Slap lesions are tears of the labrum at the superior aspect of the glenoid. That is to say, the labrum is torn from the top of the shoulder socket. These usually involve the attachment of the long head of the biceps tendon as well.
These can be acquired over a lifetime of use, but are usually the result of injury. SLAP tears and other labral tears may be associated with ganglion cysts of the shoulder, a fluid-filled cavity that may connect to the joint via a small stalk through the tear in the labrum:
These lesions often do not heal on their own. They usually cause pain deep in the front of the shoulder, which may radiate to the biceps tendon and muscle, aggravated by reaching and overhead activities. The may produce popping, or other mechanical symtoms.
Diagnosis can be challenging, but special testing during the clinical exam by an experienced shoulder specialist with a high index of suspicion may indicate the presence of such a tear. They are easy to miss on a plain MRI study. MRI done with contrast injection, read carefully by an experienced radiologist may provide the diagnosis. However, arthroscopic exam may be necessary to document the lesion, and execute a repair. These are difficult, if not impossible, to see and repair via an open technique.
Conservative treatment usually involves eliminating aggravating activities, rest, and rehabilitation (physical therapy- stretching and strengthening exercises). Medication may provide some relief, but do not solve the problem. Injections are not helpful.
They can be repaired arthroscopically if necessary:
First, the edge of the glenoid is debrided to bleeding bone to facilitate healing. A ganglion was also present behind the capsule, which was resected with a shaver prior to the planned repair of the labrum.
Next, an anchor with attached sutures is placed into the edge of the glenoid:
The sutures are passed through the torn labrum and withdrawn from the anterior portal:
The sutures are then tied to compress the torn labrum to the prepared glenoid:
Post-operative Care:
After repair, the shoulder is protected in a sling or immobilizer for several weeks while therapy is undertaken. Healing takes time and therefore return to vigorous activities and sports must be delayed. Range of motion and strength is gradually restored while protecting the repair site, and return to unlimited activities can be expected between 3 and 6 months after surgery, depending on the size of the tear, security of the repair, and age and goals of the patient.
Surgical risks include: potential permanent loss of motion (and frozen shoulder), failure of the procedure to resolve all symptoms, failure of the tear to heal, retear of the labrum and/or biceps, nerve injury, infection, and hardware-related problems, among others.
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