The Doctor Is In: SLAP Lesions

Published in the November/December 2007 issue of Women’s Adventure Magazine

“Whenever I serve in tennis, I get a sharp pain in my shoulder.”

“My shoulder has been popping and catching ever since my dog jerked my arm on a walk three months ago”

“I’ve been a distance swimmer for many years, but I just started noticing a sharp pain deep in my shoulder with the backstroke.”

“Ever since I fell skiing six months ago, my shoulder aches whenever I lift something heavy.”

Four different women, four different complaints- and all with the same diagnosis: a SLAP lesion.  What is it?  Post Falls, ID based orthopedic surgeon Joanne Halbrecht, M.D., breaks it down for us.

The shoulder is the most complicated joint in the human body.  Unlike the knee and elbow, which can only bend and straighten, the shoulder can move in a circle (circumduction).  Anatomically, the shoulder consists of numerous muscles, several nerves, and a socket that is seemingly too small to hold the ball of the humerus (arm bone) in place.  The oddest of all of these structures is the attachment of the biceps tendon deep in the shoulder.  The biceps tendon blends with the labrum, the cartilage rim that surrounds the socket.  The labrum attaches to the bone around the socket.  The attachment can tear if there is repetitive stress to the biceps such as during sports like swimming, volleyball or tennis.  It can also tear as a result of a fall or direct trauma to the shoulder.  The acronym SLAP stands for superior labrum anterior posterior, which describes the anatomic location of the tear.  Symptoms of a SLAP lesion include popping, catching, weakness, pain with overhead activity, or aching with activity.  Because of the varied causes and symptoms, this diagnosis remains one of the most difficult in the shoulder.

Diagnosis is made using the individual’s history, a physical examination, and an MRI (magnetic resonance imaging scan).  The level of experience of the orthopedist and the radiologist are important factors in making a correct diagnosis.

Symptoms will persist unless the SLAP lesion is repaired surgically.  This requires arthroscopic surgery, the use of a sling for three weeks, and physical therapy.  You can expect to be active again three months after surgery.

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