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SLAP Injuries

A commonly quoted research paper on the incidence of SLAP tears (superior labrum anterior-posterior) in ‘normal’ shoulders is the Orlando study from 2016. Randy Schwartzberg and his colleagues found that in 53 middle aged men and women (45-60) who had pain-free shoulders and never had surgery, that between 55-72% of them had signs of superior labral injury on MRI (one radiologist found 72% and the other 55%). The take home message may be interpreted as being that if at least 1 in 2 people have a SLAP lesion should we even worry about it if we see one on an MRI? Does this mean that athletic shoulders will show similar findings? Read on…

The Sports Injury Bulletin has presented a few articles in the past on SLAP tears and the management of these conditions (Issues 135, 155 and 156). What is evident is that there exists a high degree of variability in SLAP pathologies. Usually four variations are described (Types 1-4), however some authors have described up to 10 different types of SLAP lesions. These are too complex and in-depth to describe in this ezine.

It is likely that what the Orlando group found are the simple Type 1 SLAP tears that are described as simple fraying of the biceps anchor onto the labrum. As we get older, due to wear and tear, the biceps anchor may start to degenerate and show pathology that may in fact be 100% pain-free. Think of it as the ‘wrinkles’ or ‘grey hair’ of the biceps anchor.

However, in athletes (who on the balance of things tend to be much younger than 45) a small Type 1 SLAP tear may be felt as a ‘grumpy’ pain inside the shoulder and it may progress onto the more serious Type 2 and 3 lesions that will cause a degree of functional disability. Therefore, for the treating clinician or therapist, the dilemma may lie in the decision whether or not to MRI a sore shoulder. They may be lead into believing that it has a 50% chance of showing a SLAP tear anyway that may or may not be the source of the pain.

As with most things in sports medicine, it is an inexact science. For example, there are a host of clinical tests for SLAP lesions and none of them have great specificity and sensitivity. Often clinicians will conduct 4 or 5 different clinical tests for SLAP lesions and if they get more than 1 hit then they start increasing the suspicion of a SLAP lesion. The clinician will marry the clinical examination, the history of the injury and known mechanisms and then look at what the MRI shows to make a decision.

For the athlete involved in overhead sports (swimmers, tennis, cross fit etc..) or in the contact athletes (football and martial arts), even a Type 1 SLAP lesion may be a problem that can and should not be ignored. This should involve intensive and consistent rehab for the scapula and shoulder and entire kinetic chain and if this fails then surgical interventions may be needed.

Schwartzberg et al (2016) High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. The Orthopaedic Journal of Sports Medicine, 4(1).

Source: Sports Injury Bulletin

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