SLAP (Superior Labrum Anterior and Posterior) Lesion

slap lesion

SLAP (Superior Labrum Anterior and Posterior) Lesion    

What is the labrum?

The shoulder is considered a “ball and socket” joint – think of a golf ball sitting on a tee. The bones of the joint do not provide a lot of stability and because of this, the labrum is important. The labrum of the shoulder provides greater depth to the “socket” and improves the stability of the shoulder joint while maintaining mobility. 

What is a SLAP tear?

A SLAP tear is an injury to the superior labrum that extends anteriorly to posteriorly. Individuals with a SLAP tear will often describe anterior shoulder pain. They may describe clicking or catching in certain positions, most specifically in a throwing position. Also, these injuries are often accompanied with other shoulder injuries such as rotator cuff or biceps tendinopathy. For this reason, and for the lack of specific testing, it is often difficult to diagnose a SLAP tear.

Surgery versus Physiotherapy

The recommendation consistently across the literature recommends that a comprehensive rehabilitative program with a physiotherapist should be the first line of management with suspected SLAP tears. Surgical intervention to repair the labrum is becoming less common and should only be considered for certain individuals. These factors include the type of tear, level of athlete, the demands of the athlete and/or the demands of the individual’s occupation. 

When considering surgical intervention, the results are poor for most individuals when compared to conservative physiotherapy management. Individuals over the age of 36 years of age, those that are recreational athletes or those with low occupational demands perform as good or better with a comprehensive rehabilitation program when compared to surgical intervention. It appears the best time to consider surgery is if you are a young competitive baseball player. More specifically, it seems positional players had the best outcomes in returning to playing baseball, and returning to their previous level of performance. However, pitchers had better results in their recovery and performance with physiotherapy.

Ultimately, having a detailed assessment from a physiotherapist will be valuable in determining the best steps in your recovery. A physiotherapist will determine your limitations, the extent of injury and will also design a specific program tailored to your needs in recovering from a SLAP lesion, regardless of your demands.

DO YOU HAVE A SHOULDER INJURY?

Contact us and we can arrange for a Free Consultation with one of our Physiotherapists to speak with you about your individual case.

FAQ:

  1. Can a SLAP lesion heal on its own?
  • The labrum cannot heal on its own but through conservative physiotherapy management, you can become pain free and return to activity/sport.
  1. How serious is a torn labrum?
  • It all depends on the severity of the tear and if other structures are involved. An assessment is the best thing to do to determine the extent of the problem. 
  1. Should I get an MRI or Ultrasound?
  • An MRI may give you evidence of a tear in the labrum but due to all the tendons, muscles and ligaments present in the shoulder, however, an MRI can still miss a torn labrum.

References

Brockmeyer, M., Tompkins, M., Kohn, D. M., & Lorbach, O. (2016). SLAP lesions: a treatment algorithm. Knee Surgery, Sports Traumatology, Arthroscopy24(2), 447-455.

Fedoriw, W. W., Ramkumar, P., McCulloch, P. C., & Lintner, D. M. (2014). Return to play after treatment of superior labral tears in professional baseball players. The American journal of sports medicine42(5), 1155-1160.

Provencher, M. T., McCormick, F., Dewing, C., McIntire, S., & Solomon, D. (2013). A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. The American journal of sports medicine41(4), 880-886.

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