A superior labral anterior and posterior lesion, commonly known as a SLAP lesion, is an injury to the labrum of the shoulder joint. The labrum is the cuff of cartilage that forms a cup for the arm bone to move within, increasing shoulder stability. Injury to the labrum is often caused by a repetitive motion that pulls on the biceps tendon or an acute type of trauma such as a shoulder dislocation or fall with the arm stretched out. It may also be due to wear and tear in the superior labrum that occurs over time and generally appears in individuals over the age of 40.
Patients with a SLAP lesion may experience pain with movement, limited range of motion, frequent dislocation and a catching sensation in the shoulder. SLAP lesions are typically diagnosed after a medical history is taken and a physical examination is performed. In addition, imaging testing may be necessary, which may include X-rays or an MRI scan.
There are several different variations of SLAP lesions, each of which may require its own specific treatment. Some SLAP lesions may only cause mild pain that patients can choose to treat with conservative measures if they do not want to undergo surgery, as this condition may not worsen with time. For those SLAP lesions that cause more severe pain, surgery is usually the most effective course of treatment.
Surgery to repair a SLAP lesion is performed on an outpatient basis and generally takes approximately 90 minutes to complete. General anesthesia is administered to the patient and in some cases a nerve block is used as well. These procedures can usually be performed arthroscopically through several small incisions into which a camera and tiny surgical instruments are inserted.
Whether the surgical approach is arthroscopic or open, there are a number of ways to repair the damage to the labrum. The technique used may not be determined until the tear is visible to the surgeon and the procedure may include:
Patients may experience some pain and mild swelling following the surgery, but this should be relieved by prescription medication and application of ice to the site. To support and protect the arm during the initial phase of healing, a sling will be worn for two to four weeks following the procedure. It is important for patients to comply with the doctor’s instructions on use of the sling because keeping the arm immobilized greatly improves the chances of a successful outcome.
Physical therapy may be required for several months after surgery to ensure that the joint heals properly. Physical therapy can be quite effective in improving flexibility and regaining strength in the affected shoulder. Most patients can return to sedentary jobs after a few weeks, but the timing will depend on both the severity of the damage and the individual’s progress in recovery. Sports and other active pursuits may typically be resumed within four to eight months.
While SLAP repair is considered a safe procedure with a very low incidence of complications, there are some risks inherent in any form of surgery. The risks associated with a SLAP repair may include infection, formation of a blood clot, bleeding, stiffness in the shoulder and nerve or blood vessel injury.