SLAP: Superior Labrum Anterior to Posterior
By Dr. Steven Bird

Let’s discuss one of the conditions of the shoulder. A SLAP lesion of the shoulder stands for Superior Labrum Anterior to Posterior. This condition can be very difficult to diagnose solely using orthopedic tests. In assessing the shoulder we take a broad approach at the position of the shoulder, a person’s posture, their movements and their recreational and exercise or sports activity history. SLAP lesions are seen more commonly in activities like heavy lifting, overhead exercise and even throwers, or the repetitive action of each.

In the shoulder joint there is the head of the humerus, the arm bone, that sits adjacent to the scapula in what’s called a glenoid fossa. That glenoid fossa isn’t particularly deep when looking at the bone architecture only. A band of tissue surrounds that glenoid to deepen the articulation of the humerus. While it does a moderate job at helping provide a better connecting point, the shoulder is still required to move in many ranges of motion. With that increased freedom of movement at the shoulder and repetition of movements, like throwing or heavy lifting, is the beginning of degeneration or fraying or a lesion of the labral tissue.

SLAP lesions have multiple types. They are as follows:
Type 1: a degeneration of the superior labrum with no bicep tendon involvement.
Type 2: a detachment of the superior labrum and biceps from the glenoid.
Type 3: a bucket handle tear of the labrum with an intact biceps tendon.
Type 4: a bucket handle tear of the labrum which is displaced into the joint along with biceps tendon anchor.

Using MR Angiograms is the gold standard at seeing the structure of the shoulder. While that is true there are plenty of asymptomatic patients that have SLAP lesions.

While assessing the shoulder to build a differential diagnosis list and proper treatments, we use orthopedic tests within our examinations.
Orthopedic tests are movements and positions that place the body or joints in positions to provoke symptoms. These tests will either be a positive or negative. Each of these tests are helpful to understand the whole picture. If one of the tests is positive or negative is not a guarantee to a definite diagnosis. Any functional tests performed show us what you can currently do and help to build your baseline.

Orthopedic and Functional Tests

Bicep Load Test
Crank test
Clunk test
Hawkins-Kennedy test
Forced Abduction and Elbow Flexion Test
Dynamic Labral Shear test
Quad Rock
Wall Angel
Throwing Mechanics
Lifting form

If you have a shoulder complaint of any kind you need an assessment to know what the diagnosis is, what your treatment options are. Having an experienced clinician to help you with all of this is imperative to a better outcome. Never guess, we assess. A great rule of thumb is “test, treat, retest, retreat.”

A SLAP lesion can be disabling in different ways for you compared to another. Doing nothing, leads to lack of shoulder range of motion, strength and ability to use your shoulder to even an adequate level.

At ChiroMovement, our assessment involves the above mentioned tests, along with appropriate movements and loading strategies of the shoulder. Your shoulder pain may seem scary or intense, but with proper testing, the right diagnosis and a plan in place, you can be confident that your injury won’t be disabling. Our goal is to see our patients lives improve through a guided treatment plan and recover well.

Treatment of SLAP lesions:

When taking the conservative approach to SLAP lesions when possible it is important to remember the baselines of your function and ability. A conservative approach incorporates manual therapies from mobilization to manipulation for joint segments with restrictions, soft tissue therapies to improve function of the shoulder complex and any regional areas of concern.
Conservative approach is a very acceptable approach for shoulder complaints, including SLAP lesions. Our biggest concern with the treatment of any shoulder condition is that your treatment plan progresses you toward a better function and restoration of the shoulder, as it was prior to injury or better.

Stathellis A, Brilakis E, Georgoulis JD, Antonogiannakis E, Georgoulis A. Treatment of SLAP Lesions. Open Orthop J. 2018 Jul 31;12:288-294. doi: 10.2174/1874325001812010288. PMID: 30197710; PMCID: PMC6110059.
Hester WA, O’Brien MJ, Heard WMR, Savoie FH. Current Concepts in the Evaluation and Management of Type II Superior Labral Lesions of the Shoulder. Open Orthop J. 2018 Jul 31;12:331-341. doi: 10.2174/1874325001812010331. PMID: 30197715; PMCID: PMC6110065.
Mathew CJ, Lintner DM. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018 Jul 31;12:303-313. doi: 10.2174/1874325001812010303. PMID: 30197712; PMCID: PMC6110067.