It can be painful andor limit movement in the shoulder, especially overhead motions. Slap lesion repair emily cotey, emily hurysz, and patrick. 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. Associated tear of the anterior inferior labrum bankart lesion with superior extension of.
Slap lesions are often seen in combination with other shoulder problems and this makes it difficult to diagnose. A slap tear or lesion occurs when there is damage to the. 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. Pdf superior labral anterior posterior lesions of the shoulder. Pathology of the superior aspect of the glenoid labrum slap lesion poses a significant challenge. A specific pattern of injury to the superior labrum of the shoulder was identified. If conservative treatment fails, successful arthroscopic repair of symptomatic slap lesions has been described in the literature particularly for young athletes. Slap tear itself accounts for 8090% of labral pathology in stable shoulder but its only found in 6% on arthroscopy. Retrospective cohort studies have suggested that the benefits of tenodesis include pain relief and improved function, and higher patient satisfaction, which was reported in a prospective non. 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. Acromion shoulder blade scapula clavicle collarbone humerus rotator. Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles, ligaments and a rim of cartilage called the labrum to stabilise it during movement. The journal of arthroscopic and related surgery 64.
The case demonstrates the superiority of the mr arthrography in detection of slap lesions. The biceps tendon attaches at the top of the labrum. A slap tear is a torn piece of cartilage in the inner portion of the shoulder joint. A slap tear or lesion occurs when there is damage to the superior uppermost area of the labrum. Additionally, the authors found that the creation of a slap lesion resulted in a 102% to 120% increase in the amount of strain recorded in the anterior superior band of the inferior glenohumeral ligament. All 10 slap lesion subtypes are characterized by tearing of the. The fibers of the biceps tendon blend with the superior labrum continuing posteriorly. Diagnostic performance of mr arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. Superior labrum anterior posterior slap tears uptodate. The term slap stands for superior labral tear anterior to posterior.
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. A bankart lesion is the most common injury sustained with traumatic dislocation, but other injuries can occur. Slap lesions were not recognized until the 1980s when keyhole surgery of the shoulder was starting to be performed. However, the results in throwing athletes are less successful with a significant amount. Firstly, the methodological quality of the included studies was generally low. Slap tear refers to a specific injury of the superior portion of the glenoid. Mri approach to the diagnosis of slap lesions mri and mr arthrography play key roles in the noninvasive diagnosis of. Slap lesions are becoming a more recognized cause of shoulder pain and disability. Superior labral anterior posterior slap lesions of the glenoid labrum. Superior labral anterior posterior lesions of the shoulder. An mri is usually performed if a slap tear is suspected, but arthroscopic surgery is the best way to confirm this injury. Repairing a slap tear without surgery if you are reading this article you are likely someone very involved in sports or you have a physically demanding job.
This is accomplished through a variety of manual resistance and end range. 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. Of 544 shoulder arthroscopy procedures performed, 9 26%. Sep 15, 2010 the authors suggest that given these results yergasons test is the only clinical test that demonstrates a clinically significant plr for the diagnosis of slap lesions. Using arthroscopic surgical techniques, the superior labrum is mobilized along the entire area of detachment using a 4. Superior labrum anterior posterior slap lesions can also be associated with other shoulder pathology. Associated tear of the anterior inferior labrum bankart lesion with superior extension of the tear is seen and considered as slap v lesion. The associated lesions are also treated such as labrum and ligament lesions with instability. It stands for superior labral anterior to posterior tear, meaning a tear of the upper rim of the labrum from front to back. Signs and symptoms poorly localized pain in and around the. Bankart tear tear of the anteroinferior glenoid labrum.
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. 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. A slap tear is when there is damage to the ring of cartilage on the socket of the shoulder joint, known as the labrum. Imaging the glenoid labrum and labral tears rsna publications. Slap tear shoulder injury and treatment sportshealth. Retrospective cohort studies have suggested that the benefits of tenodesis include pain relief and improved function, and higher patient satisfaction, which was reported in a prospective nonrandomised study.
More specifically, superior labrum lesions about the insertion of the long biceps tendon were typically noted or managed using standard open surgical techniques. Mri is useful if the diagnosis of instability is uncertain, in multidirectional instability, or if there may be accompanying pathology, including rotator cuff pathology, biceps tendon pathology, slap lesions and isolated ligamentous or capsular injuries. Background slap tear injury is tear of superior part of glenoid labrum in the region of the insertion of the biceps tendon. Slap lesion of the shoulder joint cooper university. The mechanical characteristics of suture anchors are more favorable in resisting the pathologic forces responsible for the peelback mechanism. 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. When the shoulder is placed in a position of maximal external rotation, the rotation produces. This motion performed while the hand carries a weight places stress on the labrum. A type viii slap lesion is a slap extension along the posterior glenoid labrum as. Both mri and mra can be utilized in making the diagnosis with the coronal images being the most sensitive. Examination of the biceps tendon and superior labrum. The labrum is the cuff of cartilage that extends the socket part of the shoulder blade to better accept the ball end of the arm bone. When throwing a ball or other object, or performing similar motions eg, swinging a hammer, the shoulder is forcefully abducted and externally rotated during the cocking phase.
I dont want to have surgery, but not climbing is bringing me. However, the results in throwing athletes are less successful with a significant amount of. You may be a baseball pitcher or the parent of a baseball player, likely a pitcher, doing your research looking for that nonsurgical alternative that will save next season for your son. Slap stands for superior labrum anterior and posterior, which defines the anatomical location of the injured area. Repetitive overhead activity has been hypothesized as a common mechanism for producing slap lesions. Efficacy of labral repair, biceps tenodesis, and diagnostic. In swimming, this injury is one of many shoulder injuries contributing to shoulder pain. A slap lesion is a tear that occurs where the tendon of the biceps muscle meets the labrum. Slap lesions the tear is located in the top portion of the labrum at the front of the biceps tendon to the back of the joint socket. Coexisting injuries may confound the clinical findings.
The most common clinical complaints were pain, greater with. The glenoid labrum enhances shoulder stability in 4 distinct ways. Injury to the superior aspect of the glenoid labrum slap lesions poses a significant challenge. Nonslap lesions the tear tends to be unstable and degenerative in nature. The authors suggest that given these results yergasons test is the only clinical test that demonstrates a clinically significant plr for the diagnosis of slap lesions. This article describes the structure and function of the labrumbiceps slap lesions. The most prevalent is type ii which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Interestingly, combining all four tests did not improve the or for detecting isls or csls. An slap lesion is defined as a lesion of the superior labrum, which typically originates at the site of attachment of the lhbt biceps anchor and may extend to the anterior or posterior portions. The authors have identified a number of limitations to this research. A slap tear is an injury to the superior part of the labrum in the shoulder.
Slap lesions are a unique type of labral tear in the shoulder. Lesions of the superior labrum anterior and posterior slap to the biceps tendon. The glenoid labrum is most commonly injured by a fall or from repetitive overhead movements, such. This detachment leads to instability, pain, and functional decline. Anterior shoulder instability with concomitant superior. The higher success rate of arthroscopic suture anchor repair of slap lesions compared with open capsulolabral reconstruction suggests that slap lesions are the usual cause of the dead arm syndrome. Huijbregts, pt, dpt, ocs, faaompt, fcamt2, richard jensen, pt, phd3 s uperior labrum anteriortoposterior slap lesions have been dis. Snyder and coworkers described a superior glenoid labral lesion that begins posteriorly and ends anteriorly, and coined the term slap. Mri in shoulder instability and slap lesions springerlink. These mechanisms of injury are also associated with a. The shoulder labrum is a ring of cartilage around the shoulder socket that stabilizes the head of the upper arm bone. A 30 percent increase of maximum external rotation was achieved with a gradual increase in torque applied to the shoulder. Before the use of shoulder arthroscopy and magnetic resonance imaging mri in the diagnosis and management of shoulder problems, glenoid labrum lesions were underappreciated.
Injury to the superior aspect of the glenoid labrum slap lesions poses a significant. In addition, the rotator cuff muscles are essential to ensure dynamic shoulder. Stretching of the anterior capsule in external rotation created anterior laxity. A slap tear is an injury to a part of the shoulder joint called the labrum. Mr imaging of slap lesions open orthopaedics journal. Evaluation of oxford instability shoulder score, western. Slap lesion repair emily cotey, emily hurysz, and patrick schroeder abstract slap lesion, which stands for superior labrum anterior and posterior, is a detachment tear of the superior labrum that originates posteriorly to the tendon of the long head of the biceps and extends anteriorly. I have a slap lesion a cartilage tear on the rim of the shoulder socket having injured my shoulder seven months ago. Mar 22, 2018 background on slap lesions superior labral anterior posterior slap lesion is a pathology where the superior labrum, anterior and posterior biceps anchor detach.
Pdf superior labral anterior posterior lesions of the. Background on slap lesions superior labral anterior posterior slap lesion is a pathology where the superior labrum, anterior and posterior biceps anchor detach. Concurrent shoulder injuries are often present including rotator cuff tears, cystic changes. Evaluation of oxford instability shoulder score, western ontario shoulder instability index and euroqol in patients with slap superior labral anterior posterior lesions or recurrent anterior dislocations of the shoulder.
A slap lesion typically occurs from a fall on an outstretched hand, sudden deceleration or traction forces such as catching a heavy falling object, and anterior and posterior instability. Buckethandle tear of the anterior superior glenoid labrum associated with bicipital tendinosis. If you have associated instability, perhaps with a labrum tear in the front of the shoulder, you may also feel shifting in the shoulder. 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. Many slap lesions occur in throwing or overhead athletes. 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. Slap v lesion mr arthrography of the shoulder radiology. Some slap lesions can be simply debrided and cleaned, whilst most need repairing depending on the severity of the lesion. Examination of the biceps tendon and superior labrum anterior. These mechanisms include a fall upon the extremity with an outstretched arm, workrelated injuries, shoulder dislocation, and overuse due to overhead.
This is a very common diagnosis for shoulder injuries. Slap lesions of the shoulder are challenging to diagnose by clinical means alone. Slap lesion of the shoulder joint cooper university health care. The procedures include labral repair or biceps tenodesis. Anatomy your shoulder is a ballandsocket joint made up of three bones. The second reason slap lesions are difficult to diagnose is that there are many mechanisms that can produce slap lesions, so the patients history may not be helpful in making the diagnosis. The diagnosis of these lesions is difficult due to vague symptoms and high degree of. Fall onto an outstretched hand repetitive overhead.
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. It is difficult to identify a slap tear by symptoms alone. A slap tear or lesion occurs when there is damage to superior portion of the glenoid labrum. Thus, in the presence of a superior labral lesion, similar to a type ii slap lesion as described in. Threedimensional isotropic shoulder mr arthrography. The shoulder socket is very shallow, similar to a golf tee, to allow for lots of movement. The labrum deepens the golf tee to help make the shoulder more stable. Slap lesions occur in overhead athletes due to chronic repetitive stress. Slap lesion is mostly combined with a lesion of the proximal head of the biceps because it attaches on the. Signs and symptoms poorly localized pain in and around the shoulder exacerbated with overhead and twisting tasks. Usually an mriarthrogram is required to demonstrate the s. There many different variations of slap tears, which have different levels of severity and treatment strategies.
Prevention strong shoulder muscles remain the best defence against shoulder injuries. Diagnostic utility of clinical tests for slap lesions. These injuries can usually be diagnosed on an mrarthrogram or ctarthrogram. Pdf the recognition and treatment of superior labral slap lesions. One research group suggests that combining two of three sensitive tests. Mghl courses deep to the subscapularis tendon to blend and. The term slap lesion is used to describe anatomic lesions of the superior glenoid labrum and biceps anchor. Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. However, more extensive labral tears do occur, some of which may be progression of preexisting slap lesions, or its combination with a bankart lesion slap type v. Slap lesion and cortisone i have a slap lesion a cartilage tear on the rim of the shoulder socket having injured my shoulder seven months ago.
Repairing a slap tear without surgery caring medical. Slap tear injuries can cause feelings of unsteadiness, as though the shoulder will pop out of its socket. Slap lesions were first classified by snyder et al. Pdf imaging of glenoid labrum lesions researchgate.
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