slap lesions

definition

·      SLAP = Superior Labrum Anterior & Posterior

·      injury to superior part of glenoid labrum involving region of biceps tendon insertion

epidemiology

·      most common in young males

·      often associated with rotator cuff tear

aetiology

·      two mechanisms

1.   compression force applied to shoulder

·      usually as result of fall on outstretched hand

·      arm in abduction and forward flexion

2.   traction on arm

·      sudden pull on arm, esp. grab while falling or waterskiing OR

·      overhead motion, esp. throwing, hammering

clinical
Symptoms

·      pain, esp. on overhead activities

·      catching or popping on overhead activities

Signs

·      positive Speed’s test

·      biceps tension test

·      resisted shoulder flexion with elbow extended and forearm supinated

·      positive if painful

·      positive shoulder McMurray’s test

·      compression-rotation test

·      patient supine with shoulder abducted 90o and elbow flexed 90o

·      compression force to humerus

·      humerus rotated

·      in attempt to trap torn labrum

·      positive if pain and click

investigations
Imaging

·      may be demonstrated on CT-arthrogram or MRI

·      lesion often missed or misdiagnosed

Arthroscopy

·      definitive diagnostic technique

classification
Type 1

·      fraying and degeneration of superior labrum

·      no detachment of labrum or biceps tendon

Type 2

·      superior labrum and attached biceps tendon stripped off glenoid

Type 3

·      bucket handle tear of superior labrum

·      displacement of central rim of labrum into joint

·      peripheral labrum and biceps tendon attached to glenoid

Type 4

·      bucket handle tear of superior labrum

·      extension into biceps tendon which remains attached but with partial tear

Type 5

·      extension of anterior-inferior Bankart lesion superiorly

·      includes separation of biceps tendon

treatment

·      usually arthrosopic diagnosis

·      treated at time of arthroscopy

·      consists of

·      shaving of frayed labrum

·      abrasion of superior rim of glenoid to encourage healing

·      reattachment of superior labrum with bone tacks or sutures

·      biceps tenodesis