In this article, we will discuss the Clinical presentation, etiology and physical exam of SLAP lesions. So, let’s get started.
Clinical Presentation, Etiology and Physical Exam
The clinical diagnosis of SLAP lesions is difficult. Non-specific shoulder pain, particularly with over-head or cross-body motion, is the most common clinical presentation. Additional symptoms include popping, clicking, catching, weakness, stiffness and instability. The majority of patients present with concurrent shoulder injuries. In a retrospective review of 140 arthroscopically-proven SLAP lesions by Snyder et al, the reported incidence of associated intra-articular disease included 29% with partial rotator cuff tears, 11% of full rotator cuff tears, 22% with Bankart lesions and 10% with glenohumeral chondromalacia.
Clinical history may involve a traction injury, direct trauma to the shoulder or fall on an outstretched hand. Frequently, no antecedent injury or activity is reported. On physical exam, patient may have increased shoulder laxity and positive findings with many shoulder provocative tests. No single test or sign is specific for SLAP lesions and physical findings can be confusing due to associated lesions (e.g. rotator cuff tears). The clinical diagnosis of SLAP lesions is difficult and imaging plays a key role in diagnosis.
Recently, a cadaveric study has confirmed the peel-back theory of SLAP lesions. In the abducted and externally rotated shoulder, the biceps tendon assumes a more vertical and posteriorly directed orientation, which transmits a force to the superior labrum, causing it to peel off the glenoid. Common mechanism of injury include microtrauma secondary to repetitive overhead arm motion and direct trauma due to fall on an outstretched hand. Repetitive overhead motion such as throwing and swimming are thought to cause injury secondary to traction on the arm due to sudden pulling, throwing or other overhead motion. Additional findings in repetitive overhead motion injury include, undersurface rotator cuff tears, cystic change in the humeral head related to posterosuperior impingement and capsular laxity. Falling on an outstretched hand usually causes injury secondary to a compressive force applied to the shoulder, usually with the shoulder abducted and slightly anteriorly flexed. This mechanism can result in marrow edema secondary to impaction of the humeral head against the glenoid. If an associated anterior dislocation is present, a Hill-Sachs deformity and a Bankart lesions may occur.
