SLAP Lesion: Causes and Treatment

A SLAP lesion (Superior Labrum Anterior and Posterior lesion) is an injury to the top (superior) part of the labrum, where the biceps tendon attaches to the shoulder socket (glenoid). This injury can compromise shoulder stability and function, causing pain and weakness.

Causes of SLAP Lesions

1. Trauma or Injury:
   • Fall on an Outstretched Arm: The force can pull or tear the labrum.
   • Direct Shoulder Blow: Common in contact sports or accidents.
2. Repetitive Overhead Movements:
   • Frequent overhead motions, such as throwing, swimming, or serving in tennis, can stress the labrum.
   • Common in athletes like pitchers or swimmers.
3. Sudden Forceful Movements:
   • Heavy lifting or jerking motions, such as pulling on a heavy object, can tear the labrum.
4. Degeneration with Age:
   • Wear and tear over time can weaken the labrum, making it more prone to injury.
   • Often seen in individuals over 40.
5. Biceps Tendon Tension:
   • The long head of the biceps tendon exerts tension on the superior labrum during certain activities, contributing to tearing.
6. Shoulder Instability or Dislocation:
   • Recurrent instability or prior dislocations can lead to labral damage.

Symptoms of SLAP Lesions

• Pain:
  • Deep shoulder pain, often felt at the front or top of the shoulder.
  • Worsened by overhead or throwing activities.
• Clicking, Popping, or Grinding:
  • Sensation during shoulder movement.
• Weakness:
  • Reduced strength, especially in overhead or lifting motions.
• Decreased Range of Motion:
  • Difficulty reaching overhead or behind the back.
• Instability:
  • The shoulder may feel loose or like it could slip out of place.

Treatment Options for SLAP Lesions

Non-Surgical Treatments

1. Rest and Activity Modification:
   • Avoid aggravating activities, particularly overhead or heavy lifting.
2. Physical Therapy:
   • Stretching Exercises: Improve shoulder flexibility, especially in the posterior capsule.
   • Strengthening Exercises: Focus on rotator cuff and scapular stabilizers to enhance shoulder stability.
   • Correcting Biomechanics: Optimize movements to reduce stress on the labrum.
3. Pain Management:
   • NSAIDs (e.g., ibuprofen, naproxen) to reduce inflammation and pain.
4. Corticosteroid Injections:
   • Reduce inflammation and pain in persistent cases.

Surgical Treatments (For Severe or Persistent Lesions)

1. Arthroscopic Repair:
   • The labrum is repaired using anchors and sutures to reattach it to the glenoid.
2. Biceps Tenodesis or Tenotomy:
   • In cases with significant biceps tendon involvement, the tendon may be detached and reattached (tenodesis) or released (tenotomy) to relieve tension.
3. Debridement:
   • Damaged tissue is removed if the lesion is small or frayed but not fully torn.

Rehabilitation After Surgery

• Immobilization:
  • The arm is immobilized in a sling for 3–6 weeks to protect the repair.
• Gradual Physical Therapy:
  • Begin with gentle passive range-of-motion exercises, progressing to active strengthening over months.
• Full Recovery Timeline:
  • Return to full activity or sports typically takes 4–6 months.

Prevention Tips for SLAP Lesions

1. Avoid Overuse:
   • Limit repetitive overhead activities or use proper techniques.
2. Strengthen Shoulder Muscles:
   • Build strong rotator cuff and scapular stabilizers to support the labrum.
3. Warm-Up and Stretch:
   • Prepare the shoulder before physical activity to reduce injury risk.
4. Address Shoulder Instability:
   • Seek early treatment for loose or dislocating shoulders.
5. Correct Throwing or Lifting Mechanics:
   • Proper form can minimize stress on the shoulder joint.