SLAP Tear
The shoulder joint is a ball and socket joint. The socket of the shoulder is called the glenoid which is a shallow joint that is deepened and stabilized by the labrum which is a cuff of cartilage around the socket. The biceps tendon inserts into the top of the labrum and glenoid. A SLAP (superior labral anterior to posterior) tear occurs at the location where the biceps tendon inserts into the glenoid labrum. This area of the labrum where the SLAP tear occurs is susceptible to injury because it is an area of poor vascularity. A SLAP tear is usually caused by either a fall onto an outstretched hand, repetitive overhead activity, or heavy lifting. In comparison to a SLAP tear, a Bankart lesion is an injury to the anterior inferior glenoid labrum due to repeated anterior shoulder dislocation. Conditions associated with a SLAP tear include rotator cuff in about 40% and shoulder instability.
There are seven classifications of SLAP lesions with the most common classification dividing SLAP lesions into four types, initially classified by Snyder from which Maffet expanded the classification to include Types V, VI, and VII which include concomitant pathology in addition to the SLAP lesion.
-Type I is usually degenerative in nature, and it is present in the majority of active population. Isolated fraying of the superior labrum with a firm attachment of the labrum to the glenoid.
-Type II is the most common type of SLAP tear characterized by a detachment of the superior labrum as well as the long head of the biceps from the glenoid.
-Type III is rare and is characterized by a bucket-handle tear of the labrum with an intact biceps insertion. The labrum tears and flips into the joint.
-Type IV is also rare, and it is a bucket-handle tear of the labrum that extends into the biceps tendon.
-Type V is a Bankart lesion of the anterior capsule that extends into the anterior superior labrum.
-Type VI is a disruption of the biceps tendon anchor with an anterior or posterior superior labral flap tear.
-Type VII is an extension of a SLAP lesion anteriorly to involve the area inferior to the middle glenohumeral ligament.
