SLAP Lesions: Structure, Function, and Physical Therapy Diagnosis and Treatment

Peter A. Huijbregts, DPT, OCS, FAAOMPT

Abstract: This article describes the structure and function of the labral-bicipital complex. It also discusses incidence, classification, injury mechanisms, subjective and physical examination findings, and conservative treatment options for lesions to the labral-bicipital complex, also known as SLAP-lesions.

Key Words: Labrum, SLAP-Lesion, Structure, Function, Diagnosis, Treatmen

The glenoid labrum receives only scant attention in classic anatomy texts: Spalteholz and Spanner1 devote one line in their entire text to the labrum, describing it as a fibrocartilaginous structure reinforcing the glenoid cavity. Advances in arthroscopic surgery have, however, greatly increased our need for a more precise anatomic description. At the same time, these advances have enhanced our ability to diagnose, treat, and understand labral pathology2, including lesions to the superior labrum and the tendon of the long head of the biceps. This labral-bicipital-complex is becoming increasingly recognized as an important stabilizing structure for the glenohumeral joint3.

In 1985, Andrews et al4 described antero-superior glenoid labrum tears in 83% of 73 throwing athletes evaluated arthroscopically. In 1990, Snyder et al5 retrospectively reviewed 700 shoulder arthroscopies and identified 27 patients with an injury to the superior labrum; they established a classification system for these injuries and coined the acronym “SLAP”-lesion for Superior Labrum, Anterior and Posterior-lesion. In a later retrospective review, Snyder et al6 described 140 (6%) of 2375 patients treated arthroscopically as presenting with a SLAP-lesion. Maffet et al7 found arthroscopic abnormalities of the superior labrum in 206 (29%) of 712 patients. LaBan et al8 noted that 16% of all rotator cuff tears are accompanied by SLAP- lesions. Field and Savoie9 observed a 2% prevalence of two types of unstable SLAP-lesions during two years of arthroscopic shoulder surgeries. Based upon studies with a large series of patients undergoing an arthroscopy for various conditions, Bey et al10 estimated the prevalence of SLAP-lesions in this admittedly heterogenous population to be between 6 and 11%.

The superior labrum-biceps complex plays an important role in the function of the glenohumeral joint. Accurate diagnosis of a SLAP-lesion may have important implications for pursuit of a conservative approach. This article describes the structure and function of the labrum-biceps complex. It also discusses diagnosis using the means available to the physical therapist as well as conservative treatment options for SLAP-lesions. The goal of this article is to improve the therapist’s understanding of SLAP-lesions to facilitate appropriate evaluation and treatment decisions.

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