SLAP Lesions

SLAP lesions are tears of the superior labrum (meniscus-like tissue around the glenoid socket) that include the attachment 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”, meaning that they think there is a SLAP lesion present when none is. In these cases, the SLAP lesion is a “red herring”, and not the cause of the shoulder pain. Sometimes there can actually be a SLAP lesion, but it’s still not the cause of shoulder pain. Because of this, even if a SLAP lesion is suspected, the initial treatment should usually include rest and therapeutic strengthening of the shoulder muscles. In throwers, special stretches can be helpful. If symptoms persist following 3 months of non-operative management, 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. Repairing SLAP lesions in patients over the age of 45-50 years often leads to painful stiffness. So, if a SLAP lesion is causing problems in patients greater than 45-50 years old, it is usually preferable to leave the SLAP lesion unrepaired, to avoid complications, and take the biceps tendon off of the SLAP lesion and simply repair the biceps tendon to the humeral head; this gets the biceps tendon out of the shoulder joint so that it no longer causes pain, while allowing it to still function to flex the elbow.

All in all, SLAP lesions are injuries that are very treatable by either non-operative or arthroscopic management.