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SLAP Lesion: Causes, Symptoms & Treatment
A SLAP lesion is a tear of the shoulder joint cartilage (labrum) at the attachment point of the long biceps tendon. It causes shoulder pain and restricted movement.
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A SLAP lesion is a tear of the shoulder joint cartilage (labrum) at the attachment point of the long biceps tendon. It causes shoulder pain and restricted movement.
What Is a SLAP Lesion?
The term SLAP stands for Superior Labrum Anterior to Posterior and describes a tear of the upper portion of the glenoid labrum – the fibrocartilaginous ring that surrounds and stabilizes the shoulder socket. The tear runs from front to back at the site where the long head of the biceps tendon attaches to the labrum. SLAP lesions are among the more common shoulder injuries, particularly in athletes and physically active individuals.
Causes
A SLAP lesion can result from several mechanisms:
- Acute trauma: A fall onto an outstretched arm or a sudden pulling force on the biceps tendon, such as when catching a heavy object.
- Repetitive overhead loading: Repeated throwing or overhead motions, as seen in baseball, tennis, handball, or swimming.
- Shoulder instability: Pre-existing instability of the shoulder joint can place additional stress on the labrum.
- Degenerative changes: Age-related wear and tear can lead to SLAP lesions in older individuals.
Classification
SLAP lesions are classified into four main types according to the Snyder classification:
- Type I: Fraying and degeneration of the superior labrum without complete detachment.
- Type II: Complete detachment of the labrum and biceps anchor from the glenoid (most common type).
- Type III: Bucket-handle tear of the labrum with an intact biceps tendon.
- Type IV: Bucket-handle tear extending into the biceps tendon.
Symptoms
The symptoms of a SLAP lesion are often non-specific and can be confused with other shoulder conditions. Common complaints include:
- Deep, difficult-to-localize shoulder pain, especially with overhead movements
- Pain during throwing, lifting, or carrying
- A feeling of instability or clicking in the shoulder joint
- Loss of strength and range of motion in the arm
- Occasional pain radiating into the arm or neck
Diagnosis
Diagnosing a SLAP lesion requires a careful combination of clinical examination and imaging:
Clinical Tests
Several specialized shoulder tests can indicate a SLAP lesion, including the O'Brien test, the Speed test, and the Clunk test. However, no single test is fully reliable, so multiple tests are always used in combination.
Imaging
- MRI (Magnetic Resonance Imaging): MRI, particularly with intra-articular contrast agent (MR arthrography), is considered the gold standard for visualizing labrum tears.
- Arthroscopy: Shoulder arthroscopy is the most reliable method for definitive diagnosis and allows simultaneous treatment.
Treatment
Conservative Treatment
For less severe SLAP lesions (especially Type I) or in older patients, conservative treatment is recommended first:
- Physiotherapy to strengthen the muscles surrounding the shoulder (particularly the rotator cuff)
- Anti-inflammatory medications (e.g., NSAIDs) for pain relief
- Corticosteroid injections into the shoulder joint for persistent symptoms
- Rest and avoidance of aggravating activities
Surgical Treatment
For higher-grade SLAP lesions (Types II–IV) or when conservative therapy is insufficient, surgical intervention is indicated:
- Labral refixation: The detached labrum is reattached to the glenoid arthroscopically using small anchors (suture anchors). This is the standard approach in younger, athletically active patients.
- Biceps tenotomy or tenodesis: In older patients or when the labrum is severely damaged, the long head of the biceps tendon is either released or reattached at a new site to relieve symptoms.
Rehabilitation and Prognosis
After surgical repair, full rehabilitation typically takes 4 to 6 months. Physiotherapy progresses in phases: the initial focus is on pain reduction and restoring range of motion, followed by strength and functional training. With consistent rehabilitation, most patients – including athletes – can return to their previous level of activity. The overall prognosis is good, but depends on the severity of the lesion and the age of the patient.
References
- Snyder SJ et al. - SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274-279.
- Maffet MW et al. - Superior labrum-biceps tendon complex lesions of the shoulder. American Journal of Sports Medicine. 1995;23(1):93-98.
- Provencher MT et al. - The surgical treatment of SLAP lesions: a critical analysis review. JBJS Reviews. 2014;2(9).
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