Rehabilitation guidelines for slap lesion repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee. Pdf superior labrum anterior to posterior slap lesions. Slap lesions of the shoulder are challenging to diagnose by clinical means alone. Superior labral anterior posterior slap lesions often lead to painful shoulder impairment and especially in overhead athletes to restriction in sport specific activity.
Prevention strong shoulder muscles remain the best defence against shoulder injuries. A slap tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint. Clinical examination to detect slap lesions can often be difficult because of. If the arm is forcefully bent inward and twists at the shoulder, the humeral head acts as a lever and tears the biceps tendon and labrum cartilage from the glenoid bone in a fronttoback anteriorposterior direction. Radiology corner the superior labrum, anteriortoposterior. The labrum is a ring of strong, fibrous tissue or cartilage that lines and supports the ball and socket of the shoulder joint. Injuries to the superior labrum can be caused by acute trauma or by repetitive shoulder motion.
Jan 27, 2016 tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. Superior labral tears clinical examination slap tear test. Patients with slap lesions complain of shoulder pain while performing overhead movements and often develop mechanical popping or catching within the. Type 2 slap tears can be further subdivided into a anterior b posterior, and c combined anteriorposterior lesions. Slap lesion of the shoulder, but evidence of their efficacy is lacking. Remember, slap tears are just one type of shoulder labral tears, as the superior labrum is just a portion of the glenoid labrum. The injury of the superior labrum begins posteriorly and extends anteriorly. The labrum deep ens the golf tee to help make the shoulder more stable. The test was named biceps load test ii as a counterpart of the original biceps load test for slap lesions in shoulders with recurrent anterior dislocation. If you can repair the slap lesion, then biceps tenotomy is thought to speed recovery by removing the stimulus to spasm. When compared with the standard of referencethat is, arthroscopydirect mr arthrography yields sensitivities that range from 82% to 100%, specificities between 71% and 98%, and accuracies between 83% and 94% in detection of slap lesions 11,22. Diagnostic utility of clinical tests for slap lesions. Superior labrum anterior to posterior slap lesions of the shoulder. Huijbregts, pt, dpt, ocs, faaompt, fcamt2, richard jensen, pt, phd3 s uperior labrum anteriortoposterior slap lesions have been dis.
The case demonstrates the superiority of the mr arthrography in detection of slap lesions. Arthroscopic debridement of type i and iii slap lesions protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic debridement of a type i or iii slap lesion. When it comes to slap lesions, a type of shoulder injury, there are numerous types of treatment options available for the affected individuals. A slap tear occurs in the top superior, the front anterior and back posterior of the point where the biceps tendon attaches to the labrum. The labrum is a lip like piece of cartilage that deepens the socket of the shoulder. Causes of slap lesions one theory about slap tears is that they result when the shoulder joint tries to dislocate. Diagnosing a slap lesion remains a challenge for clinicians treating shoulder disorders. Clinical examination to detect slap lesions is often difficult because of the common presence of concomitant pathology in patients presenting with this type of condition. There have been ten slap lesions described, based on the location of torn labrum and biceps involvement. Pdf superior labrum anterior to posterior slap lesions of. These lesions have come into public awareness because of their frequency in athletes involved in overhead and throwing activities in turn relating to relatively recent description of labral injuries in throwing athletes, 4 and initial definitions. Slap lesion superior labrum anterior and posterior. Although advancement in arthroscopic techniques has enhanced arthroscopic repair of slap lesions, the clinical diagnosis of slap lesions can still be difficult.
Slap lesions occur in overhead athletes due to chronic repetitive stress. Type ii slap lesions are created when the biceps anchor has pulled away from the glenoid attachment. Home exercise program for slap lesions perform the exercises in the order listed. Repairing a slap tear without surgery caring medical.
The term slap stands for superior labral tear anterior to posterior. A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twentyseven patients. Incidence rates, complications, and outcomes as reported by abos part ii candidates ss19. Superior labral tears slap lesions can pose a significant challenge to orthopaedic surgeons and rehabilitation specialists alike. Pdf the superior labrum, anteriortoposterior slap lesion. Lastly, there is a high incidence of associated pathology and injuries with slap lesions, including rotator cuff disorders partialthickness rotator cuff tears, 40% to 29%, and full.
It can be painful andor limit movement in the shoulder, especially overhead motions. Mr imaging of slap lesions open orthopaedics journal. Slap lesions are often seen in combination with other shoulder problems and this makes it difficult to diagnose. Superior labral anterior posterior lesion slap lesion. The associated lesions are also treated such as labrum and ligament lesions with instability. The term slap is an acronym for superior labrum anterior and posterior. A very short talk by don buford, md showing what is possible with ultrasound used to diagnose slap lesions. Type iv slap lesions involve a buckethandle tear of the superior labrum in which the tear extends into the biceps tendon. However, the results in throwing athletes are less successful with a significant amount. Pain localized in the ac joint or in the posterior rotator cuff is not specific for the presence of a slap lesion. Injury occurs from inferior traction on the shoulder, as well as excessive tension on and twisting of the long head of biceps tendon lhb at its insertion along the superior labrum that occurs during the cocking motion of throwing 2, 3.
Apply dry or moist heat to the shoulder prior to the exercises and during the sleeper stretch. Waldt s, burkart a, lange p, imhoff p, rummeny ej, woertler k. A slap tear is when there is damage to the ring of cartilage on the socket of the shoulder joint, known as the labrum. A clinical test for slap lesions in shoulders with recurrent anterior dislocation, the biceps load test of kim, has been reported as a dynamic test that is a function of the intact bicepssuperior labral complex and explained by the 3 mechanisms. A slap tear can be caused by an acute injury such as a fall onto an outstretched arm, a shoulder dislocation or a motor vehicle accident or it may be due to repetitive overhead activities. Superior labral anteroposterior lesions of the shoulder. Anatomy your shoulder is a ballandsocket joint made up of three bones. Is it necessary to repair a large slap lesion in a stable. In this setting, slap tears typically occur posterior to the insertion site of the biceps tendon on the labrum 3. A slap tear is an injury to the superior part of the labrum in the shoulder. This is because the articular surface of the round humeral head is approximately four times greater than that of the relatively flat shoulder blade face glenoid fossa1 figure 1.
Superior labrum anteriortoposterior slap lesions predominantly occur in athletes that perform repetitive overhead motions, namely baseball players, gymnasts or swimmers, and individuals that are subjected to direct compression of the shoulder secondary to falls or contact sports 1. We evaluated the effect of labral repair, biceps tenodesis and sham surgery on slap lesions. This is where the top part of the arm bone the head of humerus, which is shaped like a ball, fits in a socket on the front of the shoulder blade glenoid fossa. However, a standard therapy of slap lesions in the shoulder surgery has not been established yet. The posterior shoulder symptoms are indicative of provocative strain on the rotator cuff musculature when the shoulder is placed in this position. The feature that makes slap possible is the way the upper biceps tendon hooks over the head of the humerus. A slap tear is a torn piece of cartilage in the inner portion of the shoulder joint. This pathology is fairly common, in fact up to 14 of patients undergoing shoulder arthroscopy for any diagnosis will demonstrate a slap lesion. The goal of surgical repair of a slap lesion is to obtain a strong repair that allows the patient to aggressively rehabilitate the shoulder and return to full activities or sports competition.
As the shoulder slides back the head of the humerus clips the distended labrum resulting in a tear. Arthroscopic labral repair protocol, ii, iv, and complex tears. When this occurs, the biceps tendon contracts to prevent the dislocation and distracts the glenoid labrum form its origin. It stands for superior labral anterior to posterior tear, meaning a tear of the upper rim of the labrum from front to back. The shoulder labrum is a ring of cartilage around the shoulder socket that stabilizes the head of the upper arm bone. Slap v lesion mr arthrography of the shoulder radiology. Oct 18, 2015 the first classification of slap lesions was described in 1990, a subdivision in four types existed. Arthroscopic debridement of type i and iii slap lesions.
The rising comprehension of pathology and pathophysiology in slap lesions contributed to increase the types in slap classification to ten. Diagnostic performance of mr arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. For inpatients diagnosed with slap lesions, the mean shoulder numeric rating scale score decreased from 5. The superior labrum is completely torn off the glenoid, due to an injury often a shoulder dislocation. Methods a doubleblind, shamcontrolled trial was conducted with 118 surgical candidates mean age 40 years, with patient history, clinical symptoms and. Background labral repair and biceps tenodesis are routine operations for superior labrum anterior posterior slap lesion of the shoulder, but evidence of their efficacy is lacking. A specific pattern of injury to the superior labrum of the shoulder was identified. To diagnose the problem, your healthcare provider will check your arm and shoulder. A slap tear or lesion occurs when there is damage to the. Huijbregts, pt, dpt, ocs, faaompt, fcamt2, richard jensen, pt, phd3 s uperior labrum anteriortoposterior slap lesions have been discussed, defined, and investigated since andrews et al1 first described this. Slap lesions are common in athletic populations, particularly those requiring overhead motions that encourage the biceps to pull the labrum from its underlying bony attachment.
While bankart 1 is given credit for describing injury to the anteriorinferior glenoid labrum in 1938, the first description of injuries to the superior glenoid labrum in throwing athletes was in 1985 by andrews et al. Slap lesions of the shoulder pain is usually aggravated by overhead activ ity and may be associated by clicking, popping, stiffness, and glenohumeral instability 9. Methods a doubleblind, shamcontrolled trial was conducted with 118 surgical candidates mean age 40 years, with. Slap tear shoulder injury and treatment sportshealth. Dec 11, 2016 this pathology is fairly common, in fact up to 14 of patients undergoing shoulder arthroscopy for any diagnosis will demonstrate a slap lesion. Nov 01, 2017 a very short talk by don buford, md showing what is possible with ultrasound used to diagnose slap lesions. The biceps tendon attaches at the top of the labrum. According to the type of lesion, the age of the individual and the functional level of the athlete, a specific treatment plan will be prescribed for these slap lesions.
There many different variations of slap tears, which have different levels of severity and treatment strategies. Snyder et al later coined the phrase slap to represent lesions of the superior labrum from anterior to posterior. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The muscle spasms and tightness is an attempt to stabilize the shoulder and prevent further injury. Three simple tests for identifying slap lesions chiroup. Biceps tenotomy is the cutting of the tendon to release its hold on the muscle and reduce spasms and stiffness. Snyder et al described four types of superior labral lesions anterior to posterior slap lesions which occur as single entity or associated to additional disorders of the shoulder. A slap superior labrum anterior posterior lesion is a term used to describe an injury to the cartilage the labrum that covers the top part of the shoulder socket glenoid and may include an injury to the biceps tendon anchor. Oct 11, 2016 normal variants, such as a buford complex, may predispose the labrum to formation of slap lesions, although the exact mechanism of this phenomenon remains unclear 14,17,48. Type iii slap lesions involve a buckethandle tear of this superior labrum with an intact biceps anchor. The glenoid labrum is most commonly injured by a fall or from repetitive overhead movements, such.
Using arthroscopic surgical techniques, the superior labrum is mobilized along the entire area of detachment using a 4. Concerning the causative mechanism of slap lesions, acute trauma has to be differed from chronic degeneration. This article describes the structure and function of the labrumbiceps slap lesions. Methods a prospective study was performed in 127 patients to evaluate the diagnostic accuracy for the biceps load test ii. Associated tear of the anterior inferior labrum bankart lesion with superior extension of the tear is seen and considered as slap v lesion. This is because the articular surface of the round.
However, the results in throwing athletes are less successful with a significant amount of. Rehabilitation guidelines for slap lesion repair uw health. Mri approach to the diagnosis of slap lesions mri and mr arthrography play key roles in the noninvasive diagnosis of. This is a very common diagnosis for shoulder injuries. These mechanisms of injury are also associated with a. Msk ultrasound for slap lesions in the shoulder youtube. Snyder and coworkers described a superior glenoid labral lesion that begins posteriorly and ends anteriorly, and coined the term slap. Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. A slap tear or lesion occurs when there is damage to the superior uppermost area of the labrum. Slap tear itself accounts for 8090% of labral pathology in stable shoulder but its only found in 6% on arthroscopy. This type leaves a gap between the articular cartilage and the labral attachment to the bone. If conservative treatment fails, successful arthroscopic repair of symptomatic slap lesions has been described in the literature particularly for young athletes.
Imaging the glenoid labrum and labral tears radiographics. Sham surgery versus labral repair or biceps tenodesis for. Slap lesion of the shoulder joint saint lukes health system. Buckethandle tear of the anterior superior glenoid labrum associated with bicipital tendinosis. In the context of diagnostic examination, magnetic resonance arthrography is of particular importance, not only in detection of slap lesions and concomitent pathologic findings but also in differentiation from. Snyder first presented in 1990 a comprehensive classification of the slap lesions. Progress in detection of slap lesions and development of modern suture anchor systems led to an increasing number of arthroscopic slaprepairs. The slap lesions were with this classification separated in four different types. Slap lesion is mostly combined with a lesion of the proximal head of the biceps because it attaches on the. Forceful lifting or pulling on the arm, such as trying to catch a heavy object. The shoulders large, though useful, range of motion can also lead to injuries. Coexisting injuries may confound the clinical findings. Superior labral anterior posterior lesions of the shoulder.
One type is the superior labrum anterior to posterior slap lesion. An algorithm on how to treat slap lesions according to their type and data on the factors that influence the surgical outcome is essential for the everyday clinical practice. Repeated overhead motions such as throwing shoulder dislocation. Slap lesions can be a source of pain and disability in patients, particularly during overhead activity. The anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee. Methods a doubleblind, shamcontrolled trial was conducted with 118 surgical candidates mean age. Clinical examination to detect slap lesions can often be difficult because of the presence of concomitant pathology. Slap lesions are a unique type of labral tear in the shoulder. The shoulder socket is very shallow, similar to a golf tee, to allow for lots of movement.
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