SLAP tear

With a SLAP lesion ie the cartilage lip ( labrum ) ( SLAP stands for the superior labrum from anterior to posterior is ), is an injury (lesion ) of the upper ( superior ) labrum - biceps anchor complex at the top of the shoulder blade socket ( glenoid cavity, glenoid too short ), where the long biceps tendon attaches.

We distinguish between the following four types:

However, there are also other classifications with subdivisions in other subtypes or combination of injuries.

Accompanying pathologies

SLAP lesions occur frequently in combination with other injuries: in 40% of cases considered with partial or even complete lesions of the rotator cuff in 22 % with Bankart lesions and in 10% with a glenohumeral chondromalacia. Furthermore, SLAP lesions were found together with demolition of injury or dislocation of the long biceps tendon.

There is a significant association between SLAP lesions of type I and partial lesions of the supraspinatus tendon. Type II is more common in people under 40 years with a Bankart lesion and in more than 40 years with a tear of the supraspinatus tendon or glenoid wear before. SLAP lesions of type III and IV are found in patients with Bankart lesion or severe occupational exposure.

Causes

Due to a sudden and unexpected train or pressure on the already -biased biceps tendon a SLAP lesion can be caused. For example, when lifting heavy objects in strong wind while windsurfing or in a fall on the slightly splayed, bent arm at elbow extended.

Another cause of SLAP lesion can be a micro- traumatic triggered ( by slight, imperceptible injuries ) injury that is particularly launcher, or sports related movements ( Javelin, tennis). When Wurfakt occur distinct train and torsional forces on the biceps tendon, which can lead to the detachment of the upper labrum - biceps anchor complex.

Diagnosis and Therapy

The extremely painful injury is difficult to diagnose. Ultrasonography ( echography ), X-ray and CT (computed tomography) can not represent the lesion, also a representation with MRI (magnetic resonance imaging / magnetic resonance imaging ) is difficult. Better results brings an MRI scan after contrast injection into the affected joint (arthro - MRI). The injection needle is hereby introduced before the MR scan in CT and controls their correct position with iodinated contrast media. As MRI contrast agent in the shoulder joint is then used gadolinium or saline. After injection, the needle is removed and carried out the actual MRI examination. As the contrast agent, usually 8-15 mL, rapidly flows out of the joint into the surrounding tissue, there is a limited time window of approximately 30 minutes. The investigation is performed by radiology departments and practices. Is further complicated the diagnosis of a SLAP lesion by the fact that the labrum having anatomical variations that may be mistaken for a SLAP lesion, but are normal and do not require treatment. Therefore, final diagnostic confidence can often only be obtained by an arthroscopy.

Only when the type I, conservative treatment is recommended. The other types should, in particular in an instability of the shoulder joint, surgical management: The torn labrum is arthroscopically with small bone anchors usually minimally invasive - have proven their worth anchor of titanium alloys - attached to its normal anatomic position at the joint socket and can thus back waxing. In some cases, however, an open operation is advantageous.