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.
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
- Compressive stress due to FOOSH
- Tensile stress due to eccentric contraction on the biceps will peel off glenoid
Snyder’s Classification of SLAP
| Type | Features | Management |
|---|---|---|
| Type I | Biceps fraying, intact anchor on superior labrum | Arthroscopic debridement |
| Type II | Detachment of biceps anchor | Repair vs tenotomy/tenodesis |
| Type III | Bucket handle superior labrum tear, bicep intact | Arthroscopic debridement |
| Type IV | Bucket handle tear of superior labrum into biceps | <30 %ntendon involvement: Debridement >30 % tendon involvement: Repair/debridement / tenodesis of tendon |
| Type V | Antero-inferior labral tear + SLAP | Stabilization of both |
| Type VI | Superior flap tear (displaced) but intact biceps | Debridement |
| Type VII | Capsular injury + SLAP lesion; tear extending to capsule | Repair and stabilization |
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
