A SLAP lesion is an injury involving the shoulder capsule, where the cartilage (glenoid labrum) that surrounds the shoulder socket is damaged. SLAP indicates the location of this injury; superior labral anterior & posterior. These injuries are common in overhead athletes, particularly throwing athletes like cricket, handball, baseball and water polo. Other physical activities like weightlifting and overhead gym based movements are also frequently associated with these injuries. The symptoms of a SLAP lesion commonly present as pain at the front of the shoulder, involving the biceps tendon. Symptoms are typically worse on overhead or throwing movements, with a potential painful click in the shoulder on movement.

These injuries very rarely occur on their own, with the biceps and rotator cuff tendons frequently involved in the pathology. Damage to the labrum is very common, many individuals however have no symptoms. MRI studies comparing symptomatic vs asymptomatic shoulders has highlighted how common labral damage is in both groups. What is interesting to think about, is that the cartilage of the labrum is minimally innervated with nerves. Whilst, surrounding structures of the shoulder complex have a higher innervation. Therefore, attributing the pain experienced to a SLAP lesion is very debatable. So when managing a condition that has showed a SLAP lesion on a scan, we treat and rehabilitate the entire shoulder complex. The goal is to establish tolerance to the many movements the shoulder completes. We speak about this a lot more when discussing rotator cuff related shoulder pain. By managing a SLAP lesion in this way, we are ensuring we are addressing it holistically. Most importantly we are improving confidence and restoring your faith in the ability of your shoulder to function.

If we want to be specific to a SLAP lesion, the anatomy is important to note. As mentioned earlier, a SLAP lesion includes the cartilage surrounding the shoulder socket (glenoid labrum). The role of the labrum is to provide stability and shock absorption within the shoulder joint. It also plays a role as an attachment site for the shoulder capsule, glenohumeral ligaments and the tendon for the long head of the biceps brachii muscle. This tendon anchors itself to the superior portion of the labrum and is commonly involved in the pathology of a SLAP lesion. The lesion of is characterised by beginning posteriorly and then extending anteriorly (to front of the shoulder), often including the anchor of the biceps long head tendon.

There are four types of SLAP lesion, graded based off severity and if the pathology involves the long head of the biceps tendon.

Type 1 - Evidence of degenerative changes and fraying of the labrum, however it is firmly attached to the glenoid rim of the scapula.

Type 2 - Involves a detachment of the superior labrum from the glenoid, with it including the long head of biceps tendon from the glenoid rim of the scapula.

This type of lesion is by far the most prevalent in throwing/overhead athletes, with it making up approximately 50% of cases.

Type 3 - The superior labrum is torn and displaced into the joint, however the biceps tendon is still attached to the glenoid rim.

Type 4 - The tear of the superior labrum extends into the biceps tendon, with it partly being displaced into the joint.

As mentioned earlier, conservative management (osteopathy and exercise rehabilitation) is the recommended treatment strategy. The goals are to improve the capacity in the shoulder to perform daily movements and athletic skills (like throwing). Surgical options are always available if conservative management fails after 8-12 weeks. However, surgical procedures carry risks and do not guarantee superior results to exercise rehabilitation. The Reform Lab Osteopathy guides you through a complete rehabilitation process in the elite gym Project Reform. This is one of the many reasons which makes our clinic unique.