SLAP

How does a SLAP (Superior Labral Anterior Posterior lesion) lesion occur:

  • Fall on your outstretched arm.
  • Fall on your shoulder.
  • Brace yourself with your outstretched arm in a car accident.
  • Lift heavy objects repeatedly or too suddenly.
  • Do a lot of overhead activities, such as throwing a ball (cricket, baseball) or hitting a ball (volleyball).

Symptoms:

  • Painful popping, clicking, or catching in the shoulder.
  • Pain when you move your arm over your head or reach back.
  • Pain when you throw a ball.
  • An ache often described as being deep inside the shoulder.

Types of SLAP tears: (Lennard Funk)

If you have been diagnosed with a SLAP  tear, your surgeon may have called it a ‘Type 1 or 2 or 3, etc’. SLAP tears have been classified according to their severity of tear. Please note that it does not mean that the outcome of surgery is worse, it just gives us surgeons a guide to management and a form of communication. The common types are types 1 to 4. There are other types, but these are rare.

SLAP Type 1

This is a partial tear and degeneration to the superior labrum, where the edges are rough and fray along the free margin, but the labrum is not completely detached.

Treatment is usually to ‘debride‘ (clean) the edges.

SLAP Type 2

Type 2 is the comonest type of SLAP tear. The superior labrum is completely torn off the glenoid, due to an injury (often a shoulder dislocation). This type leaves a gap between the articular cartilage and the labral attachment to the bone. Type 2 SLAP tears can be further subdivided into (a) anterior (b) posterior, and (c) combined anteriorposterior lesions.

Treatment is reattachment of the labrum. This is done arthroscopically using anchors.

SLAP Type 3

A Type 3 tear is a ‘bucket-handle’ tear of the labrum, where the torn labrum hangs into the joint and causes symptoms of ‘locking’ and ‘popping’ or ‘clunking’.

Treatment usually involves removal of the ‘bucket-handle’ segment and then repair of any remaining detached, unstable labrum.

SLAP Type 4

The Type 4 SLAP tear is one where the tear of the labrum extends into the long head of biceps tendon.

Treatment is reattachment of the labrum and repair of the biceps tear, or a biceps tenodesis. 

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