SLAP tear
A superior labral tear from anterior to posterior in the shoulder.
A SLAP tear (Superior Labrum Anterior and Posterior lesion) is an injury to the superior glenoid labrum, the fibrocartilaginous rim that deepens the shoulder socket. It begins at the back of the labrum and extends forward to the attachment of the long head of the biceps tendon. These lesions are commonly seen in overhead throwing athletes and middle-aged labor workers, and can result from chronic overuse or an acute stretch injury.
- Type
- Shoulder injury
- Common in
- Overhead throwing athletes and middle-aged labor workers
- Causes
- Chronic overuse or acute stretch injury
- Diagnosis
- MRI or arthrography, confirmed by direct arthroscopy
- Subtypes described
- 12 varieties
- Surgical success rate
- 74–94% for isolated tears
Lore & Background
The shoulder joint is a ball-and-socket joint, but the socket (glenoid fossa) is small, covering at most a third of the ball (humeral head). It is deepened by a circumferential rim of fibrocartilage called the glenoidal labrum. Previously considered a redundant evolutionary remnant, the labrum is now recognized as integral to shoulder stability. The long head of the biceps brachii tendon becomes fibrocartilaginous before attaching to the superior glenoid, and together with other cartilaginous extensions, forms the glenoid labrum. A SLAP tear damages the superior area of this labrum.
Reader's Guide
SLAP lesions have come into public awareness because of their frequency in athletes involved in overhead and throwing activities, with initial definitions of the four major subtypes occurring since the 1990s. Identification and treatment continue to evolve. Symptoms include dull aching, difficulty sleeping due to decreased joint stability, and for throwing athletes, pain, catching, loss of strength, or decreased velocity. Diagnosis is by MRI or arthrography with confirmation by direct arthroscopy. Twelve varieties have been described. Treatment can be non-surgical (physical therapy to strengthen supporting muscles) or surgical, with arthroscopic repair favored for its low infection risk. Surgical success for isolated tears ranges from 74–94%. Age over 40 and Workmen's Compensation status are independent predictors of complications, especially with associated rotator cuff injury, in which case labral debridement and biceps tenotomy may be preferred. Surgical rehabilitation is progressive, protecting the biceps from resistance for at least six weeks.
Did You Know?
- SLAP is an acronym for 'Superior Labrum Anterior and Posterior'.
- The glenoid labrum was once considered a redundant evolutionary remnant but is now integral to shoulder stability.
- Twelve varieties of SLAP lesion have been described, with initial diagnosis by MRI or arthrography and confirmation by direct arthroscopy.
- Surgical success rate for repairing isolated SLAP tears is reported between 74–94%.
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