SLAP lesion
A SLAP lesion is an injury to the fibrocartilaginous rim which surrounds the humeral head (the “ball” portion of your shoulder joint). The injury can occur at the front, back or both sides of the cartilage. There are many different forms of injury such as degeneration of the cartilage or a tear of the cartilage, there can also be an associated detachment of the biceps tendon in some cases. Repetitive throwing, falling on an outstretched arm, heavy lifting and direct trauma are common mechanisms of injury.
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1. Intermittent pain especially with overhead movements2. Painful clicking/popping of the shoulder
3. Loss of internal rotation
4. Loss of rotator cuff strength
5. Unable to lie on affected shoulder
Treatments
Arthroscopic surgery is a common treatment for these types of injury however the type of surgery can vary depending on the type of tear presenting. Many factors including age and level of sporting activity will determine whether surgery is advisable [1]. Conservative treatment with physiotherapy should be the first step for treatment aiming to increase global strength of the rotator cuff, shoulder girdle and core as well as increasing the dynamic stability of the shoulder [1][2][3][4]. Throwing exercises should be stopped for the short term and a course of anti-inflammatories may be advised [1][3]. Exercises to regain the internal rotation of the shoulder and stretch the shoulder capsule are important for overhead athletes [3]. Patients who are symptomatic and participate in throwing sports are most likely to fail with conservative treatment and need referred on for surgery [3]. If surgical intervention is required, then physiotherapy should be given after a period of immobilisation to gently regain range of movement and strength [3][4].References
1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095028/ Aydin, N., Sirin, E. and Arya, A., 2014. Superior labrum anterior to posterior lesions of the shoulder: diagnosis and arthroscopic management. World journal of orthopedics, 5(3), p.344.2. https://journals.sagepub.com/doi/abs/10.1177/0363546510370937 Edwards, S.L., Lee, J.A., Bell, J.E., Packer, J.D., Ahmad, C.S., Levine, W.N., Bigliani, L.U. and Blaine, T.A., 2010. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. The American journal of sports medicine, 38(7), pp.1456-1461.
3. https://www.jospt.org/doi/full/10.2519/jospt.2009.2850 Dodson, C.C. and Altchek, D.W., 2009. SLAP lesions: an update on recognition and treatment. journal of orthopaedic & sports physical therapy, 39(2), pp.71-80.
4. https://journals.sagepub.com/doi/abs/10.1177/0363546514526692 Cools, A.M., Borms, D., Cottens, S., Himpe, M., Meersdom, S. and Cagnie, B., 2014. Rehabilitation exercises for athletes with biceps disorders and SLAP lesions: a continuum of exercises with increasing loads on the biceps. The American journal of sports medicine, 42(6), pp.1315-1322.
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