A common cause of shoulder joint instability is injury to the superior labrum. The labrum forms a fibrous ring that helps widen the surface of the glenohumeral joint in which the head of the humerus articulates. SLAP (Superior Labrum Anterior and Posterior) injuries can result from sudden injuries such as a motor vehicle accident, a fall onto an outstretched arm, or gradual “wear and tear” of the joint through the process of normal aging. Athletes that participate in overhead throwing sports are at higher risk due to repetitive shoulder motions, yet a large demographic is the elderly population with rotator cuff tears.
SLAP tears can be typed into seven classes of severity based on extent of the tear, the amount of labrum still attached, and involvement of muscle tendons interfacing with the joint. Provocative shoulder maneuvers performed during the physical exam may clue the clinician in to the diagnosis - the active compression test being the most useful. Common symptoms include a sensation of catching or popping, a sensation of impending dislocation with certain maneuvers of the shoulder as well as pain with resisted forward flexion with the arm in the internally rotated and slightly adducted position with relief from external rotation. MRI imaging aids in the visualization of soft-tissue injury while surgical arthroscopy remains the gold standard in diagnosis through direct visualization of the joint.
Treatment options range from conservative medical therapy that combines NSAIDs and physical therapy to more invasive options such as surgical fixation of the labrum or biceps tendon repair. Surgical repair of SLAP tears has shown improvement in pain and stability of the shoulder joint compared to pre-operative status with mixed outcomes for athletes hoping to return to pre-injury performance.
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