What are SLAP Injuries or Tears

SLAP (Superior Anterior-Posterior Labral) tears or injuries cause shoulder pain and occurs in throwing athletes and in individuals doing a lot of overhead activities

Symptoms

  • Pain: SLAP injuries often cause a dull aching pain and throwing athletes complain of a ‘dead arm’.
  • Sleeping can be uncomfortable because lying in bed cause the shoulder to ‘drop’ producing discomfort.

Anatomy

The biceps tendon travels over the head of the humerus and attaches to the glenoid to form the superior labral complex. The lesions can be classified depending on the extent of the tear (Figure 1).

Who has SLAP Injuries?

  • SLAP injuries can occur in throwing athletes.
  • Repetitive overhead activities can cause SLAP tears Degenerative SLAP tears can be associated with rotator cuff injuries.
  • Degenerative SLAP tears can be associated with rotator cuff injuries.

How do we diagnose SLAP Tears?

  • On clinical exam the patients demonstrate a positive O’Brien’s test where the motion of holding the arm elbow extended and held part way across their body with the hand turned palm up produces pain as downward pressure is applied.
  • X-rays are frequently negative but MRI (magnetic resonance imaging) is an excellent test to identify SLAP tears.

How do we treat SLAP Tears?

  • Type I tears are table and can be treated with debridement.
  • Type II bucket handle tears can be repaired arthroscopically using bone anchors.
  • Type III large bucket handle tears can be treated with debridement of the displaced bucket handle tear.
  • Type IV are best treated by debridement of the tear and biceps tenodesis where the painful and frayed biceps tendon is trimmed and anchored in bone outside the shoulder joint.

Thomas E. Trumble, M.D.

*Figures courtesy of Principles of Hand Surgery and Therapy by Thomas E. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD