SHOULDER SLAP INJURY

The socket of the shoulder (glenoid) has a cartilage rim called the labrum. This is the attachment site of the shoulder capsule, the ligaments, and the long head of the biceps tendon to the socket. Injury to the superior labrum is called a SLAP lesion, which stands for Superior Labrum, Anterior to Posterior (front to back). This injury may be caused by degeneration but usually occurs from trauma. This is an uncommon source of shoulder pain in the average adult but it can cause considerable shoulder instability. Causes include repetitive throwing motions, falling on an outstretched arm, and a direct blow to the shoulder while in the cocked throwing position.

Contact sports, overhead throwing activities, history of shoulder dislocation, rotator cuff tears and poor physical conditioning all increase an athletes risk for this injury. Complications include prolonged healing time if not treated appropriately, recurrent symptoms, weakness of elbow bending or forearm rotation, and persistent pain.

Symptoms

Pain in the shoulder, worse with overhead activities and especially with follow through (after ball release)

Pain, tenderness, and weakness in the front of the shoulder, with attempted elbow bending or rotation of the wrist, such as with using a screwdriver

Intermittent locking, clicking, or snapping of the shoulder, often associated with pain

Weakness reaching overhead

Loss of velocity when trying to throw

Feeling of the shoulder wanting to dislocate

Crepitation (a crackling sound) when moving the shoulder

Considerations

Initial treatment consists of rest, ice, and anti-inflammatory medication to relieve the pain and inflammation. The next step involves stretching and strengthening exercises, and modification of the activity that initially caused the problem to occur. The key to treatment usually involves physical therapy to strengthen the rotator cuff muscles and the scapula stabilizing muscles. Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage. Anti-inflammatory medications may be prescribed to help with pain and inflammation. An injection of cortisone into the glenohumeral joint may be indicated in chronic cases or if the pain is severe.

Throwing athletes like pitchers or raqeut sports often have persistent pain despite adequate rehabilitation. If symptoms persist despite 6 weeks of physical therapy, surgery may be indicated to clean and remove torn fragments of cartilage or to reattach the cartilage back to shoulder socket. Reattachment may be performed with tacks or sutures (thread) and surgery is usually arthroscopic.

Post surgery, immobilization is usually recommended to allow the cartilage to heal to the socket. After surgery and immobilization, physical therapy is recommended to regain shoulder motion and strength.