SHOULDER SLAP Lesions
Shoulder Anatomy
The shoulder is the most mobile joint in the body consisting of bone, soft tissues and joint fluid. In order to achieve this designation is must rely primarily on soft tissue constraints for stability rather than boney boundaries such as is seen in the hip joint. The soft tissues which consist of muscles, ligaments, tendons, a joint capsule and articular cartilage serve to provide a stable environment for the humeral head as it rests 
in the socket or “glenoid” of the shoulder. When any of these tissues is disrupted the result is a loss of the vacuum phenomenon which also aids in joint stability. Picture a golf ball resting on a tee and you essentially have a shoulder joint minus all of the collective tissues that provide stability. The ball represents the “humeral head” of the arm bone and the tee is the glenoid socket. Along the periphery of the shoulder’s glenoid socket lies a circumferential cartilaginous rim known as the “labrum”. Attached to this labrum are the glenohumeral ligaments, the long head of the biceps tendon and the shoulder capsule. The most upper portion of the cartilage rim is known as the “superior labrum” and this is where the “biceps tendon” attaches. A SLAP lesion occurs when the superior labrum is torn in a front (anterior) and back (posterior) manner hence the designation “superior labrum, anterior to posterior” lesion. As arthroscopic surgery has evolved the types of tears have as well, with SLAP tears now encompassing circumferential lesions of the entire glenoid. 
These are uniquely designated by a numeric nomenclature. Traditional SLAP lesions can be the result of chronic degeneration, an acute traumatic event in which the labrum itself is torn or its attachment to the glenoid or the biceps is avulsed. Typically this is seen in individuals who perform repetitive throwing motions or have a history of falling on an outstretched arm or have had a sudden force applied to the contracted biceps. A direct blow to the shoulder while in a throwing position is also a common mechanism of injury and is frequently seen in Football players.
SLAP Tears Common Signs and Symptoms
Patients typically present with deep shoulder pain that is worse with overhead activities. Throwers will especially complain that their pain occurs after ball release with their follow through. Intermittent locking, clicking, or snapping of the shoulder may occur and is frequently associated with pain. A complaint of instability or the shoulder wanting to come out of socket is common but usually applies to the more severe cases. Additional complaints include pain, tenderness, and weakness in the front of the shoulder, with attempted elbow bending or rotation of the wrist, such as when using a screwdriver. The risk of sustaining this injury is increased in participants of contact sports, overhead sports like baseball, tennis or volleyball and those with a history of shoulder instability (dislocations and or subluxations). When other structures in the shoulder are decompensated, such as with a rotator cuff tear, then the remaining structures must pick up the slack and with time can become damaged as well, the labrum is one of these structures.
Treatment Considerations
Initial treatment consists of activity modification, anti-inflammatory medication and ice. Physical therapy both formally and home based can be initiated with a program that focuses on stretching and strengthening exercises. Often pain will persist due to an inability of the labral tear to heal on its own. The reason for this is more easily understood if one thinks of the labrum and its attachments as a rubber band that is on stretch with the stretch decreasing and increasing depending on arm position. Once the taut rubber band is torn the ends retract away from each other and therefore cannot heal unless the ends are re-approximated back to their native positions. Re-approximation of these tissues is done via Arthroscopic surgery. Surgery is recommended if symptoms persist after a period of nonoperative treatment has been attempted and failed. Through the use of small arthroscopic instruments, of which the sizes are roughly that of a common ball point pen, the labrum is debrided (cleaned and torn pieces and fragments removed) and or reattached back to the glenoid surface. Reattachment is achieved with suture (thread) and suture anchors that with time are absorbed by the body. If a repair is undertaken then a period of immobilization is recommended to allow the labrum to heal to the glenoid. Physical therapy after surgery is always recommended and is an integral component in the overall functional recovery of the patient with the ultimate goal being a return to full shoulder motion and strength.