A SLAP lesion is a specific injury to the upper biceps anchor, the so-called cartilaginous lip (labrum). This is located at the top of the shoulder joint in close proximity to where the biceps tendon originates. The injury can have various causes and is usually treated conservatively.
What is a SLAP lesion?
The term SLAP lesion is an acronym used in the medical field. The acronym SLAP stands for superior labrum from anterior to posterior and describes the location of the lesion. A lesion (Latin for injury) is nothing more than damage to the anatomical structures of the body. See wholevehicles for What are the Meanings of HIV.
This should make it clear that the physiological function of the affected area is reduced as a result of an injury. A SLAP lesion is therefore understood as an injury to the long biceps tendon. The lesion occurs where the biceps tendon enters the shoulder joint and radiates into the upper cartilaginous lip (called the socket). In medicine, a distinction is made between four different types of SLAP lesions (classification according to Snyder).
- Type 1: This is a degeneration of the upper cartilage lip (labrum) and the attachment of the biceps tendon (biceps anchor). Degeneration is understood as a formal, functional or structural deviation from the standard physical structure.
- Type 2: A tear of the biceps anchor originating from the upper edge of the shoulder socket (glenoid). The injury here occurs cranial (ie towards the head).
- Type 3: Bucket handle tear (special form of a meniscus lesion) with a functioning and uninjured biceps anchor.
- Type 4: Longitudinal split of the long biceps tendon. A characteristic feature here is that part of the biceps tendon is displaced caudally (that is, from the head downwards) into part of the joint space. Consequently, there is a dislocation.
Various factors can be considered as the cause of a SLAP lesion. Sudden and unexpected pressure on an already tight biceps tendon can occur (e.g., lifting heavy objects, falling on your arm, windsurfing). However, a SLAP lesion often presents as a sports injury.
In particular, throwers (e.g. tennis players, javelin throwers, long-distance throwers, baseball throwers) sustain micro-injuries in the course of their sport, which initially go unnoticed. When performing throws, massive torsional and tensile forces occur at the base of the biceps tendon. A large number of these micro-injuries can then lead to the formation of a SLAP lesion. SLAP lesions that develop in this way are also referred to as SLAP lesions caused by microtrauma.
Symptoms, Ailments & Signs
One problem with the SLAP version is that it has very different pain symptoms. That means not every patient experiences the same type of symptoms. However, loads in the overhead area are often perceived as painful.
The same applies to the execution of throws (abduction or external rotation) or the execution of throw-like movements. In some cases, such movements may result in an audible pop or snap. A SLAP lesion often occurs in addition to other injuries (comorbid pathologies).
Some studies report that 40 percent of the patients examined had rotator cuff injuries in addition to the SLAP lesion . Avulsion injuries and dislocations were also found.
Diagnosis & course of disease
Diagnosing a SLAP lesion is not easy. X -rays cannot detect it. This also applies to computed tomography (CT) or echography (sonography). The different pain symptoms of the lesion add to the difficulty.
Frequently, therefore, only a depiction of the injury by means of magnetic resonance imaging (MRI – magnetic resonance imaging) remains in order to make a final and reliable diagnosis. A speed test can be used as part of a purely physical examination without an MRI. This is an orthopedic test to examine the biceps tendon.
It is also called the Paml-up test. At best, the test is used as a supplement to the diagnosis of a SLAP lesion. In most cases, an MRI is then performed before which a contrast medium is administered. Even the representation in an MRI is not always perfect.
The contrast medium is administered by injecting it directly into the affected joint. The contrast medium flows out of the joint within 50 to 30 minutes on average, so that only a maximum of 30 minutes are left for the MRI to be carried out.
The SLAP lesion usually does not result in serious complications. However, those affected suffer from limited mobility of the affected arm. This can lead to incorrect posture and evasive movements, which accelerate joint wear and tear and can cause permanent malpositions. If severe pain sets in, this can affect the mental state of those affected.
An untreated SLAP lesion in particular therefore represents a significant impairment of quality of life and well-being. The therapy of the SLAP lesion is also associated with risks. Complications such as infection, bleeding or nerve damage can always occur during a surgical procedure. After the procedure, wound healing disorders occasionally occur or the seam opens and the operation has to be repeated.
In individual cases, the bone anchor used can slip and cause pressure pain as well as nerve and muscle damage. If medication is prescribed to the patient, side effects and interactions cannot be ruled out. Occasionally, after taking painkillers, headaches occur or the patient feels tired and exhausted. Rarely, cardiac arrhythmias and skin irritations can also occur. Allergic reactions to the substances used cannot be ruled out either.
When should you go to the doctor?
A SLAP lesion should always be treated by a doctor. In most cases, there is no self-healing, so that the affected person is dependent on medical treatment by a doctor. Failure to treat the SLAP lesion can result in significant discomfort or complications. A doctor should be consulted if the person concerned is suffering from significant pain. These usually appear at the top of the head, but can also spread to neighboring regions.
In many cases there are also limitations in movement. The bones may also make a snapping sound. If these symptoms occur, a doctor must be consulted. Dislocations also indicate the SLAP lesion and should always be examined. The earlier the SLAP lesion is recognized and treated, the better the further course of this disease.
Treatment & Therapy
Conservative therapy is only possible for type 1 lesions. The small tears on the stable biceps anchor are protected by immobilization. Larger tears are treated with surgery. Regular tears or lesions of types 2 to 4 are treated arthroscopically.
The torn or torn labrum is fixed in the usual place on the joint socket with small bone anchors and can then grow back in. This form of treatment is minimally invasive and is covered by health insurance companies. Inpatient admission is usually not necessary after successful agitation.
Prevention is only possible for throwers. As with other sports, they should take regular breaks. This avoids an excessive accumulation of microscopic injuries. Care must therefore always be taken to avoid overloading. The number of training units and the training duration should only be increased slowly in order to minimize the risk of injury.
Depending on the severity of the damage (five degrees of severity) and the decision of the relevant specialist, a SLAP lesion can be treated conservatively or surgically. Conservative therapy is used according to the rules for damage of severity level 1. Aftercare measures are then limited to continuing the therapeutically scheduled physiotherapy. The subject of physiotherapy are special physiotherapeutic exercises.
The exercises are designed to strengthen the rotator cuff in the shoulder joint. In addition, physical applications (e.g. electrotherapy or cold therapy) can be prescribed by a doctor to support the strengthening exercises during aftercare. If the SLAP lesion is treated in parallel with medication using anti-inflammatory drugs or cortisone injections, the medication must be checked regularly and adapted to the current clinical picture.
In the remaining four degrees of severity (grades 2 to 5), the SLAP lesion is treated surgically. The operation can be performed on an outpatient basis or clinically. The biceps tendon anchor is reconstructed (straightening, suturing or tenodesis) by means of arthroscopy. The task of aftercare is to support the healing of the surgical wound and to restore the full range of motion in the shoulder joint through physiotherapy.
For this purpose, the arm is placed in a shoulder pillow for a period of three weeks and gently mobilized through physiotherapeutic exercises while the tendons are healing. The physiotherapeutic exercises that are already started during the healing process are aimed at achieving optimal mobility of the shoulder joint in the affected person as early as possible.
You can do that yourself
With a SLAP lesion, the patient must rest. The biceps anchor injury is painful and may increase in intensity with movement. It is therefore important to wear a cast and to comply with the doctor’s instructions. The prescribed painkillers should be taken as discussed so that there are no bad postures and the injury subsides quickly.
Sport and other physical activities that involve the affected arm should be avoided until the doctor gives the okay. Instead, physiotherapy or physiotherapy is recommended. Yoga exercises are also possible, provided the SLAP lesion is not severe. The patient should ask a physiotherapist for advice on this in order to rule out any risks.
In addition, the cause of the lesion must be determined. It is usually caused by an accident or a fall, but a SLAP lesion can also occur as a result of chronic bone diseases such as rheumatism. If the symptoms do not subside in the usual time, a doctor’s visit is recommended. Because of its location on the biceps, the SLAP lesion is a condition that is difficult to heal. Therefore, further measures such as an operation may have to be initiated.