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SLAP lesion

Definition of

SLAP tear(superior labral tear from anterior to posterior), injury to the labrum-bicepsanchor complex, i.e. the upper part of the glenoid labrum. There are various classifications, including combination injuries. Distinguish mainly between 4 types (according to Snyder):

1. Type I: Stable biceps anchor, but degenerative changes in the labrum with fanning but without detachment
2. Type II: Tear-off of the biceps anchor from the upper glenoid in a cranial direction
3. Type III: Basket handle-shaped detachment of the upper labrum with intact biceps anchor
4. Type IV: Longitudinal tear of the long biceps tendon with caudal dislocation of a part caudally into the joint space

In 40% of cases, a (partial or complete) rotator cuff lesion is present at the same time, with Bankart lesions (22%), with glenohumeral chondromalacia (10%). In addition, SLAP lesions were found together with biceps tendon ruptureor dislocation of the long biceps tendon. Type 1 is significantly associated with partial lesions of the supraspinatus tendon. SLAP lesions are found in approximately 4-10% of all shoulder arthroscopies. There are several scenarios in which a SLAP lesion develops:

1. due to trauma that is transmitted, such as a fall onto an elbow or an outstretched arm, where the elbow joint does not absorb any energy from the fall
2. together with a Bankart lesion (tear or avulsion of the inferior part of the labrum) in abduction-exorotation trauma
3. as an overuse phenomenon in throwers due to traction forces and shear forces of the original tendon of the caput longum of the biceps

ICD S46.2

Cause

1. Brief, strong impact of force on the already pre-tensioned biceps tendon, e.g. when windsurfing or when falling on the outstretched, slightly abducted arm or when lifting heavy objects that cannot be easily controlled
2. Dislocation of the shoulder joint
3. progressive microtraumatic in various athletes (baseball, handball, basketball, javelin throwers, tennis players, weightlifters, gymnasts, squash players). Some batting/throwing athletes show posteriosuperior impingement
4. Overloading in the direction of exorotation causes damage to the anterior labrum
5. Fall on forward extended arm resulting in posteriorly directed force in the glenoid
6. Blow/fall on the shoulder
7. Tension injuries (extreme tension on the arm)

Predisposing

1. preexisting microlesions

Diagnosis

1. History of fall/stroke/trauma
2. even an MRI does not necessarily show the injury well, only with contrast medium
3. Arthroscopy if necessary
4. Tests and signs: Speed Test, Yergason, Biceps Load 1, Biceps Load 2, O’Brien, Dynamic Labral Shear Test, SLAP Lesion Test Cluster, Active Compression Test, Passive Distraction Test.

Symptoms

1. Pronounced pain on movement, painful restriction of movement in the direction of wide abduction, the pain is localized as deep in the shoulder. Activity worsens
2. Sudden onset of pain with trauma or (heavy or fast) movement
3. Possibly asymptomatic for longer with progressive non-traumatic development
4. Feeling of instabilityin the shoulder (alternating between physiological and subluxated state)
5. Possibly reproducible cracking during movement
6. possibly pain in the rotator cuff due to altered tension
7. Possibly painful restriction of movement
8. Loss of strength and speed (most noticeable in athletes)
9. Smaller lesions can remain asymptomatic for a long time
10. joint swelling if necessary

Complications

1. Dislocation

Therapy

1. Type I conservative. During immobilization, flexion of the elbow joint for lifting loads and stronger supination of the forearm should be avoided
2. Larger tears arthroscopically (with resorbable or titanium bone anchor)
3. Less frequent open surgery