Instability

Labrum / SLAP Lesion

Lesion of the superior glenoid labrum (SLAP: Superior Labrum Anterior to Posterior). Snyder classification in 4 types.

The SLAP lesion (Superior Labrum Anterior to Posterior) is a tear of the superior glenoid labrum at the long head of biceps tendon insertion. It mainly affects overhead athletes (throwing, tennis, swimming, volleyball) and heavy laborers. The Snyder classification distinguishes 4 main types: type I (fraying), type II (detachment of the superior labrum with the biceps anchor — the most common, 40-55%), type III (bucket handle without biceps anchor involvement), type IV (bucket handle extending into the biceps tendon). Diagnosis relies on MR arthrography (sensitivity 82-100%) and arthroscopic confirmation.

Characteristics

  • Deep shoulder pain, worsened by overhead movements and throwing. Clicking or catching sensation inside the joint. Frequent night pain.
  • O'Brien's test (active compression test): pain in 90° flexion + 10° adduction against resistance in internal rotation, relieved in supination. Speed's test (palm-up test) for the biceps.
  • MR arthrography: reference examination (intra-articular gadolinium injection). Sensitivity 82-100% for SLAP II lesions. Arthroscopy remains the diagnostic and therapeutic gold standard.
  • Often associated lesions: long head of biceps tendinopathy, rotator cuff tear (supraspinatus), paralabral cyst (suprascapular nerve compression).

Medical and surgical management

  • Type I and patients > 40 years: conservative treatment first line. Physiotherapy 3-6 months. Effective in 40-60% of cases.
  • Type II (most common): arthroscopic repair with resorbable anchors. Reattaches the superior labrum and biceps anchor to the glenoid. Success rate 80-90% in young athletes.
  • Patient > 40 years with SLAP II: biceps tenodesis (fixation of the biceps tendon outside the joint) rather than labral repair. Comparable functional results with faster recovery.

Physiotherapy rehabilitation

  • Initial conservative treatment: rotator cuff strengthening and scapular stabilizer work. Correction of internal rotation deficits (GIRD).
  • Post-arthroscopic rehabilitation (SLAP repair): 4-6 weeks sling immobilization, then progressive passive mobilization. No forced external rotation for 6 weeks.
  • Progressive strengthening from 8-12 weeks: eccentric rotator cuff work, posterior chain strengthening, scapulohumeral rhythm rehabilitation.
  • Return to overhead sports: 6-9 months minimum after repair. Progressive throwing program. Biomechanical analysis of sports technique.

Classification

  1. Type I — Fraying

    Fraying and degeneration of the superior labrum. Biceps anchor intact. Arthroscopic debridement.

  2. Type II — Detachment (most common)

    Detachment of the superior labrum with biceps anchor. Biceps-labrum complex instability. Anchor repair.

  3. Type III — Bucket handle

    Bucket handle of the superior labrum without biceps anchor involvement. Arthroscopic resection.

  4. Type IV — Bucket handle + biceps

    Bucket handle extending into the long head of biceps tendon. Repair or tenodesis depending on extent.

  5. Other types

    Other forms of superior labrum injury.

Average duration

12 to 24 weeks post-operative

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.