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“SLAP” stands for Superior Labrum Anterior Posterior, and describes a tear or detachment of the shoulder’s superior glenoid labrum. The superior labrum is an anchor site for the long head of the biceps tendon which extends into the anterior and posterior portions of the labrum. Up to 1/4 of individuals undergoing shoulder arthroscopy demonstrate a SLAP lesion.

The glenoid labrum is a oval shaped rim of fibrocartilage that surrounds the entire glenoid socket. (4-6) The labrum is similar to the knee’s meniscus. (7) There are differences between the inferior and superior labrum. The inferior labrum is tightly attached to the glenoid rim. The superior labrum has a less secure attachment to the glenoid socket which makes it more “meniscus like.” (8) The superior surface of the labrum is also where 50% of the long head of the bicep tendon becomes the labrum.

One of the labrums functions is to deepen the shallow socket of the glenoid and to serve as an attachment site for tendons and ligaments. (9,10) Approximately fifty percent of the glenoids depth is from the labrum. (11) like the meniscus of the knee, the labrums blood supply decreases with age. (12,13)

Causes of SLAP injuries

Labral tears can be caused by injury or be the result of repetitive microtrauma. (14) If it is causes by injury, it is because of compression of the shoulder or traction downwards on the shoulder. (14) This is usually due to a fall or a direct blow to the shoulder. (14) This can happen from a fall onto an outstretched arm. (14)

SLAP lesions are most common in athletic populations, particularly those requiring overhead motions. (15) As was mentioned earlier the long head of the bicep inserts onto the labrum. One of the jobs of this tendon is to stabilize the shoulder and stop it from dislocating. This tendon also moves the top of the arm bone downward when the arm is raised overhead in order to stop it from compressing the labrum and subacromial contents. It protects the shoulder when it is healthy. When it is not healthy repetitive contraction of the bicep can rip a piece of the labrum off and if not addressed properly can cause problems as the tear progresses. (15)

SLAP injuries are almost never isolated problems and usually accompany rotator cuff dysfunction. The irritated rotator cuff tendons lose their ability to depress the top of the arm bone. Over time this can rip the labrum from its attachment. (16) Other possible problems that will show up with SLAP injuries are Bankart lesions (22% of SLAP cases), A/C arthrosis, instability and supraglenoid ganglion cysts. (17,19)

The most widely accepted classification system for these injuries is as follows:

Type 1- fraying or degeneration at the margins of the glenoid labrum. No detachment or biceps tendon avulsion.
Type 2- detachment of the glenoid labrum from the bony rim. Unstable biceps anchor that may be lifted during muscular contraction.
Type 3- the injury has progressed to a “bucket handle” displacement of the superior labrum into the glenohumeral joint. Is still attached to the glenoid rim and biceps tendon.
Type 4- There is a partial rupture of the long head of the biceps tendon in addition to the Type 3 injury.
Common symptoms of SLAP injuries

The severity of complaints is often equal to the complexity of the injury and can be a minor nuisance or completely disabling. Injured individuals describe a deep, vague, non-specific shoulder pain that is made worse by overhead and cross-body activity. (20,21) Complaints of popping, clicking, grinding or catching are common. (20,21) There is often weakness and stiffness that will limit athletic performance, particularly in overhead athletes. A common complaint is having a “dead arm.” (20,21) Pinching, slipping, apprehension or “looseness” are indications that there is instability from a more severe presentation.