SLAP lesion

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Classification according to ICD-10
S46.2 Injury to the muscle and tendon on other parts of the biceps brachii
ICD-10 online (WHO version 2019)

In a SLAP lesion (SLAP is the abbreviation for s uperiores L abrum of a Nterior according p osterior ) is a breach ( lesion ) of the upper (superior) labrum biceps anchor complex, so the cartilage lip ( labrum ) on upper edge of the scapula joint socket ( Cavitas glenoidalis , also short glenoid ), where the long biceps tendon originates .

There are four different types:

  • Type I: Degeneration of the upper labrum and the biceps anchor (biceps tendon attachment) without detachment, but with fraying;
  • Type II: demolition of the labrum biceps-anchor complex of the upper glenoid upwards ( cranially );
  • Type III: Bucket handle-shaped detachment of the upper labrum with intact biceps anchor;
  • Type IV: Longitudinal splitting of the long biceps tendon with shifting of a part of the labrum-biceps downwards ( caudally ) into the joint space .

However, there are also other classifications with subdivisions into further subtypes or combination violations.

Accompanying pathologies

SLAP lesions often occur in combination with other injuries: in 40% of the observed cases with partial or even complete lesions of the rotator cuff , in 22% with Bankart lesions and in 10% with glenohumeral chondromalacia . SLAP lesions were also found along with avulsion injuries or dislocations of the long biceps tendon.

There is a significant association between SLAP type I lesions and partial lesions of the supraspinatus tendon . Type II occurs more frequently in under 40-year-olds with a Bankart lesion and in over 40-year-olds with a tear of the supraspinatus tendon or with wear on the shoulder joint . Type III and IV SLAP lesions are found in patients with Bankart lesions or severe occupational stress.

causes

Sudden and unexpected tension or pressure on the already tensioned biceps tendon can cause a SLAP lesion. For example, when lifting heavy objects, in strong winds while windsurfing or if you fall on your slightly splayed , bent arm with your elbow straight .

Another cause of the SLAP lesion can be a micro- traumatic injury (caused by minor, imperceptible wounds), which particularly affects throwers or sports with similar movements (javelin throw, tennis). During the throwing act, significant tensile and torsional forces occur at the attachment of the biceps tendons, which can lead to the detachment of the upper labrum-biceps anchor complex.

Diagnosis and therapy

The extremely painful injury is difficult to diagnose . Sonography (echography), x-rays and CT ( computed tomography ) cannot depict the lesion, and imaging with MRI ( magnetic resonance imaging / magnetic resonance imaging) is difficult. An MRI scan after a contrast medium has been injected into the affected joint (arthro-MRT) gives better results. The injection needle is inserted before the MR scan in the CT or under fluoroscopy. Their correct position can be checked with a contrast medium containing iodine. Gadolinium or a saline solution is then used as an MRI contrast medium in the shoulder joint . After the injection, the needle is removed and the actual MRI examination is carried out. Since the contrast medium, usually 8–15 ml, flows quickly from the joint into the surrounding tissue, there is a limited time window of around 30 minutes. The examination is carried out by radiological departments and practices. The diagnosis of a SLAP lesion is made more difficult by the fact that the labrum has anatomical variants which can be misinterpreted as a SLAP lesion, but which are normal and do not require treatment. Therefore, the ultimate diagnostic certainty can often only be obtained through an arthroscopy .

Conservative therapy is only recommended for type I. The other types should be treated surgically , especially in the case of instability of the shoulder joint : The torn joint lip is usually minimally invasive arthroscopically with small bone anchors - anchors made of resorbable materials have proven themselves - at its normal anatomical location on the joint socket and can be restored in this way wax. In some cases, however, open surgery is beneficial.

literature

  • P. Waldherr, S. J. Snyder: SLAP lesion of the shoulder . In: The orthopedist . tape 32 , no. 7 , 2003, p. 632-636 , doi : 10.1007 / s00132-003-0496-0 .
  • Wolfgang Nebelung, Ernst Wiedemann (Ed.): Shoulder arthroscopy . Springer, Berlin / Heidelberg 2002, ISBN 3-540-41894-6 , Chapter 17 Cranial Labral Lesions (SLAP Lesions) , p. 259-269 .
  • M. Thomas, M. W. Busse: SLAP lesion of the shoulder: etiology, classification, diagnosis and therapy . In: KCS . tape 6 , no. 1 , 2005, p. 9–18 ( klinischesportmedizin.de [PDF; 140 kB ]).

Web links

Individual evidence

  1. ↑ Also called labrum-biceps tendon complex, labrum-biceps tendon complex, labrum-biceps complex or SLAP complex.
  2. ↑ S. J. Snyder, R. P. Karzel, W. Del Pizzo, R. D. Ferkel, M. J. Friedman: SLAP lesions of the shoulder. In: Arthroscopy 6 (4), 1990, pp. 274-279.