1. SLAP Lesions

2. 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

3. Pathophysiology
Superior Labrum Anterior to Posterior Tear
Labral tear

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

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

6. Mechanism Of Injury

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

8. Mechanism Of Injury

9. 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

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

11. 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

12. 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

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

14. 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.

15. Further Investigation
MRI with Arthrogram
Arthroscopic Surgery

16. Further Investigation

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

18. 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

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

20. Surgical - Management
Dependent on type
Debridement
Surgical Fixation

21. 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