The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.
Causes of Slap Tear :
Injuries to the superior labrum can be caused by acute trauma or by repetitive shoulder motion.
The common causes of Slap are :
- A fall onto an outstretched arm
- Forceful pulling on the arm, such as when trying to catch a heavy object
- Rapid or forceful movement of the arm when it is above the level of the shoulder
- Shoulder dislocation
People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears as a result of repeated shoulder motion.
Many SLAP tears, however, are the result of a wearing down of the labrum that occurs slowly over time. In patients over 40 years of age, tearing or fraying of the superior labrum can be seen as a normal process of aging. This differs from an acute injury in a person under the age of 40.
Clinical Examination :
The routine examination of shoulder is followed by the special tests. The o’briens test is very sensitive for a slap tear.
Conservative Treatment : Investigations :
MRI is the best imaging modality for Slap
All patients should be treated non-operatively initially.
This consists of :
Surgical Treatment :
- Rest to allow the lesion to heal
- Non- Steroidal Anti-inflammatory Medications
Those patients who fail to respond to non-operative treatment are offered Arthroscopic surgery.
The type of surgery required depends upon the type of SLAP tear.
The surgical options include :
- Arthroscopic debridement of the SLAP lesion.
- Arthroscopic repair (fixing back the avulsed superior labrum and the biceps anchor back to the glenoid).
- Biceps tenodesis (re-attaching the biceps tendon to the upper end of the humerus). This is reserved for patients with frayed or torn biceps tendon. This can be done
arthroscopic or open.