Presentation
Patient Symptoms Patients presenting with a SLAP lesion typically have several very similar complaints that led to them seeking medical attention. [medbridgeeducation.com]
Out of the 71 patients evaluated, 68 (96%) presented associated lesions, and only three cases (4%) presented a SLAP lesion alone. [scielo.br]
For example, the majority of overhead athletes present with posterosuperior lesions while individuals who have traumatic SLAP lesions typically present with anterosuperior lesions. [mikereinold.com]
If the two are present, then they are both repaired during the same procedure. [orlincohen.com]
Very little evidence about non-operative treatment for type II SLAP lesions was available when the present study was designed. [bjsm.bmj.com]
Entire Body System
- Pain
Catching feeling with or without pain as you move your shoulder Throbbing pain in the shoulder or its back side Pain in the front shoulder area when SLAP tears spread into bicep tendons Pain during overhead activities Locking or popping sensation in the [ospiarizona.com]
These include pain with specific shoulder positions, pain during overhead activities such as tennis or throwing sports, or impaired shoulder strength. A range of patients with varying ages and activity profiles can experience these symptoms. [mayoclinic.org]
Pain in the front of the shoulder and down to the biceps muscle Pain that is often worse with lifting the arm in front of the body or above the shoulder Snapping of the biceps tendon with shoulder motion Pain that interferes with daily life, recreation [wexnermedical.osu.edu]
If the initial condition does not heal properly, pain will result and worsen over time. The typical symptoms are pain at the top of the shoulder, clicking and pain with overhead activities. [shoulderdoc.co.uk]
SLAP Tear Symptoms: Deep, aching pain Popping, clicking, catching, locking or grinding in the shoulder Decreased range of motion Shoulder instability Pain when lifting or carrying objects Pain when moving the arm or shoulder Decreased shoulder strength [reboundmd.com]
- Falling
Particularly in the elderly it is critical to introduce any form of fall prevention. [pathologies.lexmedicus.com.au]
Examples of Traction injuries: Sudden pull downward when one loses hold of a heavy object Pull of the arm in an upward direction when grabbing an overhead object in attempt to stop a fall from a height Forward pull of the arm (anteriorly) can occur when [sportsandortho.com]
Trauma injuries: A fall onto an outstretched arm or the shoulder. A sudden pull to the shoulder, such as when tying to lift a heavy object. A sudden upward motion, such as when pitching a ball or trying to stop a fall or slide. [orthospecmd.com]
- Surgical Procedure
The overall goals of the surgical procedure and rehabilitation are to: Control pain and inflammation Regain normal upper extremity strength and endurance Regain normal shoulder range of motion Achieve the level of function based on the orthopedic and [neosmteam.com]
This surgical procedure is generally done arthroscopically through three small (approximately one centimeter) incisions. [sportsandortho.com]
SLAP lesion repair is a surgical procedure to repair a tear resulting from an injury to the labrum located in the shoulder joint. SLAP is an acronym for Superior Labrum from Anterior to Posterior. [advancedregenerativeorthopedics.com]
- Inflammation
By reducing the inflammation and swelling the tendons can return to their usual state and perform as usual. Injections – Cortisone injections can be used to reduce inflammation in the shoulder joint. [kneeandshoulderclinic.com.au]
Medications Anti-Inflammatory medications may reduce pain and inflammation associated with this injury. [tria.com]
Medications: Anti-inflammatory medications can aid in the reduction of swelling and inflammation and minimize shoulder pain as a result. [uhhospitals.org]
The overall goals of the surgical procedure and rehabilitation are to: Control pain and inflammation Regain normal upper extremity strength and endurance Regain normal shoulder range of motion Achieve the level of function based on the orthopedic and [neosmteam.com]
Anti-inflammatory treatment is advised to reduce local inflammation resulting from the injury. [pathologies.lexmedicus.com.au]
- Asymptomatic
SLAP lesion complaints can vary from asymptomatic to disabling. [chiroup.com]
High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. Journal of Sports Medicine. January 2016 vol. 4 no. 1 Williams RJ. Superior Labrum Tears. [ilchiro.org]
Treatment and prognosis type I tears are usually asymptomatic and do not require treatment type II tears require surgical reattachment type III tears usually require resection of the bucket handle tear 2 sublabral sulcus : SLAP type II tears can appear [radiopaedia.org]
A negative DLST indicates that either there is no SLAP lesion or, if there is, it is asymptomatic. Comments Dr. [mayoclinic.org]
The diagnosis is controversial; the validity of clinical tests, 3 and even arthroscopy and MRI arthrography is questioned. 4–8 In addition, a high prevalence of SLAP lesions has been reported in a middle-aged asymptomatic population. 9 Figure 1 CONSORT [bjsm.bmj.com]
Neurologic
- Irritability
How a physio can help Labral tears are usually treated with arthroscopic surgery to the shoulder to either cut away the torn and irritated tissue or to re-attach the labrum to the socket of the shoulder. [sportscarephysio.com.au]
Weakened and irritated rotator cuff tendons lose their ability to depress the humeral head within the glenoid cavity during arm elevation. [ilchiro.org]
Workup
MRI is typically included in the initial workup for patients with suspected labral pathology. (42) The incorporation of gadolinium-enhanced MR arthrography provides the highest sensitivity (82-96%) and specificity (91-98%) for detecting SLAP lesions. [ilchiro.org]
Treatment
Treatment = 3 months of physical therapy focusing on strengthening the dynamic stabilizers. If non-op treatment fails to eliminate symptoms arthroscopic biceps tenotomy with or without Biceps Tenodesis is indicated. [eorif.com]
Anti-inflammatory treatment is advised to reduce local inflammation resulting from the injury. [pathologies.lexmedicus.com.au]
Conservative, non-surgical, treatment is always preferable if those treatments are effective and successful in actually resolving a complaint. [academyofclinicalmassage.com]
A review of treatments, which will work and when. [caringmedical.com]
Controversies about treatment The initial treatment for a patient with what might be considered to be a SLAP lesion is non-operative treatment. [ncbi.nlm.nih.gov]
Prognosis
Treatment and prognosis type I tears are usually asymptomatic and do not require treatment type II tears require surgical reattachment type III tears usually require resection of the bucket handle tear 2 sublabral sulcus : SLAP type II tears can appear [radiopaedia.org]
[…] injury the suprascapular nerve Failed SLAP repair and persistent symptoms many causes including articular cartilage injuries, hardware failure and anchor pullout failures associated with age >36 years biceps tenodesis better option in this age group Prognosis [orthobullets.com]
Poor outcomes after SLAP repair: descriptive analysis and prognosis. Arthroscopy. 2009;25(8):849-55. [ Links ] 27. Voos JE, Pearle AD, Mattern CJ, Cordasco FA, Allen AA, Warren RF. Outcomes of combined arthroscopic rotator cuff and labral repair. [scielo.br]
Prognosis Initial reports suggested good results with arthroscopic superior labral repairs with a high success both in nonthrowing and throwing athletes, as well as a high rate of overhead athletes returning to their preinjury level of activity. [19, [emedicine.medscape.com]
Poor outcomes after SLAP repair: descriptive analysis and prognosis. Arthroscopy. 2009 Aug; 25(8): 849-55. [ Links ] 28. Oh JH, Kim SH, Lee HK, Jo KH, Bae KJ. [scielo.org.za]
Etiology
Etiology In the acute setting they are most frequently seen in falls onto an outstretched arm or in throwing sports athletes. Classification The most widely used system for classification of SLAP tears was originally described by Snyder 7. [radiopaedia.org]
Etiology In considering the etiology of superior labral (labrum) lesions, it is useful to divide them into the the following two broad categories: Compression injuries - These are usually secondary to a fall on an outstretched arm that is in an abducted [emedicine.medscape.com]
Epidemiology Incidence uncommon injuries, account for less than 5% of all shoulder injuries Demographics dominant shoulder of overhead and throwing athletes Risk factors glenohumeral internal rotation deficit Etiology Pathophysiology mechanisms of injury [orthobullets.com]
[…] its labral anchor – becoming progressively more problematic as the tear progresses. (15) Chronic SLAP lesions do not typically occur in the absence of concurrent shoulder pathology; in fact, only 28% of SLAP tears are isolated problems. (17) Chronic etiologies [ilchiro.org]
Although both authors reported on similar lesions, the etiology remained unclear. [jospt.org]
Epidemiology
Definition Superior labrum anterior & posterior Injury to superior part of glenoid labrum involving region of biceps tendon insertion Epidemiology 2 groups 1. [52.62.202.235]
Epidemiology Incidence uncommon injuries, account for less than 5% of all shoulder injuries Demographics dominant shoulder of overhead and throwing athletes Risk factors glenohumeral internal rotation deficit Etiology Pathophysiology mechanisms of injury [orthobullets.com]
The identification of these normal variants can help to prevent the misdiagnosis of labral lesions.[6] Epidemiology/Aetiology[edit | edit source] In the acute setting, they are most frequently seen in falls onto an outstretched arm or in throwing sports [physio-pedia.com]
Epidemiology Superior labral (labrum) lesions are unusual. The reported prevalence in patients undergoing shoulder arthroscopy has ranged from 3.9% to 6%. [emedicine.medscape.com]
Pathophysiology
The understanding on the pathophysiology behind SLAP lesions has progressed greatly since the advent of arthroscopic shoulder surgery. [sportsinjurybulletin.com]
Epidemiology Incidence uncommon injuries, account for less than 5% of all shoulder injuries Demographics dominant shoulder of overhead and throwing athletes Risk factors glenohumeral internal rotation deficit Etiology Pathophysiology mechanisms of injury [orthobullets.com]
Pathophysiology On a biomechanical level, incompetence of the superior labrum and biceps anchor has been shown to have a deleterious effect on anterior glenohumeral stability. [emedicine.medscape.com]
Aetiology There are several controversies about the pathophysiology of SLAP tears. [eor.bioscientifica.com]
Prevention
Keeping a strong musculature around the shoulder prevents a SLAP tear Prevention Prevention of SLAP lesions is best achieved with adequate strengthening of the shoulder muscles and shoulder blades to increase the stability of the rotator cuff and, at [pathologies.lexmedicus.com.au]
The best option for the treatment of a SLAP tear is prevention. As there may be an association with poor mechanics, overhead athletes should maintain a stretching program to maintain overall internal rotation of the shoulder. [rchsd.org]
Adequate warm-up before activity and avoidance of high-contact sports will help prevent of an instability-causing injury. [shoulderdoc.co.uk]
Younger athletes in particular should certainly consider arthroscopic SLAP tear surgery to prevent shoulder instability and further injury down the road. [sportsmedicineoregon.com]
The technique used may not be determined until the tear is visible to the surgeon and the repair procedure may include: Debridement of fraying tissue to prevent a tear Securing the loose labrum to the cup of the joint Repair or removing the torn labrum [losalortho.com]