SLAP tear

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SLAP tear
Classification and external resources
Gray328.png
Glenoid fossa of right side. (Glenoidal labrum labeled as "glenoid lig.")
ICD-9840.7
 
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SLAP tear
Classification and external resources
Gray328.png
Glenoid fossa of right side. (Glenoidal labrum labeled as "glenoid lig.")
ICD-9840.7

A SLAP tear or SLAP lesion is an injury to the Glenoid labrum (fibrocartilaginous rim attached around the margin of the glenoid cavity). SLAP is an acronym that stands for "superior labral tear from anterior to posterior".

Overview[edit]

The shoulder joint is considered a 'ball and socket' joint. However, in bony terms the 'socket' (the glenoid fossa of the scapula) is quite small, covering at most only a third of the 'ball' (the head of the humerus). The socket is somewhat deepened by a circumferential rim of fibrocartilage which is called the glenoidal labrum. Previously there was some argument as to the structure (it is fibrocartilaginous as opposed to the hyaline cartilage found in the remainder of the glenoid fossa) and function (it was considered a redundant evolutionary remnant, but is now considered integral to shoulder stability). Most authorities agree that the tendon of the long head of the biceps brachii muscle proximally becomes fibrocartilaginous prior to attaching to the superior aspect of the glenoid. Similarly the long head of the triceps brachii inserts inferiorly.[1] Together these cartilaginous extensions of the tendon are termed the 'glenoid labrum'. A SLAP tear or lesion occurs when there is damage to the superior or uppermost area of the labrum. SLAP lesions have come into public awareness with their increasing frequency in overhead and particularly throwing athletes. The increased frequency relates to the relatively recent description of labral injuries in throwing athletes[2] and the initial definitions of the 4 SLAP sub-types[3] all happening since the 1990s. The identification and treatment of these injuries continues to evolve, however it is safe to say that a baseball pitcher suffering a 'dead arm' caused by a SLAP lesion today is far more likely to recover such that he can return to the game at its highest level than was the case previously.[citation needed]

Sub-types[edit]

At least ten types of this injury are recognized with varying degrees of damage,[4] seven of which are listed here

  1. Degenerative fraying of the superior portion of the labrum, with the labrum remaining firmly attached to the glenoid rim
  2. Separation of the superior portion of the glenoid labrum and tendon of the biceps brachii muscle from the glenoid rim
  3. Bucket-handle tears of the superior portion of the labrum without involvement of the biceps brachii (long head) attachment
  4. Bucket-handle tears of the superior portion of the labrum extending into the biceps tendon
  5. Anteroinferior Bankart lesion that extends upward to include a separation of the biceps tendon
  6. Unstable radial of flap tears associated with separation of the biceps anchor
  7. Anterior extension of the SLAP lesion beneath the middle glenohumeral ligament

Symptoms[edit]

There are several symptoms that are common with this type of injury:[citation needed]

Treatment[edit]

Very few patients with SLAP lesion injuries return to full capability without surgical intervention. In some cases, physical therapy can strengthen the supporting muscles in the shoulder joint to the point of reestablishing stability. For all other cases the choice is do nothing or have surgery to reattach the labrum to the glenoid.[citation needed]

While the surgery can be performed as a traditional open procedure, the recommended course of action is an arthroscopic surgery.[by whom?] This type of procedure is vastly less intrusive to the body and reduces chances of infection.[citation needed]

During the procedure the surgeon should check the general health of the shoulder joint.[why?] There are at least twenty different items of conditions that he/she should examine or look for.[citation needed] These include:


Procedure[edit]

Arthroscopic SLAP Lesion (type 2) repair

The basic procedure is as follows.

Following inspection and determination of the extent of the injury the basic labrum repair, be it SLAP or Bankart lesion is as follows.

The glenoid and labrum are roughened to increase contact surface area and promote re-growth.

Locations for the bone anchors are selected based on number and severity of tear. A severe tear involving both SLAP and Bankart lesions may require seven anchors. Simple tears may only require one.

The glenoid is drilled for the anchor implantation.

The anchors are inserted in the glenoid.

The suture component of the implant is tied through the labrum and knotted such that the labrum is in tight contact with the glenoid surface.

SLAP Tear


Repair of SLAP Tear


Repair of SLAP tear

Surgical recovery[edit]

Note that this timeline is only approximate and will vary according to surgeon preferences and the extent of damage.[citation needed]

References[edit]

  1. ^ Huber, WP; Putz, RV (1997 Dec). "Periarticular fiber system of the shoulder joint.". Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 13 (6): 680–91. PMID 9442320. 
  2. ^ Andrews, JR; Carson WG, Jr; McLeod, WD (1985 Sep-Oct). "Glenoid labrum tears related to the long head of the biceps.". The American journal of sports medicine 13 (5): 337–41. PMID 4051091. 
  3. ^ Snyder, SJ; Karzel, RP; Del Pizzo, W; Ferkel, RD; Friedman, MJ (1990). "SLAP lesions of the shoulder.". Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 6 (4): 274–9. PMID 2264894. 
  4. ^ Mohana-Borges AV, Chung CB, Resnick D (December 2003). "Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography". AJR Am J Roentgenol 181 (6): 1449–62. doi:10.2214/ajr.181.6.1811449. PMID 14627555. 

External links[edit]