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What to do when your shoulder is a burden.

Shoulder injuries are among the most common suffered by athletes and nonathletes alike. When you're in pain or are experiencing weakness or instability in your shoulder, it's time to consult a specialist. Let's explore the most common questions about SLAP lesions.

What is a SLAP lesion, and what does SLAP stand for?

SLAP lesions are also known as SLAP tears. They are injuries to the glenoid labium, usually due to a sudden or forceful pull on the biceps through lifting a heavy object, falling or sustaining a trauma, such as a shoulder dislocation.

When you sustain a SLAP lesion, your superior labrum detaches from the biceps tendon. This is termed a SLAP lesion because it is an injury to the Superior Labrum both Anterior (in front) to Posterior (behind) the biceps tendon.

What is the labrum, and what does it do?

The labrum is the soft tissue situated between the humerus and the glenoid and helps stabilize the shoulder. This fibrocartilagenous structure goes all the way around the glenoid but is more defined at the front and top of the glenoid, so the labrum acts as a bumper for the joint. It allows the humeral head to fit more securely into the glenoid socket as well as permit the shoulder to have a wide range of motion.

What are the different types of SLAP lesions?

* Type I: These lesions involve the isolated fraying of the superior labrum surrounding the socket, without detaching completely from the glenoid. These lesions are typically degenerative in nature, are often found in older athletes and can be treated without surgery.

* Type II: This is the most common type of SLAP lesion, in which the labrum detaches from the top of the socket and the biceps tendon anchor. This type of tear exists in three variations, depending on daily activities and the mechanisms of the patient's injuries. However, no matter the variant of the tear, all three Type II SLAP lesions result in instability of the biceps-labral anchor.

The three variations are anterosuperior lesion, posterosuperior lesion and combined anterior and postereosuperior lesion.

* Type III: These are characterized by a bucket-handle tear of the labrum, with the labrum tearing and flipping into the joint with the bicep anchor still attached.

* Type IV: For this type, the bucket-handle tear of the labrum extends into the biceps tendon, causing instability of the biceps-labrum anchor.

What are the symptoms of a SLAP tear?

Here are several indicators of a SLAP tear:

* Deep pain in the shoulder joint.

* Pain with certain shoulder movements, such as stretching the arm behind the head, lifting objects overhead, throwing a baseball or football, hitting a tennis ball or serving a volleyball.

* Pain when keeping the shoulder in specific positions.

* Difficulty sleeping due to shoulder pain.

* Dull, throbbing ache in the shoulder joint.

* Shoulder weakness.

* Decline in sports performance, such as decrease in shoulder power, reduced range of motion or "dead arm" sensation.

* Feeling unsteadiness, as though the shoulder will pop out of the socket. For instance, locking, popping, clicking or grinding in the shoulder, or audible clicking and popping in your shoulder as you move.

How is a SLAP lesion diagnosed?

A SLAP tear is initially diagnosed through a thorough physical examination by a physician, a physician's assistant, a nurse practitioner, a physical therapist or an athletic trainer.

However, if there is significant evidence of a tear, an MRI is necessary to confirm the severity and obtain a more reliable diagnosis. More specifically, an MRI with dye (arthrogram) is typically ordered, which allows for better results. The dye is used because it will fill the space where the tear is, which makes the tear more visible on the MRI and thus easier for the radiologist to read and diagnose.

How is a SLAP lesion treated?

Treatment depends on the severity of the tear. Once the tissue tears away from the socket, the potential for healing is limited. The joint fluid of the shoulder serves as grease that impedes the ability of the tissue to scar back to the bone. In cases when pain persists after initial treatment, surgery is considered.

* Initial, non-surgical treatments can include:

* Non-steroidal anti-inflammatory medication, such as ibuprofen or naproxen.

* Physical therapy.

* Flexibility and range-of-motion exercises.

* Strength exercises for the muscles that support the shoulder.

* Steroid injection.

* Surgical treatment is another option.

SLAP lesions can be repaired arthro-scopically, in which the surgeon makes a small incision and inserts a small camera (arthroscope) into the shoulder joint. Then the surgeon will be able to completely assess the extent of the SLAP lesion and determine how best to repair the injury once it is fully visible on the screen during the arthroscopic surgery.

The repair route may include any of the following: removing the torn part of the labrum, reattaching the torn part of the labrum using sutures, and sometimes even cutting the biceps tendon attachment and relocating it to the armpit. These are all items to discuss with your physician while you go through your symptoms and possible need for surgery.

Who is at risk for SLAP tears? What are the risk factors?

This can be broken down into chronic injury, acute injury and aging.

Sports that require excessive use of the arm, especially repetitive overhead motions such as those in baseball, softball, swimming, weightlifting, tennis and football, tend to result in the labrum or cartilage progressively wearing down over time because of the repetition. This elevates the risk of a SLAP tear.

Acute or sudden trauma can also cause a SLAP tear. Typical instances of acute trauma are falling on an outstretched arm, pulling on the arm too powerfully or moving the arm quickly when it is over the shoulder.

Tearing or fraying your labrum can develop as part of the general aging process. SLAP tears are not uncommon injuries among people over 40.

When is it time to consult a shoulder specialist?

After reading this article, if you notice you've been experiencing similar symptoms with your shoulder or having persistent pain, it's best to get it checked. If you've had an acute injury with persistent pain, it's also recommended that you see a specialist.

By Robert Rolf
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Title Annotation:HEALTH
Author:Rolf, Robert
Date:Aug 1, 2019
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