Lesions Of The Shoulder SLAP Tear - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing SLAP tear lesions of the shoulder.

SLAP tear is a tear at the top of the glenoid labrum.
The MRI sensitivity is about 50%, but when you do MRI arthrogram, the specificity is over 90%.
A Buford complex superiorly is not a tear (not a SLAP tear). SLAP tear is a difficult diagnosis.
Type II SLAP tear is the most common type and in young adults, you will repair this tear. In this situation (Type II), the superior labrum is completely torn from the glenoid. SLAP tears can be isolated or be a part of internal impingement, which has an articular sided cuff tear. SLAP tears may also be associated with shoulder instability. SLAP tears may also be associated with a cuff tear in about 40% of the time.
SLAP tears are common in throwing athletes, however they are not common in general and are hard to diagnose.
The anterosuperior labrum has a poor blood supply. The superior labrum anchors the biceps just posterior to the 12 o’clock position. The superior labrum is weak and subject to tearing. Superior labrum tear is a SLAP tear.
There are four types of SLAP tears. Type I is fraying of the superior labrum, do a debridement of the labrum. Type II is a detached biceps tendon anchor, if the patient is young, reattach the biceps anchor to the labrum. Type III is a bucket handle tear with intact biceps insertion, do a debridement of the bucket handle. Type IV is a bucket handle tear that extends to the biceps tendon, this will create a detached biceps tendon anchor. Treatment is a debridement plus biceps tenotomy or biceps tenodesis.
Symptoms: The patient will have deep shoulder pain with catching, popping, clicking and weakness, decreased throwing velocity or distance and difficulty in overhead activity.
Examination: The O’Brien’s Test is the most commonly used test. There are a lot of other tests that can be used to diagnose a SLAP tear. The more positive the test, the most that you can confirm the presence of a SLAP tear. MRI arthrogram can then be used for definitive diagnosis. There may also be some tenderness over the area of the biceps if the process involved the biceps tendon.
If the patient has a spinoglenoid cyst as diagnosed by MRI, this will involve the suprascapular nerve and the patient will have decreased external rotation due to involvement of the infraspinatus.
When you treat the SLAP tear by either repair or debridement, you then want to decompress this cyst.
O’Brien’s Test: patient is standing or sitting with the arm at 90° of flexion, 10° of adduction, and full internal rotation with the forearm pronated. The examiner applies pressure to the forearm and instructs the patient to resist the applied downward force. Pain at the shoulder joint suggests a SLAP lesion. Decrease in pain of the shoulder joint on supination of the arm is suggestive of a SLAP tear.
MRI Arthrogram: MRI arthrogram is the best study to diagnose a SLAP tear. You want to look at the coronal images, because you want to see the superior labrum. With a Bankart lesion, you want to look at the axial cut, because you want to see the anterior labrum. The normal superior labrum is seen on coronal MRI as a black signal. The superior labrum is completely dark and triangular. A bright signal within the superior labrum is a SLAP tear. The dye will only go inside the labrum if there is a tear of the labrum. The white area with the dye inside highlights the area of the tear.
Treatment: in general treatment should start with physical therapy, anti-inflammatory medication, and injections. When conservative treatment fails, surgery is considered. Surgery includes debridement, biceps tenodesis and biceps tenotomy (in older population).


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