SLAP tear / SLAP lesion

SLAP means ‘Superior Labrum Anterior Posterior’. The so-called labrum is cartilage around the socket of the shoulder joint of which the head of the upper arm (humerus) is surrounded. The humerus is like a ball in the socket. If the labrum tears from anterior to posterior (forwards to backwards), it is not able to stabilize the shoulder joint sufficiently. The consequences are an unstable shoulder as well as further symptoms.

Symptoms SLAP tear / SLAP lesion

The symptoms of SLAP tear can be very different. They partially congruent with the symptoms of the impingement syndrome, shoulder arthritis, shoulder dislocation or shoulder separation. Patients suffering from SLAP tear can feel a shoulder instability and pain inside the shoulder. There may be also grinding sounds, increasing pain while moving the shoulder or the corresponding arm or pain while lying on them and restricted range of motion. Thus, efficient diagnostics are crucial to differentiate the various causes of the symptoms from the SLAP tear.

The symptoms of SLAP lesion in short:

  • shoulder instability
  • pain increasing while moving shoulder and the corresponding arm or pain while lying on the shoulder
  • grinding sounds
  • restricted range of motion

Causes SLAP tear / SLAP lesion

An SLAP tear often occurs due to a sudden external force that damages the shoulder. Causes are hits, strong pulling of the arm or falls on the shoulder while the arm is stretched out. This can happen during fights (hit on the shoulder), motorcycle accidents (fall on the stretched out arm) or sports accidents (pulling the arm strongly during performing martial arts like judo). The SLAP lesion may also emerge as a result of shoulder-intensive sports activities like handball or basketball.

The glenoid labrum that is normally stabilizing the socket of the shoulder tears due to an external force or longtime sports activities. The head of the upper arm (humerus), thus, has too much space to move around, and the shoulder becomes unstable.

Diagnostics SLAP tear / SLAP lesion

The diagnosis SLAP tear necessitates a comprehensive orthopedic examination. Often imaging procedures like MRI or X-raying are used to differentiate different diseases that may cause similar or the same symptoms like the impingement syndrome. The best method to differentiate between different injuries is MRIMRI enables us to visualize very different structures during one examination like muscles, ligaments, tendons, cartilage and bones. If it is necessary, we do also apply a well-tolerated contrast agent to improve the visibility of certain structures.

In some cases, it may be necessary to perform a shoulder arthroscopy, during which an endoscope is inserted through small incisions to visualize the different structures of the shoulder enlarged. If indicated, a subsequent arthroscopic surgery is possible directly after the arthroscopic examination.

Crucial for planning an efficient therapy is to find out the extent of the SLAP lesion and other possibly damaged shoulder structures (SLAP tear grades 1-4, sometimes even 1-7).

Therapy SLAP tear / SLAP lesion

Very slight SLAP tears are treated with physiotherapy combined with drugs. However, arthroscopic surgery is indicated in most cases.

During minimally invasive shoulder arthroscopy, an endoscope is inserted through small skin incisions. With the help of the endoscope, the surgeon is able to see the damaged shoulder structures enlarged at a monitor. In addition to that, surgeons are also able to operate through the endoscope and repair or remove damaged structures of the shoulder. Subject to the extent of the SLAP lesion, structures of the shoulder are smoothed, stitched, roughened or stabilized with anchors. The SLAP tear, the accompanying pain, instability and restricted range of motion can be treated this way.

After arthroscopic surgery, physiotherapy and rehabilitation should follow in order to improve strength and range of motion.

Read more about minimally invasive shoulder arthroscopy