SLAP lesions are tears of the superior labrum (meniscus-like tissue around the glenoid socket) that include the ‘root’ of the biceps tendon. These are uncommon injuries, except in throwing athletes and in patients who have had significant trauma (ski accidents, bad falls, motor vehicle accidents, etc). It is rare to see a painful SLAP tear in a patient who is not an overhead athlete and has not sustained a significant trauma.
It should be understood that a history, physical examination and MRI are not reliable for the diagnosis of SLAP lesions. Many times MRIs are ‘overread’, and the SLAP lesion is a ‘red herring’, and not the cause of the shoulder pain. Because of this, even if a SLAP lesion is suspected, the initial treatment should usually include rest and strengthening of the shoulder muscles. Certain directions of decreased motion are often found in throwers, which should be addressed by special stretches before surgery. If symptoms persist after 3 months of strengthening, surgery may be considered.
In young athletes, SLAP lesion repair has >95% success rate. Early motion is started after surgery to decrease the chance of stiffness. However, SLAP lesions usually do not cause pain in patients over 40 years old. Pain in patients over the age of 40 is much more commonly due to rotator cuff problems. If the SLAP lesion is causing problems in patients greater than 45-50, it is usually preferable to simply repair the biceps tendon to the humeral head and leave the SLAP lesion unrepaired. This is because repair of SLAP lesions in patients over the age of 45-50 years often leads to painful stiffness.
| A SLAP lesion: the superior labrum has been torn off of the glenoid socket. | ||
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 Suture anchors, little harpoons that stick into the glenoid socket with sutures attached to them, are placed. |
Suture passing devices are used to shuttle the sutures around the SLAP lesion |
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The suture is tied around the SLAP tear, fixing it back to the glenoid bone (socket). |
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