SLAP Lesions

Normal Anatomy Labrum surrounds glenoid to create depth Increases static stability of shoulder Superior aspect of labrum looser than inferior aspect Long Head of Biceps attaches into superior labrum

Pathophysiology Superior Labrum Anterior to Posterior Tear Labral tear

Mechanism Of Injury Traumatic Compression- falling onto out stretched arm Bracing in an RTC Traction

Mechanism Of Injury Overuse Eccentric activity of biceps during arm deceleration and follow through phase of throwing Long head pulls away at labrum

Mechanism Of Injury

Mechanism Of Injury Overuse ‘Peel Back’ Mechanism Abduction and maximal external rotation Base of Biceps twists and pulls at labrum During late cocking phase

Mechanism Of Injury

Associated Pathologies Due to long head of biceps providing anterior stability many patients will report anterior instability symptoms when having SLAP lesions Following on from this it is not uncommon for patients to develop internal impingement of the posterior rotator cuff due to increased anterior translation of the humeral head

Classification Type Labrum Biceps Anchor Type 1 Degeneration In Tact Bucket Handle Tear Type 2 Detached Type 4

Classification Types 5 – 12 have also been discussed in the literature These are relatively uncommon and classify with associated pathologies Types 1 – 4 are the most common

Subjective Traumatic- fall onto outstretched arm OR traction Overuse- repeated overhead throwing Decrease in throwing or serving velocity Vague symptoms Intermittent pain associated with overhead activity Mechanical pain with specific movements or positions- Nil at rest PAINFUL clicking or catching – usually in abduction external rotation

Objective Pain with external rotation overpressure at 90° abduction Pain with active arm elevation

Special Tests Active compression test Compression rotation or grind test Speeds Test Clunk test Crank test Anterior slide Biceps load Biceps load II Pain provocation test Resisted supination external rotation Pronated load test Diagnosis can ONLY be made with a battery of tests.

Further Investigation MRI with Arthrogram Arthroscopic Surgery

Further Investigation

Management Surgery Conservative management is sometimes considered in Type 1 and 3 SLAP lesions

Conservative - Management Mobility Control inflammation Soft tissue to any structures with increased tone or to reduce swelling/ inflammation if present Inferior capsule mobilisations Stability Posterior rotator cuff and scapular motor control Dynamic stability

Conservative - Management Precautions Avoid aggressive external rotation Caution with loading biceps

Surgical - Management Dependent on type Debridement Surgical Fixation

Post Operative Rehabilitation Varies between surgeons and types of surgery See the reading list for examples of post operative rehabilitation programmes from some of the best specialist shoulder surgeons and physiotherapists in the world