SLAP lesions
SLAP: Superior Labrum from Anterior to Posterior tears
Physiopathology:
Repetetive overhead activities (throwing athletes) :Tightness of postero-IGHL à shift the glenohumeral contact posterosuperiorly à more shear forces on superior labrum. Rotator cuff is also at risk
Fall on outstreched hand, traction of the arm
Symptoms
Vague deep shoulder pain
Mechanical popping and clicking
Weakness, easy fatigue, decreased athletic performance
Physical exam
Biceps tendon tenderness
Internal rotation deficit
Apprehension test positive in 85%
Suprascapular neuropathy: deep pain, atrophy of supraspinatus and/or infra spinatus
O’Brian test
Crank test
Dynamic labral shear test
Snyder classification
Type 2a
Imaging
Xrays : normal
MRI:
T2 signal intensity between the superior labrum, lateral to glenoid rim, and posterior to the biceps
Sensibility 50% only… But Increase if Arthro-MRI
can show paralabral cyst (sign of tear)
Arthroscopy : Gold standard for diagnosis and Treatment
MRI: Paralabral Cyst
Arthroscopy view
Treatment:
Physical therapy + res + NSAIDs : first line treatment
Surgical : Arthroscopy
Debridement (If fraying or flaps)
Labral reinsertion ( type 2)
Labral Variants
Normal variants are all located in 11-3 o’clock position, can mimick a SLAP tear
Sublabral recess: between glenoid cartilage and the labrum, 11-1 o’clock
Sublabral foramen: unattached anterosuperior labrum at 1-3 o’clock
Budford complex: congenital absence of labrum between 1-3 o’clock, thickened middle glenohumeral ligament
