A SLAP tear is a tear
that occurs where the biceps tendon inserts into the superior labrum. A SLAP
tear is different from a Bankart lesion. A Bankart lesion is a lesion of the
anterior inferior labrum, and it usually occurs with shoulder dislocation. SLAP
tear is not common and can be hard to diagnose. Symptoms include pain deep
within the shoulder or in back of the shoulder, pain when throwing a ball with
decrease in velocity and the feeling of having a dead arm after pitching, pain
with overhead activity which mimics impingement syndrome, and SLAP tear
typically affects throwing athletes. When the biceps tendon is involved, pain
may also be located at the front of the shoulder. SLAP tear can be an isolated
lesion or it can be associated with internal impingement, articular sided cuff
tear, or associated with instability. For clinical examination diagnosis of
SLAP tear, usually the O’Brien test is the most commonly used test. Multiple
tests are usually used (anterior slide test, clunk test, etc.). MRI with
contrast is usually helpful. To perform the O’Brien’s test, the patient is
standing or sitting with the arm at 90 degrees of flexion, 10 degrees of
adduction, and full internal rotation with the forearm pronated. Do internal
rotation of the arm with pronated forearm. The examiner applies pressure to the
forearm and instructs the patient to resist the applied downward force. Pain at
the shoulder joint suggests a SLAP lesion. Decrease in pain of the shoulder
joint on supination of the arm is suggestive of a SLAP tear. Decrease in pain
on supination of the arm. A normal labrum is seen on coronal MRI, and the
normal superior labrum will show a black signal. The superior labrum is
completely dark and triangular. A bright signal within superior labrum indicates
a SLAP tear. Type II is the most common type. Type III is a bucket handle tear.
White area with dye inside highlights the area of the tear. Treatment includes
physical therapy, anti-inflammatory medication, injections, and surgery when
conservative treatment fails. Surgery can be labral debridement for minor
tearing and fraying. Biceps tenodesis is becoming popular; it is a procedure
that cuts the biceps tendon where it attaches to the labrum and reinserts it in
another area, usually in front of the shoulder. Biceps tenotomy is a procedure
that cuts the biceps tendon from the glenoid and lets it fly. Releasing the long
head of the biceps tendon from its attachment allowing it to fall into the
upper arm out of the shoulder joint. Biceps tenotomy is probably suitable for
some elderly patients. The patient may get a Popeye deformity and cramping of
the upper arm. SLAP repair is a procedure which uses sutures to anchor the torn
labrum to the glenoid. It is usually done for athletes and patients under the age
of 40 years old.
