quite challenging, as there is no single test that can be performed to confirm the diagnosis of a SLAP lesion. Further, the physical symptoms may be difficult to interpret owing to damage to other local structures of the shoulder joint.

Some commonly reported causes of SLAP lesions include:

• Falling on an outstretched arm
• Motor vehicle accidents
• Shoulder dislocation
• Forceful pull to the arm (e.g., attempting to catch a very heavy object)
• Blunt force placed on the arm when it is raised
• Repetitive movements involving the arms overhead

In many instances, the patient may not recall an injury occurring in the area. A SLAP lesion can also occur as the result of deterioration and weakening of the labrum over time. Diagnosis of a SLAP lesion will typically involve an in-depth physical examination. During this procedure, your doctor will physically manipulate the shoulder joint while assessing for sensations of discomfort, redness, swelling, joint stiffness, and degree of flexion. Your doctor may also wish to use imaging techniques to aid in diagnosis. Given that the labrum is comprised of soft tissue, it will not show up on X-rays; however, your doctor may wish to order an X-ray of the shoulder to rule out other possible problems within the area. Typically, magnetic resonance imaging (MRI) is used to aid in diagnosing SLAP lesions. This technique utilizes a magnetic field and radio waves to transmit detailed images of the internal structures of the shoulder.

Treatments for SLAP Lesions

For many cases of SLAP lesions, symptoms may be effectively managed using conservative methods and without the need for surgery. For instance, many patients can achieve relief from pain and discomfort by using non-steroidal anti-inflammatory drugs. These types of medications are preferred, as they help reduce swelling in the area. In some instances, steroid injections may be necessary to provide relief from pain and discomfort. For this procedure, a steroid medication, such as cortisone, is injected into the area of the shoulder joint. This medication acts by reducing inflammation and blocking the transmission of pain signals from the peripheral nerves to the spinal cord and brain.

Your doctor may also suggest physical therapy as a treatment option for SLAP lesions. The goal of this treatment is to instruct the patient on specific stretches and other exercises to increase flexibility, restore movement, and strengthen the shoulder. Typically, it is recommended that individuals participate in physical therapy twice weekly for several months, in order to ensure full recovery, A portion of cases of SLAP lesions will not respond to conservative forms of treatment. In these instances, surgical repair may be the only option. Typically, shoulder arthroscopy is performed in conjunction with the surgical repair in order to aid the doctor in properly completing the procedure and to minimize the need for large incisions.

There are a number of methods involved in surgical SLAP repair. Your doctor will determine the procedure that is appropriate for your condition. In most instances, the SLAP lesion can be repaired simply by trimming away the torn part of the labrum or by reattaching it using sutures. The most common complication following surgical SLAP lesion repair is risk for stiffness. Typically, this is mild and are outweighed by the benefits of the procedure. Recovery from surgical SLAP lesion repair can take between eight to twelve weeks.

Conclusion

A SLAP lesion occurs when the superior labral anterior posterior (SLAP), or the cartilage that surrounds the shoulder joint, becomes torn. This can occur as the result of blunt force or trauma sustained to the area, typically while the arms are in the raised position. This can result in pain and discomfort in the shoulder and upper arms. Further, SLAP lesion patients may report a weakening of the shoulder joint. Most cases of SLAP lesions can be treated using conservative methods; however, surgical repair may be the only option for more severe, refractory symptoms. Patients are encouraged to speak with their doctor about the risks and benefits of surgical SLAP repair.

References

1. Bencardino JT, Beltran J, Rosenberg ZS, et al. (2000) Superior labrum anterior-posterior lesions: Diagnosis with MR arthrography of the shoulder. Radiology 214:267–271.
2. Chang D, Mohana-Borges A, Borso M, Chung C (2008) SLAP lesions: Anatomy, clinical presentation, MR imaging diagnosis and characterization. Eur J Radiology 68:72-87.
3. Dinauer PA, Flemming D, Murphy KP, Doukas WC (2007) Diagnosis of superior labral lesions: Comparison of non-contrast MRI with indirect MR arthrography in unexercised shoulders. Skelet Radiol 36: 195–202.
4. Ellman HGG (1993) Miscellaneous intra-articular conditions. In: Ellman HGG, editor. Arthroscopic shoulder surgery and related procedures. Philadelphia: Lea & Febiger p. 277–362.
5. Jee WH, McCauley TR, Katz LD, Matheny JM, Ruwe PA, Daigneault JP, et al. (2001) Superior labral anterior posterior (SLAP) lesions of the glenoid labrum: Reliability and accuracy of MR arthrography for diagnosis. Radiology 218:127–132.
6. Monu JU, Pope Jr TL, Chabon SJ, Vanarthos WJ (1994) MR diagnosis of superior labral anterior posterior (SLAP) injuries of the glenoid labrum: Value of routine imaging without intraarticular injection of contrast material. Am J Roentgenol 163:1425–1429.
7. Palmer WE, Caslowitz PL, Chew FS (1995) MR arthrography of the shoulder: Normal intraarticular structures and common abnormalities. Am J Roentgenol 164:141–146.