By Dr. Avi Chezar, shoulder surgeonIn brief
Summarized and reviewed by Dr. Avi Chezar, shoulder surgery specialist, Assuta Haifa and RMC Afula.
- What it is
- A SLAP lesion is a tear of the upper labrum where the long head of the biceps tendon attaches to the glenoid. The tear was originally associated with injuries in baseball players, but it also appears in other injuries.
- Symptoms
- Usually young people with non-specific shoulder pain, mainly with lifting movements that pull backwards and with backward rotation. There is no restriction of movement and shoulder strength is preserved.
- Diagnosis
- MRI arthrogram (an MRI with contrast injected into the shoulder before the scan) to detect the tear. It can also be seen on an MRI without contrast, but with lower sensitivity.
- Treatment
- In most cases the labrum is not the real cause of the pain and there is no place for surgery. A conservative protocol to strengthen the shoulder muscles is the first treatment; surgery is rare and only with a clear clinical indication.
So what is a SLAP lesion?
The long tendon of the biceps muscle passes inside the shoulder joint and attaches, at the top of the labrum, to the glenoid. The term SLAP (Superior Labrum Anterior to Posterior) refers to a tear of the upper labrum where the long head of the biceps tendon (LHB) attaches.
A SLAP tear is a tear of the upper labrum. The tear was originally associated with injuries in baseball players. There is a classification of the tear by grades, which is descriptive and has no significance at the clinical level.
About the problem and its treatment
A tear of the upper labrum, or SLAP, is described in MRI reports, mainly MRI arthrograms. In my experience, in most cases where such a tear is apparently identified, it is not a tear at all but a normal variant of the tissue, or at most slight wear with no clinical significance.
In most cases:
- the tear is not the cause of the shoulder pain
- it is an incidental, unimportant finding on imaging
Who is the typical patient apparently diagnosed with a SLAP tear?
Usually young people who work out at the gym and complain of non-specific shoulder pain. Pain is common with arm movements, mainly:
- lifting with a backward pull
- backward rotation
Other features:
- no restriction of movement
- shoulder strength is preserved
How is a SLAP lesion diagnosed?
The patient is referred for a scan, and the tear is seen on an MRI arthrogram – an MRI of the shoulder in which contrast is injected into the shoulder before the scan. The tear can also be identified on an MRI without contrast, but the accuracy or sensitivity is lower.
How is a SLAP lesion treated?
As I mentioned, this is an imaging finding, and usually the shoulder pain does not come from damage to the labrum. There is no place to consider surgical repair, because the labrum is almost certainly not the cause of the pain.
Whether there is any justification for surgery of any kind with a diagnosis of an upper labral tear should be considered very carefully.
When there is shoulder pain without evidence of other injuries, conservative treatment that includes a muscle-strengthening protocol can be given.
Further reading from leading medical sources
For readers who want to go deeper, here are reliable sources from the American Academy of Orthopaedic Surgeons (AAOS – OrthoInfo):
- SLAP Tears — OrthoInfo (AAOS)SLAP tear of the upper labrum – diagnosis and treatment
External sources in English · open in a new tab