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SLAP 3 lesion, arthroscopy photo

SLAP 3 lesion in a 29 year old professional athlete. He felt onto the outstretched arm while playing a tennis match.


X-ray SLAP 2 repair

X-ray of an arthroscopic SLAP 2 a repair. Suture anchors remain permanently.


posterior capsular shoulder release

Arthroscopic view from anterosuperior into the posteroinferior parts of the shoulder joint, in a 21 year old high competition athlete. Although a posterior contract capsule was treated with intensive sports physiotherapy, it got worse and the posterior capsule had to be dissected arthroscopically.







SLAP lesions

SLAP lesion, explanation
Lateral view onto the glenoid cavity ( ball of the humeral head is removed ). The upper glenoid rimb is a problematic area, affected from SLAP lesions.
Here you can read:
What is a SLAP lesion ?
What is causing a SLAP lesion ?
Types of SLAP lesions
Signs and symptoms of a SLAP lesion ?
Diagnosis of a SLAP lesion of the shoulder ?
Special aspects of SLAP lesions in sports:
How to treat SLAP lesions of the shoulder ?
Prognosis of SLAP lesions ?
What happens after an operation of a SLAP lesion ?
What is a SLAP lesion of the shoulder ?
SLAP is an abbreviation which means "superior labrum anterior posterior". It sounds quite complicated, but it isn´t. Keep it simple: around the glenoid rimb we can see the labrum. If it is torn above, at the upper glenoid, those lesions are called SLAP lesions. Depending on the kind of lesion, different types are described. We call it a SLAP 1 lesion, if it´s a fringy lesion. SLAP 2 means, that the labrum is separated completely from the upper glenoid and a SLAP 3 is like a buckethandle tear of the upper labrum. In a rare condition this buckethandle tear involves the long head of the biceps tendon, it is then called a SLAP 4 lesion.


What is causing a SLAP lesion ?
The typical mechanism is to fall onto the outstretched arm or a direct blow against the shoulder. Traction to the affected shoulder and repetitive microtraumata ( over years, in professional athletes ) can lead to SLAP lesions, especially in throwing sports, like baseball.


Types of SLAP lesions:
There are 7 types of SLAP lesions.
A SLAP 1 lesion is a fraying of the upper labrum.
A SLAP 2 lesion is a complete delamination of the upper labrum from the bony glenoid. Depending whether it is located more in front, middle or back side of the upper glenoid, it is called a SLAP 2a, SLAP2b or SLAP2c lesion.
SLAP 3 lesions are a buckethandle like tear of the upper labrum and
SLAP 4 lesions are tears of the upper labrum, which run into the long head of the biceps tendon.
A SLAP 5 lesion is a SLAP 2 type with a Bankart lesion.
SLAP 6 lesions are a SLAP 2 lesion with a clothlike tear.
And, SLAP 7 lesions are type 2 lesions running into the anterior capsule / the glenohumeral ligament ( MGHL ).


Signs and symptoms of a SLAP lesion ?
Typically, SLAP lesions cause different problems. It might be pain, even at night. Sometimes a snapping or cracking is present in the shoulder joint. Shoulder pain is located deep in the shoulder and is getting worse while moving the arm. Some patients feel an instability or have symptoms of a loose shoulder.


Diagnosis of a SLAP lesion of the shoulder ?
The diagnosis of a SLAP lesion is quite often difficult. Taking the patients history and physical examination are helpful. MRI, especially using contrast media, sometimes show these SLAP injuries. Most of the time, SLAP lesions are recognized during arthroscopy of the shoulder joint.


Special aspects of SLAP lesions in sports:
Posterosuperior impingement occurs in throwing and racket sports ( like: baseball, tennis, squash, badminton, and so on ). Structures in the posterosuperior part of the shoulder joint are impinging ( the posterosuperior labrum is shut between rotator cuff muscle and bony glenoid ). In those cases, we call it a SLAP 2b lesion, which is not due to an accident, but caused by repetitive stress onto these structure ( for years ) during sports training and in competition. Those athletes often also have a contract / shortened posterior shoulder capsule, regularly. If diagnosis is made early, a special stretching programm can be started to get pain relief.


How to treat of SLAP lesions of the shoulder ?
An attempt of nonoperative treatment, using strengthening exercises for shoulder abduction and external rotation, might be useful. A very effective concept are stretching exercises for the posterior capsule.
But most of the SLAP lesions do not heal with conservative measures. One reason might be the fact, that SLAP lesions are often accompanied by other shoulder pathologies. Arthroscopy with arthroscopic suturing / debridement of the SLAP lesion, is the therapy of choice. SLAP 1 lesions will be debrided arthroscopically. SLAP 2 lesions will be closed with arthroscopic sutures. In SLAP 3 tears, the buckethandle part will be removed and then suture anchors will be positioned arthroscopically. SLAP 4 lesions are treated similar and combined with an endoscopic suture of the torn biceps tendon.


Prognosis SLAP lesions ?
If SLAP lesions are recognized and treated in an early stage, prognosis is good.


What happens after an operation of a SLAP lesion ?
There are nearly no limitations, if a SLAP 1 lesion is debrided arthroscopically. The affected arm / shoulder can be used actively. But, associated pathologies - if present and also operated - have to be taken into consideration and postoperative training program has to be adapted.
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