SLAP TEAR

Dr Aniket Koley
Junior Resident -2
Department of Orthopaedics, NRSMCH
• Superior labrum anterior posterior
(SLAP) tears are injuries of
the glenoid labrum
• They involve the superior glenoid
labrum, where the long head
of biceps tendon inserts
• They may extend into the tendon,
involve the glenohumeral ligaments
or extend into other quadrants of
the labrum
EPIDEMIOLOGY
• It is estimated that SLAP tears account for 80% -90% of labral
pathology in the stable shoulder
• However they are usually seen in association with other shoulder
pathologies and rarely in isolation
• Age variations – From the average age of 35 > Below the age of 30
ETIOLOGY
• In the acute setting, SLAP injuries are most frequently seen in falls
onto an outstretched arm
• In this situation the shoulder is abducted and slightly forward-flexed at
the time of the impact.
• Other mechanisms of injury include:
1. Repetitive throwing
2. Hyperextension
3. Heavy lifting
4. Direct Trauma
CLINICAL PRESENTATION
• The most common complaint in patients that present with SLAP
lesions is pain
• Pain is typically intermittent and often associated with overhead
movements
• While performing overhead movements, patient may develop “dead
arm” syndrome in which they have a painful shoulder with throwing
and can no longer throw with pre-injury velocity.
• They may also report a loss of velocity and accuracy along with
discomfort in the shoulder.
• The majority of patients with SLAP lesions will also complain of:
1. Sensation of painful clicking and/or popping with shoulder
movement
2. loss of glenohumeral internal rotation range of motion
3. pain with overhead motions
4. loss of rotator cuff muscular strength and endurance
5. loss of scapular stabiliser muscle strength and endurance
6. inability to lie on the affected shoulder
EXAMINATION
Inspection of the involved extremity, noting muscle bulk, atrophy etc

Inspection the affected shoulder and compared to the unaffected side

Check bilateral passive and active range of motion, noting any motion
that elicits pain (frequently seen with passive external rotation at 90° of
shoulder abduction)

Motor strength is next tested, noting rotator cuff pathology or shoulder

instability
SPECIFIC DIAGNOSTIC MANUEVERS
• A combination of two sensitive tests and one specific test is useful to
diagnose SLAP lesion
• Sensitive tests – O’Briens Test and Apprehension test
• Specific Test – Biceps Load test II
• If one of the three tests is positive, this will result in a sensitivity of
about 75%
• But if all three tests are positive this will result in a specificity of about
90%.
O’Briens Test
With the patient in sitting or standing, the upper
extremity to be tested is placed in 90° of shoulder
flexion and 10-15° of horizontal adduction

The patient then fully internally rotates the

shoulder and pronates the elbow

The examiner provides a distal stabilizing force as

the patient is instructed to apply an upward force

The procedure is then repeated in a neutral

shoulder and forearm position

A positive test occurs with pain reproduction or

clicking in the shoulder with the first position and
reduced/absent with the second position
Apprehension Test
The patient should be position in supine

Flexion of the patient's elbow to 90 degrees and

abducts the patient's shoulder to 90 degrees,
maintaining neutral rotation

slowly application of an external rotation force to

the arm to 90 degrees while carefully monitoring
the patient

Patient apprehension from this maneuver, not

pain, is considered a positive test
Biceps Load Test II
The patient is in the supine position

shoulder in 120 degrees of elevation

and full external rotation and the
elbow is in 90 degrees of flexion, and
the forearm in supination

patient is then asked to flex the elbow

while providing resistance

Patient will feel pain at this time

IMAGING
MRI is
investigation of
choice for
diagnosis
CLASSIFICATION

Snyder Classification
Types Labrum Pathology

Type I Fraying and degeneration of Superior

Labrum. Biceps remain intact
Type II This is an avulsion of the upper labrum and
Anterior-IIA the insertion of the long biceps
Posterior-IIB
Mixed-IIC
Type III “bucket handle” lesion of the upper labrum
with an intact biceps
Type IV Vertical tear of labrum extending into biceps
NONOPERATIVE MANAGEMENT
Majority of SLAP tears are tried first with

1. Anti inflammatory medications

2. Cryotherapy
3. Ice application
4. Rest and activity modification
OPEARTIVE MANAGEMENT
• Type I – Debridement
• Type II – Anatomic arthroscopic repair
• Type III – Debride Labrum
• Type IV – Repair of Labrum and Biceps tendon tear
THANK YOU