SLAP Lesion (Superior Labral Anterior Posterior)

Updated 02/21/2015
Written and edited by Aruna Seneviratne, M.D

SLAP lesions are common injuries among athletes and some non-athletes. It can result in a painful shoulder and may cause a significant loss of power with throwing a ball or overhead motions such as a tennis serve or volley.

Symptoms:
A slap lesion can occur due to trauma due to falls or traction injuries, or repetitive use such as in athletes such as pitchers.

Biology: Why does it occur?
The labrum is a soft tissue structure that goes around the rim of the shoulder socket (the glenoid) like a rubber O ring. It serves to deepen the socket and provide stability to the shoulder. The long head of the biceps tendon is attached to upper part of the labrum, and if there is traction on it, it can tear the labrum off the bone in the upper part of the socket. If you think about a clockface, the SLAP lesion represents a tear of the labrum from 10 o'clock to 2 o'clock. A second mechanism is repetitive trauma that causes the labrum to tear.
Click to read Dr. Seneviratne's published research on SLAP lesions.

Common Diagnostic Techniques:
History: Diagnosing the problem begins with a detailed history that your surgeon will obtain from you.
Physical Exam: A thorough physical examination is then conducted by your surgeon.
X-Rays: Plain radiographs (X-Rays) are the most important diagnostic study that is performed initially. Several views will be obtained to diagnose the condition.
MRI: Allows the visualization of the damage to the soft tissues about the shoulder.

Treatment:
Non -operative:
Older patients can be treated non-operatively with a sling for a few weeks followed by physical therapy. On going pain may warrant surgery.

Operative:
There are several different ways to treat SLAP lesions, but the most common technique used by Dr. Seneviratne is the arthroscopic method. Arthroscopic SLAP repairs are reserved for patients under the age of 36. Those who are older, are treated with a procedure called biceps tenodesis, where the long head of the biceps is released from the labrum and transferred to the upper part of the humerus via a small incision. Thus, the operation that is chosen to treat the problem at hand is personalized to each patient.

The postoperative course:
SLAP repair surgery or biceps tenodesis surgery is an out-patient ambulatory surgical procedure.

After Surgery:
Pain after surgery of this nature is not very severe, and most patients manage the pain with Tylenol after a few days of narcotic pain medicine use. A sling is used for about 3 weeks. Physical therapy starts 1 week after surgery. Early healing occurs at 6 weeks post operatively. Full healing takes 6 months to an year. Most professional athletes take an year to return to their sport. Recreational athletes can return sooner at about 6 months due to the lower demand on the shoulder. Keep in mind that each patient is different and return to play will be guided by Dr. Seneviratne.

FAQ's
What is most common problem after SLAP repair?
Shoulder stiffness and loss of range of motion is the most common side effect of this operation. It is more common in patients older than 36 years of age. Even patients younger that 36 may develop shoulder stiffness. Dr. Seneviratne will carefully assess the risk factors and patient factors that may predict development of shoulder stiffness and choose the right operation for you. Other problems related to SLAP repair are the failure to heal and persistent pain. These are not common if the patient is selected carefully and meticulous attention to repair technique is used.

Can I get arthritis if I do not address my SLAP lesion?
The answer is unknown, but it is more likely to occur than in a patient without a SLAP lesion. SLAP lesions lead to mircro-instability of the shoulder and can damage the articular cartilage leading to arthritis in the future. Repair of a SLAP lesion may not necessarily prevent arthritis from occurring. Repair of SLAP lesions are performed to alleviate pain and restore power to a throwing arm.

What are the risks of shoulder SLAP repair or biceps tenodesis surgery?
Infection, bleeding, damage to nerves and blood vessels, recurrent dislocation and shoulder stiffness - all are very uncommon.

Will I have hardware in my shoulder?
A SLAP repair is performed using tiny suture anchors that are drilled into the rim of the socket. These are usually made of suture material, and patients do not feel them. For biceps tenodesis surgery, a small non metallic screw or a small metallic button will be used.

How soon after surgery:
  1. Can I drive?
    Usually in 6 weeks, but as early as 3 weeks.
  2. Can I return to work?
    About 1-2 days depending on your occupation, but a week off is recommended.
  3. Can I shower?
    Yes - in 48 hours.
  4. Can I resume sexual activity?
    Yes - within a day or two.

Can I fly in an airplane?
In about 1 week - you must arrange for an aisle seat, have your bags handled by someone else, and you MUST do ankle pumps every 15minutes, as DVT is a major concern. You must also take Aspirin to prevent DVT.