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SLAP ( SUPERIOR LABRUM ANTERO POSTERIOR ) LESIONS

An image describing a shoulder injuiry called SUPERIOR LABRUM ANTERO POSTERIOR

Superior labrum lesions, or frequently referred to as superior labrum anterior to posterior (SLAP) tears, are a subset of injuries of the labrum in the shoulder that occur in acute and chronic/degenerative settings. 


88% of Slap tears were found to have co-existent shoulder pathology. 

  •  Type-II lesions aged ≤ 40 years: - associated Bankart lesion

  •  Patients aged > 40 years:- associated with a supraspinatus tear and osteoarthritis of the humeral head. 

  •  Type-III and type-IV lesions:- associated with a high-demand occupation and a Bankart lesion


Types:-


  • Type I – Fraying of the superior labrum with intact biceps anchor

  • Type II – Fraying of the superior labrum with detached biceps anchor

A) anterior

B) posterior

C) combined anterior and posterior

  • Type III – Bucket handle tear of the superior labrum with intact biceps anchor

  • Type IV – Bucket handle tear of the superior labrum with detached biceps anchor (remains attached to the torn labrum)

  • Type V – Type II + Bankart lesion

  • Type VI – Type II + unstable flap either anteriorly or posteriorly

  • Type VII – Type II + anterior extension inferior to the MGHL

  • Type VIII – Type II + posterior labrum extension

  • Type IX – Circumferential labrum tear Type X – Type II + reverse Bankart lesion


A woman playing tennis

Etiology:-


SLAP tears are known to be caused by both macro-trauma and micro-trauma.

 Commonly recognized mechanisms include: - 

  • Traction injury to the arm

  •  Direct compression loads (axial load of a fall on an outstretched arm)

  • Repetitive overhead activities, such as throwing a ball or overhead motions.


The stability of the biceps anchor and the pattern of injury to the superior labrum/biceps complex are dependent on shoulder position during the phases of overhead throwing.

Only during the late cocking phase, when the arm was in maximal external rotation, was the increase in strain statistically significant throughout the superior labrum and the strain on the posterior portion significantly greater than that on the anterior portion of the labrum.

Repetitive overhead motion may also lead to the attenuation of static stabilizers, resulting in altered biomechanics of the dynamic stabilizers. This can lead to instability and, ultimately, impingement of the superior labrum with degenerative tearing.


Internal impingement can also result from rotator cuff tears via chronic posterosuperior or anterosuperior migration/subluxation of the humeral head.

Prognosis


Nonoperative management has efficacy for many symptomatic SLAP tears and should be considered for initial treatment. Previous studies have demonstrated non-operative management successful for 22 to 85% of patients. Operative intervention in adults has been reported to be successful between 80 and 97% of patients in several populations.


An athlete exercising his shoulder muscle

Treatment / Management


Non-operative management focuses on the initial restriction of provoking maneuvers. Typically, an anti-inflammatory and/or corticosteroid injection are utilized as initial treatment as well. Gentle ROM activities are recommended. Focus on stretching the posterior capsule is also a focus of rehabilitation. As symptoms diminish, a structured rehabilitation protocol focusing on rotator cuff and pericapsular strengthening exercises are utilized. 


Types I and III SLAP tears may be selected to undergo simple debridement as the integrity of the biceps anchor is not completely compromised. Unstable SLAP lesions are typically repaired with anchor fixation, and the extent of the injury typically determines the pattern of repair. The ultimate goal of fixation for all repair techniques is to provide a robust and stable fixation, promoting the stability of the glenohumeral joint and allowing for adequate rehabilitation without failure of repair.


Alternatively, the biceps anchor may be sacrificed, and a biceps tenotomy or tenodesis performed


References:-



 



 

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