The diagnosis of a Superior Labrum Anterior to Posterior (SLAP) Tear lesion is usually made by obtaining the history, imaging studies, and physical examination.
The most common cause of Superior Labrum Anterior to Posterior (SLAP) Tear is due to falls onto the shoulder or outstretched arm, lifting heavy objects, traumatic dislocation and overuse from overhead sports (e.g. pitcher). Therefore patient should be asked about any such incidents and/or occupation. Additionally, patients should be asked about any of the following symptoms which are commonly associated with SLAP tears:
Physical examination consists of evaluation of range of motion, strength and stability of the shoulder. The following examination maneuvers are used to assess for Superior Labrum Anterior to Posterior (SLAP) Tear:
To perform the crank test:
A positive test results in pain, a clicking sensation during the maneuver, or reproduction of symptoms similar to those experienced at work or sport.
During the Speed’s test:
A positive test results in pain in the anterior shoulder.[ii] Note: Speeds test is often used as a test for biceps tendon pathology, however it is also useful for assessing SLAP lesions. When performed following the first two tests it is has a specificity of 90% and sensitivity of 70% for diagnosis of a SLAP tear.[iii], [iv]
Imaging studies are always performed during evaluation of any orthopedic injury. Radiographic evaluation often starts with radiographs (x-rays) of the shoulder.
In most cases, the first line treatment for a SLAP tear is non-surgical and includes anti-inflammatory medication, rest and physical therapy. Non-steroidal anti-inflammatory medication is often used; this includes medications such as ibuprofen and naproxen. Other medications such as prescription pain relievers can be used to alleviate discomfort.
Conservative Management: Conservative management (non-surgical treatment) of SLAP has been shown to be unsuccessful in most patients. A trial course (6 to 8 weeks) of physical therapy and rehabilitation is recommended for patients who are not professional athletes. If pain and mechanical limitations persist, then surgical treatment should be strongly considered.[ix]
Post-operative Outcomes: Most patients report good to excellent results, with little or no physical restrictions within 3 months after arthroscopic surgical repair.[x], [xi], [xii] However, the results were not as good in patients who were throwing athletes.[xiii] Therefore surgical treatment of Superior Labrum Anterior to Posterior (SLAP) Tear due to over-use in athletes who throw over-head may be less successful than in other patients.
[i]Liu SH, Henry MH, Nuccion SL. A prospective evaluation of a new physical examination in predicting glenoid labral tears. Am J Sports Med. 1996;24(6):721. PMID:8947391
[ii]Gill HS, El Rassi G, Bahk MS, Castillo RC, McFarland EG. Physical examination for partial tears of the biceps tendon.Am J Sports Med. 2007;35(8):1334. PMID:17369556
[iii]Meserve BB, Cleland JA, Boucher TR. A meta-analysis examining clinical test utility for assessing superior labral anterior posterior lesions.Am J Sports Med. 2009;37(11):2252. PMID:19095895
[iv]Oh JH, Kim JY, Kim WS, Gong HS, Lee JH. The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion.Am J Sports Med. 2008;36(2):353. PMID:18006674
[v]Kim YJ, Choi JA, Oh JH, Hwang SI, Hong SH, Kang HS. Superior Labral Anteroposterior Tears: Accuracy and Interobserver Reliability of Multidetector CT Arthrography for Diagnosis. Radiology. Jul 2011;260(1):207-15. PMID:21518776
[vi] Connell DA, Potter HG, Wickiewicz TL, Altchek DW, Warren RF. Noncontrast magnetic resonance imaging of superior labral lesions. 102 cases confirmed at arthroscopic surgery. Am J Sports Med. 1999;27:208-213. PMID:10102103
[vii] Dodson CC, Altchek DW. SLAP Lesions: An update on recognition and treatment. J Orth Sports PhysTher 2009; 39: 71-79. PMID:19194018
[viii]Taljanovic MS, Carlson KL, Kuhn JE, et al. Sonography of the glenoid labrum: a cadaveric study with arthroscopic correlation. AJR Am J Roentgenol. Jun 2000;174(6):1717-22. PMID:10845512
[ix]Mileski RA, Snyder SJ. Superior labral lesions in the shoulder: pathoanatomy and surgical management. J Am Acad Orthop Surg. Mar-Apr 1998;6(2):121-31. PMID: 9682075
[x]Kim SH, Ha KI, Choi HJ.Results of arthroscopic treatment of superior labral lesions.J Bone Joint Surg Am. 2002;84-A:981-985. PMID:12063332
[xi] Coleman SH, Cohen DB, Drakos MC, et al.Arthroscopic repair of type II superior labral anterior posterior lesions with and without acromioplasty: a clinical analysis of 50 patients. Am J Sports Med. 2007;35:749-753. PMID:17267765
[xii] Schroder CP, Skare O, Gjengedal E, Uppheim G, Reikeras O, Brox JI. Long-term results after SLAP repair: A 5-year follow-up study of 107 patients with comparison of patient aged over and under 40 years. PMID: 22608888
[xiii] Ide J, Maeda S, Takagi K. Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes. Am J Sports Med. 2005;33:507-514. PMID:15722289