SLAP lesions
Lateral view onto the glenoid cavity ( ball of the humeral head is removed ). The upper glenoid rimb is a problematic area, affected from SLAP lesions.
What is it ?
SLAP is an abbreviation and means "superior labrum anterior posterior". It sounds quite complicated, but it isn´t. Keep it simple: around the glenoid rimb we can see the labrum. If it is torn above, at the upper glenoid, those lesions are called SLAP lesions. Depending on the kind of lesion, different types are described. We call it a SLAP 1 lesion, if it´s a fringy lesion. SLAP 2 means, that the labrum is separated completely from the upper glenoid and a SLAP 3 is like a buckethandle tear of the upper labrum. In a rare condition this buckethandle tear involves the long head of the biceps tendon, it is then called a SLAP 4 lesion.
What is causing a SLAP lesion ?
The typical mechanism is to fall onto the outstretched arm or a direct blow against the shoulder. Traction to the affected shoulder and repetitive microtraumata ( over years, in professional athletes ) can lead to SLAP lesions, especially in throwing sports, like baseball
Symptoms ?
Typically, SLAP lesions cause different problems. It might be pain, even at night. Sometimes a snapping or cracking is present in the shoulder joint. Shoulder pain is located deep in the shoulder and is getting worse while moving the arm. Some patients feel an instability or have symptoms of a loose shoulder.
Diagnosis ?
Is quite often difficult. Taking the patients history and physical examination are helpful. MRI, especially using contrast media, sometimes show these SLAP injuries. Most of the time, SLAP lesions are recognized during arthroscopy of the shoulder joint.
Special aspects in sports:
Posterosuperior impingement occurs in throwing and racket sports ( like: baseball, tennis, squash, badminton, et cetera ). Structures in the posterosuperior part of the shoulder joint are impinging ( the posterosuperior labrum is shut between rotator cuff muscle and bony glenoid ). In those cases, we call it a SLAP 2b lesion, which is not due to an accident, but caused by repetitive stress onto these structure ( for years ) during sports training and in competition. Those athletes also have a contract / shortened posterior shoulder capsule, regularly. If diagnosis is made early, a special stretching programm can be started to get pain relief.
Therapy ?
An attempt of nonoperative treatment, using strengthening exercises for shoulder abduction and external rotation, might be useful. A very effective concept are stretching exercises for the posterior capsule.
But most of the SLAP lesions do not heal with conservative measures. One reason might be the fact, that SLAP lesions are often accompanied by other shoulder pathologies. Arthroscopy with arthroscopic suturing / debridement of the SLAP lesion, is the therapy of choice. SLAP 1lesions will be debrided arthroscopically. SLAP 2 lesions will be closed with arthroscopic sutures. In SLAP 3 tears the buckethandle part will be removed and then suture anchors will be positioned arthroscopically. SLAP 4 lesions are treated similar and combined with an endoscopic suture of the torn biceps tendon.
Prognosis ?
If SLAP lesions are recognized and treated in an early stage, prognosis is good.
What happens after an operation ?
There are nearly no limitations, if a SLAP 1 lesion is debrided arthroscopically. The arm /shoulder is allowed to be moved. But, associated pathologies - if present and also operated - have to be taken into consideration and postoperative training program has to be adapted.
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Other themes & sites arround the shoulder:
Diseases of the shoulder ( german ): http://www.schulterinfo.de , http://www.schulter.info
Diseases of the shoulder ( english ): http://www.shoulderinformation.com
Shoulder arthroplasty: http://www.schulterprothesen.net , http://www.schulterprothesen.com , http://www.shoulderprosthesis.com , http://www.prothesenatlas.de
Frozen shoulder ( german ): http://www.schultersteife.de
Shoulder specialists ( german ): http://www.schulterspezialisten.de
Shoulder examination ( german ): http://www.schulteruntersuchung.de
Shoulder videos ( german ): http://www.schultervideo.de