SLAP Lesions

SLAP Lesions



Description


The socket of the shoulder, the glenoid, has a cartilage rim that lines its periphery; this cartilage rim is called the labrum, and it is important in shoulder stability. The labrum serves as the attachment site of the shoulder capsule, the ligaments, and the long head of the biceps tendon to the glenoid, one of the two upper biceps tendon attachments. The upper cartilage rim, known as the superior labrum, is where the biceps tendon attaches. Injury to the superior labrum is called a SLAP lesion; the acronym SLAP stands for superior labrum, anterior to posterior (front to back). This injury may be degeneration, a tear of the labrum, or a pulling of the labrum off the glenoid, with or without the biceps tendon attachment being pulled off or torn. SLAP lesions are an uncommon source of shoulder pain.



Common signs and symptoms



• Pain in the shoulder that is worse with overhead activities and especially with follow through after releasing a ball

• Usually, no pain at rest

• Intermittent locking, clicking, or snapping of the shoulder, often associated with pain

• Weakness reaching overhead

• Loss of velocity when trying to throw

• A feeling that the shoulder is about to dislocate

• Pain, tenderness, and weakness in the front of the shoulder with attempted elbow bending or rotation of the wrist, such as with using a screwdriver

• Crepitation (a crackling sound) when the biceps tendon or shoulder is moved or touched


Causes



• Repetitive throwing motions

• Falling onto an outstretched arm

• Pulling of the arm

• Sudden force applied to the biceps while the muscle is contracted

• A direct blow to the shoulder with the arm in a throwing position


Factors that increase risk



• Contact sports

• Overhead sports (baseball, tennis, volleyball)

• History of shoulder dislocation or subluxation

• Rotator cuff tear

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play


Preventive measures



• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes shoulder and elbow flexibility, muscle strength and endurance, and cardiovascular fitness.

• Use proper technique when throwing and falling.


Expected outcome


Symptoms may resolve with conservative treatment and resting of the affected area. Surgery is often necessary.



Possible complications



• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• Recurrence of symptoms, especially if activity is resumed too soon

• Weakness with elbow bending and forearm rotation

• Prolonged disability (uncommon)

• Risks of surgery, including infection, bleeding, injury to nerves, shoulder stiffness, shoulder and elbow weakness, inability to repair the labral tear, retearing of the labrum after repair, and rupture of the biceps tendon


General treatment considerations


Initial treatment consists of medication and ice to relieve pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer may be recommended. Often pain will persist, especially in throwing athletes. Surgery is recommended if symptoms persist despite nonoperative treatment. Surgery is performed arthroscopically to clean and remove torn pieces and fragments (debridement) or to reattach the labrum back to the glenoid. Reattachment may be performed with tacks or sutures (stitches). If repair is undertaken, immobilization is usually recommended after surgery to allow the labrum to heal to the glenoid. After surgery and immobilization, physical therapy may be recommended to regain shoulder motion and strength.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as
image

Figure 1


From Rockwood CA Jr, Matsen FA III: The shoulder, ed 2, Philadelphia, 1998, W.B. Saunders, p 302; from Snyder SJ, Karzel RP, Del Pizzo W, et al: SLAP lesions of the shoulder, Arthroscopy 6:274, 1990.


directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.


• Pain relievers may be prescribed as necessary by your physician, usually only after surgery. Use these medications only as directed, and take only as much as you need.


Heat and cold



• Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.


When to call your doctor



• Symptoms get worse or do not improve in 4 to 6 weeks despite treatment.

• Any of the following occur after surgery:
Increased pain, swelling, redness, drainage, or bleeding in the surgical area

Pain, numbness, or coldness in your hand

Blue, gray, or dusky color in your fingernails

Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever)

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.


Range of Motion and Stretching Exercises


SLAP Lesions


These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. Please remember:


• Flexible tissue is more tolerant of the stresses placed on it.

• A gentle stretching sensation should be felt.

image


Range of motion image shoulder pendulum



1. Lean forward at the waist, letting your weak arm hang freely. Support yourself by placing your opposite hand on a chair, table, or counter as shown.

2. Sway your whole body slowly, forward and back. This will cause your arm to move. Let your arm hang freely, and do not tense it up.

3. Repeat the above, swaying side to side and moving in circular patterns, clockwise and counterclockwise.
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Jul 19, 2016 | Posted by in SPORT MEDICINE | Comments Off on SLAP Lesions

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