SLAP lesion

To allow you to move your arm again, pain-free

Taking the milk out of the refrigerator or lifting a water bottle. If you are unable to perform these everyday movements without pain, you may have a SLAP lesion. This is a rupture or tear of the glenoid labrum in the glenoid cavity. 

Our experts at Schoen Clinic specialise in treating SLAP lesions. They will find the cause and the right therapy together with you.

Causes & symptoms

What do we understand by a SLAP lesion?

Our glenoid cavity is surrounded by a fibrocartilaginous rim (glenoid labrum). SLAP is an abbreviation and stands for a superior (topmost) labral tear from anterior (front) to posterior (back). In simple terms, this is a tear or rupture at the upper edge of the joint socket. There is a special feature here: The long tendon of the biceps muscle is attached to the upper edge of the glenoid labrum. The area of the upper glenoid labrum and the attachment of the long head of the biceps tendon is called the labrum-biceps tendon complex. Damage and tears in this complex are called a SLAP lesion (labral tear).

Differentiation of SLAP lesions

SLAP lesions can be divided into different types: 
  • Type I SLAP lesion: The upper portion of the glenoid rim is only frayed and not torn. 
  • Type II SLAP lesion: In this type, the glenoid rim is completely detached.
  • Type III SLAP lesion: There are bucket-handle tears to the rim here, allowing the torn labrum to droop into the shoulder joint.
  • Type IV SLAP lesion: This is a very rare version. This is a tear (type III SLAP lesion) that extends into the long head of the biceps tendon.

Causes of a SLAP lesion

There are two main causes of a SLAP lesion of the shoulder: This is either a chronic overload or an accidental injury.

SLAP lesion due to a chronic overload

This form of the disease is caused by frequent, extreme throwing movements such as baseball, handball, volleyball and tennis. During this overhead movement, the humeral head is brought into an excessive abduction and external rotation position. This leads to overloading of the long head of the biceps tendon. In the further course of the throwing movement, the forces can cause the upper glenoid labrum to “peel off” and lead to fibre tears. The repeated stresses can then lead to a SLAP lesion in the shoulder.

SLAP lesion due to accidental injury

A labral tear can occur due to sudden and unexpected tension or pressure on the pre-loaded biceps tendon. This can be a fall onto the outstretched arm or the sudden lifting of a heavy load. Younger patients who dislocate their shoulder, for example, may also experience a SLAP lesion.

Symptoms indicating a SLAP lesion

Patients with a labral tear typically have little pain at rest and during simple everyday movements. Movements of the shoulder over the head, on the other hand, are very painful. Rotating the arm behind the back, such as when reaching for a car seatbelt, also leads to pain. Some patients complain about a loss of strength in the shoulder and athletes lose speed when throwing. There are also patients who feel movements with a “cracking” sound.

Diagnostics

How we diagnose a SLAP lesion

It is not always possible to diagnose a SLAP lesion without any doubt, despite today’s possibilities. We can confirm the suspicion of a SLAP lesion with the help of many individual components. This requires a patient consultation with you, a clinical examination of your injury and subsequent imaging procedures such as magnetic resonance imaging (MRI). 

Special tests are available to us as part of the clinical examination. These are just as important as the MRI examination. It is often necessary to administer a contrast agent for the MRI examination. In this case, we rinse the tear in your shoulder joint with contrast agent to make the injury visible.