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SLAP Lesion* Cheat Sheet (DRAFT) by

SLAP Lesion Rx, Hx, PE - Tibial dyfunction needed

This is a draft cheat sheet. It is a work in progress and is not finished yet.


- Superior Labrum Anterior Posterior
- Lesion is tear of glenoid labrum (rim of fibroc­art­ilage in the glenoid fossa) at that area
- Long head of bicep conver­gences with the labrum


- Injury­/re­pet­itive microt­rauma
- Superior compre­ssi­on/­sudden inferior traction
- Fall, direct blow to the shoulder, FOOSH with shoulder abducted and flexed
- Overhead (biceps pulls labrum from underlying bony attach­ment)
- Bicep stabilises shoulder by generating compre­ssive forces - limits transl­ation
Protects shoulder from anterior sublux­ation
Depresses humeral head during arm elevation
- Chronic SLAP
Rotator cuff dysfun­ction - unable to depress humeral head - superior migration of the humeral head happens
Labrum lifts from its attachment
Barkart, A/C arthrosis, instab­ility, suprag­lenoid cysts


- Type 1: Frayin­g/d­ege­ner­ation of the margins of the glenoid labrum without detach­men­t/b­iceps tendon avulsion
- Type 2: Detachment of the glenoid labrum from the bony rim - less stable biceps anchor - may be lifted during muscular contra­ction
- Type 3: Bucket handle displa­cement of the superior labrum into GH joint
- Type 4: Dysfun­ction + partial rupture of the long head of biceps tendon
- Most common = Type 1 and 2


- Young active male thrower, however it increases with age
- Hx of trauma
- Deep vague non-sp­ecific shoulder pain
- Provoked by overhead and cross body activity
- May have weakness and stiffness, popping, clicking, grinding, catching
- Pt complains of a "dead arm"
- Advanced will have S&S of instab­ililty


- Tenderness over long Head of Bicep
- Decrea­se/Pain in ROM in cross body adduction and flexion
- Increased transl­ation of humeral head (more advanced)
- +ve Active Compre­ssion
- +ve Jobes
- +ve Passive Distra­ction
- There is not a specific test for a SLAP lesion


- AC joint sprain­/pa­tho­log­y/d­ege­ner­ation
- Biceps Tendin­opathy
- Cx radicu­lopathy
- Brachial plexus injury
- Fractu­re/­dis­loc­ation
- Bankart Injury
- GH degene­ration
- Instab­ility
- Rotator cuff tendin­opa­thy­/tear


- Can be used to rule out other pathol­ogies
- US/ MRI (gadolium)
- MRI Findings:
HIgh signal intensity of Bicep tendon anchor on the labrum
Increased signal intensity at superior glenoid fossa
Displa­cement of superior glenoid from the labrum
Presence of glenoid labrum cyst
Thickening of the middle GH ligament is a normal variant


- Conser­vative management often unsucc­essful
- Improv­ement of symptoms mainly focused on restoring shoulder motion, rotator cuff balance, hip, core and scapula stability
- 6-12 week conser­vative care before surgery
- NSAIDs, stopping activities that aggravate pain
- Restore GH internal rotation (cross body adduction and sleep stretches) especially in throwing athletes
- Streng­thening of SCapula and rotator cuff muscles - balance of anterior (pec, upper traps) and posterior (lower traps, SA, rhomboid) muscles
- STW of subscap, infras­pin­atous, anterior shoulder muscue and posterior capsule
- SMT of Cx and Tx
- IF supras­capular nerve compressed from paralabral cyst, surgical consul­tation is crucial
- Clear traumatic and cases of instab­ility = surgery
- Surgical inverv­ention is usually unsucc­essful especially type 2
- 4-6 month rehab postop­erative is recomm­ended