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A SLAP lesion is a tear to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint.
In this blog, you’ll discover everything you need to know about SLAP lesions and how to find relief.
How Does the Shoulder Joint Work?
The shoulder is a ball and socket joint.
One side of the joint is concave, and the other is convex.
You can envision the system as a ball housed within a shallow cup.
These two sides fit snugly together and allow the convex side of the joint (located at the end of the humerus) to move within the socket and mechanically traverse a tremendous range of motion.
The socket portion of the shoulder joint (called the glenoid fossa) is shallow and lacks sufficient depth to stabilize the loads required for all shoulder motion.
To compensate for this mechanical disadvantage and add stability to the joint, the body has evolved to surround the glenoid fossa with fibrocartilage on all sides.
This ring of cartilage is called the glenoid labrum (1).
There is also an integrated network of capsular ligaments that hold the shoulder joint’s bones together to add further stability.
(Remember, ligaments are tissues that connect one bone to another bone.)
The shoulder joint would never be able to move without muscles crossing over the joint.
These muscle groups are commonly known, like the rotator cuff muscles (teres minor, supraspinatus, infraspinatus, and subscapularis) and the biceps.
Other muscle groups are slightly less known but also play a significant role in providing stability and movement of the shoulder.
These obscure muscles include the latissimus dorsi, the pectoral muscles, and the rhomboids.
These muscles, and some not listed, work together to give the shoulder joint motion in 6 different planes: flexion, extension, adduction (arm across your chest), abduction (arm up to the side), internal rotation, and external rotation.
The incredible engineering required to provide the intricate motions of the human shoulder also renders the system vulnerable to injury or malfunction.
Everyday stresses like poor posture or repetitive movements (like sports, driving, or even blow-drying your hair) can result in shoulder dysfunction.
We treat the common shoulder conditions thoracic outlet syndrome, rotator cuff tears, tendonitis, and labral tears.
What is a SLAP Lesion?
SLAP stands for Superior Labrum Anterior and Posterior.
In this condition, the superior or top part of the labrum tears away from the glenoid fossa, anatomically attached.
The labrum is the fibrocartilage portion of the shoulder joint that helps with stability and provides an anchor point for the bicep tendon.
The 4 Types of SLAP Lesions
Four types of SLAP lesions are categorized depending on the severity of the injury and the structures involved.
- Type 1 SLAP Lesion: an instance where the top part of the labrum begins to fray and degeneration of the cartilage fibers can occur.
- Type 2 SLAP Lesion: a condition where there is some detachment of the labral fibers and biceps tendon (remember, some of the bicep tendon fibers attach to the labrum).
- Type 3 SLAP Lesion: colloquially referred to as a “bucket handle” tear. In this disorder, the labrum rips in a half-circle flap, which resembles the shape of a bucket handle. In this type of lesion, the biceps tendon remains attached. (2)
- Type 4 SLAP Lesion: a condition that includes a Type 3 “bucket handle” and the fibers of the biceps tendon are also damaged and begin to tear away with the labrum.
The Most Common Symptoms of a SLAP Lesion
Many activities or motions can cause a SLAP lesion.
The damage can occur gradually from activities like sports, or from trauma like fall or automobile accident that results in shoulder dislocation.
Many people with a SLAP tear will present with pain along the top of the shoulder.
Depending on the severity of the damage, some people experience weakness in the shoulder, especially with overhead movements.
A SLAP lesion can also create shoulder instability (4).
What does shoulder instability feel like? The joint might feel like it” could quickly move out of the socket” or has a “loose” feeling.
How Do I Know if I Have a SLAP Lesion?
Several orthopedic tests can be administered to indicate a shoulder injury.
Common Tests for Shoulder Injury
These more popular tests include:
These tests can diagnose specific structural dysfunctions and indicate the root cause of pain, but SLAP lesion certainty must be observed through diagnostic imaging of the shoulder.
Your doctor might refer you for an MRI or a CT arthrogram to confirm the presence of a SLAP tear and accurately grade the specific type of lesion present (4).
Some shoulder conditions may have similar symptoms to a SLAP lesion.
Shoulder hypermobility might exhibit the same loose feeling in the shoulder.
Shoulder impingement or a thoracic outlet syndrome can also cause pain in the shoulder.
For these conditions, chiropractic care and other conservative treatments can be employed to relieve your shoulder pain symptoms.
The Best Treatment Options for SLAP Lesions
Treatments for a SLAP lesion vary depending on your age, activity level, type of lesion (see types 1-4 above), and the mechanism of injury.
Was it a traumatic injury, or is it a chronic repetitive motion condition?
In most cases, conservative care is used to treat SLAP lesions.
Conservative treatments often include:
- Therapeutic Exercises
- Chiropractic Care
- Massage Therapy
- Targeted Medications
A SLAP lesion of any degree will often create shoulder instability, making it the primary treatment goal to incorporate exercises that strengthen and stabilize the shoulder.
Other modalities like massage therapy and medications will also relieve some of the discomforts that patients with SLAP lesions experience.
If conservative treatments are not helping relieve the pain from a SLAP lesion, surgery might be required.
Different surgical options depend on the type of SLAP tear diagnosis.
For a minimal tear like we see in a type one SLAP lesion, Stathellis et al. suggests that simple debridement (removal of the damaged tissue) might be the best surgical option.
For more severe SLAP lesion types, surgeries can range from resection (removing part of the tissue) to tendonitis (attaching a damaged tendon back to the bone) (3).
How Chiropractic Care Can Help Heal SLAP Lesions
As we discussed above, different types of SLAP lesions require different approaches to care.
So, how can a Chiropractor help with your pain?
Chiropractors work with extremities as well as the spine.
If you have a shoulder injury, a Chiropractor can perform the necessary neurological and orthopedic tests to help determine each of the structures involved in your injury.
Additionally, the Chiropractor can refer you for specific imaging studies (x-rays or MRIs) to guide the team in developing a homogeneous plan for treatment.
The treatment team will incorporate all the tools available to diagnose, treat, rehabilitate, and assess the corrective course of action.
As stated, conservative care is often the first step in treating a SLAP lesion.
A chiropractor is instrumental in employing massage techniques, joint manipulation, or therapeutic exercises that aid in recovery.
The shoulder joint consists of a complex system of bones, cartilage, and muscles.
An injury at the shoulder can become the root cause of underlying pain or restriction in the mid-back, neck, and elbow.
In addition to rehabilitating the shoulder, a Chiropractor can work on the adjacent structures to help avoid compounding injuries.
If your SLAP lesion is severe enough to require surgery, your Chiropractor should play an integral role within your holistic treatment approach.
An integrated treatment team providing an asymmetric course of treatment ensures your recovery considers all effective correction methods, rehabilitation, and assessment.
If you suspect you may have a SLAP lesion, talk to your doctor about symptoms you are experiencing and discuss all aspects of potential treatment.