SLAP Lesions

What are SLAP Lesions

Superior labrum anterior posterior (SLAP) lesions are injuries to part of the connective tissue (cartilage) of the shoulder joint. The top of the upper arm bone (humerus) fits into a socket in the shoulder blade to form the shoulder joint. There is a firm rim of cartilage (labrum) around the edge of the socket.

SLAP stands for S uperior L abrum A nterior- P osterior. A SLAP lesion is a type of labral tear that involves the superior labrum and extends anteriorly and/or posteriorly to variable extents.

These types of tears can be seen in the setting of trauma, such as with a fall on an outstretched arm, or in overhead throwing athletes with repetitive injury.

The labrum helps to deepen the socket and hold the humerus in place. If a certain part of the labrum becomes frayed or torn, it is called a SLAP lesion. A SLAP lesion can cause shoulder pain, instability, and weakness.

SLAP lesions are common among athletes who play sports that involve repeated overhead movements. SLAP lesions may include a tear in the cord of tissue that attaches the muscle in the front of the upper arm to the shoulder blade (proximal biceps tendon).

What are the causes?

SLAP Lesions may be caused by:

• A sudden (acute) injury, which can result from:
  • Falling on an outstretched arm.
  • Movement of the shoulder joint out of its normal place (dislocation).
  • A direct hit to the shoulder.
• Wear and tear over time, which can result from doing activities or sports that involve overhead arm movements.

What increases the risk of SLAP Lesions?

The following factors may make you more likely to develop SLAP lesions:

• Having had a dislocated shoulder in the past.
• Being age 40 or older.
• Playing certain sports, such as:
  • Sports that involve repeated overhead movements, such as baseball or volleyball.
  • Sports that put backward pressure on the arms when the arms are overhead, such as gymnastics or basketball.
  • Contact sports.
• Lifting weights.

What are the symptoms of SLAP Lesions?

The main symptom of SLAP Lesions is shoulder pain that gets worse when lifting a heavy object or raising the arm overhead. Other signs and symptoms may include:

• Feeling like your shoulder is locking, catching, grinding, or popping.
• Loss of strength.
• Stiffness and limited range of motion.
• Loss of throwing power (“dead arm”).

How are SLAP Lesions diagnosed?

SLAP Lesions may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Imaging tests, such as MRIs.

How are SLAP Lesions treated?

Treatment for SLAP Lesions may include:

• Resting your shoulder by avoiding activities that cause shoulder pain.
• NSAIDs to help reduce pain and swelling.
• Physical therapy to improve strength and range of motion.
• Surgery. This may be done if other treatment methods do not help. Surgery may involve:
  • Removing frayed pieces of the labrum.
  • Repairing tears.
  • Reattaching the labrum.
  • Repairing the biceps tendon.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe for you to drive.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Be safe and responsible while being active to avoid falls.
• Maintain physical fitness, including strength and flexibility.

Contact a health care provider if:

• Your symptoms have not improved after 6 months of treatment.
• Your symptoms get worse instead of getting better.

SLAP Lesions Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercise

This exercise warms up your muscles and joints and improves the movement and flexibility of your shoulder. This exercise also helps to relieve pain and stiffness.

Exercise A: Passive shoulder horizontal adduction

1. Sit or stand and pull your left / right elbow across your chest, toward your other shoulder. Stop when you feel a gentle stretch in the back of your shoulder and upper arm.
   1. Keep your arm at shoulder height.
   1. Keep your arm as close to your body as you comfortably can.
2. Hold for __________ seconds.
3. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Scapular protraction, supine

1. Lie on your back on a firm surface. If directed, hold a __________ weight in your left / right hand.
2. Raise your left / right arm straight into the air so your hand is directly above your shoulder joint.
3. Lift your shoulder off of the floor so you push the weight into the air. Do not move your head, neck, or back.
4. Hold for __________ seconds.
5. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Scapular retraction

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
3. Hold one end of the exercise band in each hand.
4. Squeeze your shoulder blades together and move your elbows slightly behind you. Do not shrug your shoulders.
5. Hold for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Shoulder external rotation

1. Lie down on your left / right side.
2. Bend your left / right elbow to an “L” shape (90 degrees). Place a small pillow or a rolled-up towel under your left / right upper arm.
3. With your elbow bent to 90 degrees, place your left / right hand on your abdomen.
4. Squeeze your shoulder blade back toward your spine.
5. Keeping your upper arm against the pillow or towel, move (pivot) your forearm and hand away from your abdomen and toward the ceiling. Keep your elbow bent to 90 degrees.
6. Hold for __________ seconds.
7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Shoulder extension, prone

1. Lie on your abdomen on a firm surface so your left / right arm hangs over the edge.
2. Hold a __________ weight in your hand so your palm faces in toward your body. Your arm should be straight.
3. Squeeze your shoulder blade down toward the middle of your back.
4. Slowly raise your arm behind you, up to the height of the surface that you are lying on. Keep your arm straight.
5. Hold for __________ seconds.
6. Slowly return to the starting position and relax your muscles.

Repeat __________ times. Complete this exercise __________ times a day.