PT Tip of the Month Archive

SLAP Lesions

AnatomyAnatomy

The glenohumeral (shoulder) joint can be described as a ball and socket joint. The ball portion of the joint is called the humeral head and is located on your upper arm. The socket is called the glenoid fossa and is located on the outer part of your scapula (shoulder blade). The glenoid fossa is a relatively flat surface that only covers a portion of the humeral head. This type of articulation allows for a lot of motion but sacrifices shoulder stability at the same time. Therefore, there are many mechanisms that must provide additional support to the glenohumeral joint.

The glenoid labrum is one structure that provides more shoulder stability by adding 50 percent more depth to the glenoid fossa. The labrum is a ring of cartilage that surrounds the outside of the glenoid fossa and allows for greater contact of the joint surfaces. The long head of the biceps tendon, which attaches to the superior (top) portion of the labrum, acts as another stabilizer of the glenohumeral joint.

SLAP Lesions and Mechanism of Injury

A SLAP lesion is a tear that occurs in the superior (top) aspect of the glenoid labrum. It occurs both anterior to (in front of) and posterior to (behind) the site where the long head of the biceps tendon attaches to the labrum. The term SLAP lesion is defined based on the location of the tear (Superior Labrum Anterior to Posterior).

There are many ways a SLAP lesion can occur, but the most common cause is falling onto an outstretched hand. A sudden pulling force, such as grabbing an object in an attempt to stop a fall, is also common mechanism of injury. Other traumatic causes include motor vehicle accidents, shoulder dislocations, and falling directly onto the shoulder.

Overhead throwing athletes, such as pitchers and quarterbacks, are also susceptible to developing SLAP lesions due to the repetitive loads placed on the long head of the biceps tendon. These forces can eventually cause the labrum to pull away from the glenoid fossa and can sometimes tear the biceps tendon as well.

Common symptoms associated with a SLAP lesion include pain with overhead activities and sensations of catching, locking, popping, or grinding within the shoulder.

Classification of SLAP Lesions

There are four main types of SLAP lesions:

A Type I lesion involves degenerative fraying of the labrum with the biceps tendon remaining intact. A Type II lesion involves detachment of the labrum as well as the biceps tendon from the superior glenoid. A Type III lesion produces a bucket-handle tear of the labrum but leaves the remaining portions of the labrum and the biceps tendon intact. A Type IV lesion is similar to a type III but the labral tear extends into the biceps tendon.

Treatment

Depending on the severity of your symptoms and dysfunction, your physician may recommend a conservative course of treatment through physical therapy. A plan of care addressing any underlying deficits in strength, stability, and motion will be used to help you return to your prior level of function. A surgical approach may be taken with more significant injuries or if conservative treatment is unsuccessful. Depending on the type of SLAP lesion, the damaged tissue may be debrided, removed, or anchored in place with sutures.

Regardless of your course of treatment, our licensed physical therapists are experienced in treating non-operative and post-operative SLAP lesions. Our goal is to help you return to your prior level of activity for both sports and work. Please contact one of our two locations if you have any questions about your injury.
33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282