June 20, 2024

SLAP or Superior Labrum from Anterior to Posterior tear is an injury to the labrum in the superior aspect of the ring of cartilage that surrounds the socket of the shoulder joint.

SLAP Lesion
SLAP Lesion

The superior labrum is more loosely adherent to the glenoid compared to the anteroinferior labrum

50% of the bicep tendon is attached to the superior labrum

50% of the bicep tendon is attached to the supraglenoid tubercle

Mechanism of injury of SLAP

  1. Compressive stress due to FOOSH
  2. Tensile stress due to eccentric contraction on the biceps will peel off glenoid

Snyder’s Classification of SLAP

TypeFeaturesManagement
Type IBiceps fraying, intact anchor on superior labrumArthroscopic debridement
Type IIDetachment of biceps anchorRepair vs tenotomy/tenodesis
Type IIIBucket handle superior labrum tear, bicep intactArthroscopic debridement
Type IVBucket handle tear of superior labrum into biceps<30 %ntendon involvement: Debridement
>30 % tendon involvement: Repair/debridement / tenodesis of tendon
Type VAntero-inferior labral tear + SLAPStabilization of both
Type VISuperior flap tear (displaced) but intact bicepsDebridement
Type VIICapsular injury + SLAP lesion; tear extending to capsuleRepair and stabilization
Synder classification and management

O’ Brien test

Arm in the attitude of mild flexion, adduction, and internal rotation of the shoulder

Examiner pushes down against the resistance

Again, Examiner positions shoulder in External Rotation

Examiner pushes down against the resistance

The test is positive if 1st test has more pain or 2nd test has less pain than 1st test

Other tests:

Compression rotation test

Speed test

Dynamic labrum shear test

Crank test

Kim bicep load test

See also: Shoulder examination

Investigation

USG

MR orthography is the diagnostic modality of choice

Paralabral cyst is indicative of labral tear

Treatment Options for SLAP

Non-Operative

Should be attempted virtually for all patient

Rotator cuff strengthing and scapular stabilization

Intraarticular injections

Surgery

As discussed above in Synder Classification

Post Operative rehabilitation (7-10 days post-operative)

Important complication after surgery: Stiffness