New York State Medical Treatment Guidelines for
Superior Labrum Anterior and Poster (SLAP) Lesions
in workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Superior Labrum Anterior and Poster (SLAP) Lesions.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders. The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Superior Labrum Anterior and Poster (SLAP) Lesions of Shoulder Injury

Lesions that extend anteriorly and posteriorly in relation to the insertion of the biceps tendon on the upper portion of the glenoid labrum. The following are some of the SLAP lesions that have been described:

• The superior labral edge is fraying in Type I, but the labrum is still attached to the glenoid rim.
• The biceps anchor separates from the glenoid in Type II. There are three different types of Type II lesions: anterior-only, posterior-only, and mixed anterior-and-posterior.
• Type III is a bucket handle rupture in the superior labrum with a stable attachment to the biceps tendon and the rest of the superior labrum.
• Similar to Type III, Type IV is a tear in the bucket handle that has extended into the biceps tendon. Extensions of the lesions mentioned above or extensions of Bankart lesions are among the additional forms of lesions that have been described.

History and Mechanisms of Injury for Superior Labrum Anterior and Poster (SLAP) Lesions

The following common damage mechanisms are thought to contribute to SLAP lesions:

• Injury caused by compression, such as a fall on an extended arm with the shoulder in abduction and forward flexion, or a direct impact to the glenohumeral joint;
• Traction injuries brought on by overhand tossing repeatedly, attempting to stop a fall from a height, and experiencing an abrupt pull after losing control of a heavy object;
• Automobile Accident
• Repetitive, obnoxious overhead motions, as pitching; or
• A fall on an abducted arm with elbow-upward force.

Sometimes there is no way to determine how a person was injured.

History may include:

• Symptoms when throwing anything up in the air;
• A subjective sensation of instability or a subluxation;
• Shoulder ache that is poorly localised and made worse by overhead activity;
• Snapping, popping, locking, catching;
• Minimal instability

Physical Findings of Superior Labrum Anterior and Poster (SLAP) Lesions

The physical examination is frequently nonspecific as a result of various intra-articular abnormalities that are present.

No single test, nor any set of tests, has been demonstrated to have a sufficient sensitivity, specificity, or positive predictive values for SLAP lesion diagnosis. Individual tests and test combinations have relatively low sensitivity and specificity.

Overall physical examination testing for SLAP lesions may be used to support a diagnosis of SLAP lesion, but physical examination alone should not be utilised to decide whether to proceed with occupational therapy.

• Speed Test
• Yergason’s Test
• Test of Active Compression (O’Brien)
• Test for Job Relocation
• Crank Test
• The anterior arresting manoeuvre
• The bicipital groove is tender.
• Anterior Slide (Kibler) Test
• Test of Compression Rotation
• Provocation Test for Pain
• Second Biceps Load Test

Diagnostic Testing Procedures of Superior Labrum Anterior and Poster (SLAP) Lesions

Radiographs of isolated SLAP lesions are typically unremarkable. They can be helpful in locating more abnormality sources, though.

The most accurate method for diagnosing and classifying SLAP lesions is magnetic resonance imaging (MRI) with arthrogram; however, it can be challenging to distinguish SLAP lesions, particularly Type II lesions, from normal anatomic variations and from asymptomatic ageing-related alterations.

Non-Operative Treatment Procedures of Superior Labrum Anterior and Poster (SLAP) Lesions

The majority of SLAP lesions are accompanied by other diseases, such as supraspinatus tears, biceps tendon tears, joint instability, Bankart lesions, and rotator cuff tears. The healthcare provider should follow both the surgical and non-surgical advice and refer to the treatment regimens for these disorders. Consider the following non-invasive care options for suspected isolated SLAP lesions.

Anti-inflammatory drugs and analgesics may be beneficial.

Instruction in therapeutic exercise, healthy work habits, and workstation inspection are some examples of therapeutic processes.

Therapeutic rehabilitation and rehabilitation methods may be used to produce benefits. Range of motion (ROM), active therapy, and a home exercise routine should all be included. Control of pain and edema may be achieved by both passive and aggressive therapy.

Therapy should continue with strengthening exercises and a self-directed home exercise regimen aimed at enhancing the range of motion and muscle strength of the shoulder girdle.

Injections of glenohumeral and/or subacromial bursal steroids may reduce inflammation and enable the therapist to advance with functional exercise and ROM.

• Effect-Producing Time: One Injection.
• Maximum 3 injections spaced at least 4 to 8 weeks apart over the course of a year. In diabetic individuals, steroid injections should be administered with caution. Patients with diabetes should be reminded to monitor their blood sugar levels at least once a day for two weeks following injections.

Early on in the course of treatment, returning to work with the necessary limits should be taken into consideration. In some circumstances, other non-operative therapy might be used.

Surgical Indications of Superior Labrum Anterior and Poster (SLAP) Lesions

The superior glenoid labrum and the location of the long head of the biceps tendon both exhibit a sizable amount of typical anatomic variation. It is crucial to distinguish between disease and normal variation.

If there is any further shoulder pathology, the doctor should recognise it and use the proper surgical indications. If a SLAP lesion is detected, the primary surgical treatment should be accompanied with an arthroscopic assessment, and if necessary, a suitable repair should be made.

Or

When there is no other pathology found and there is an unsatisfactory response to at least three months of non-operative therapy with an active patient involvement as demonstrated by persistent discomfort with functional limits and/or instability severely disrupting daily activities or work obligations.

Prior to surgery, the patient and treating physician should discuss the patient’s functional operative goals, the likelihood that the patient will be able to perform their daily activities or their job more easily, and the patient’s willingness to adhere to the pre- and post-operative treatment plan’s home exercise guidelines. The length of projected partial and total impairment following surgery should be made clear to the patient.

The patient should also be aware that 1) non-operative treatment is a viable alternative and 2) shoulder stiffness with pain and possibly diminished function is a potential side effect of surgery.

Operative Procedures of Superior Labrum Anterior and Poster (SLAP) Lesions

SLAP lesions are treated surgically depending on the type of lesion and whether there are any further intra-articular abnormalities. The following guidelines for surgical intervention are generally accepted.

Type I: Debridement is appropriate but not necessary;

Type II: Suture anchor repair or biceps tenotomy/tenodesis repair are viable choices;

Type III: Options that are reasonable include debridement or excision of the bucket handle component alone, repair using suture anchors, or biceps tenotomy/tenodesis;

Type IV: Reasonable alternatives include biceps tenotomy, tenodesis, and/or debridement.

Post-Operative Treatment of Superior Labrum Anterior and Poster (SLAP) Lesions

Programs for post-operative rehabilitation should be tailored to each patient’s unique needs and depend on whether any other intra-articular abnormalities remain and were surgically corrected. Information on the rehabilitation of isolated SLAP lesions is scarce. Wearing a sling and refraining from active shoulder motion for 4 to 6 weeks is common post-operative treatment.

At this point, range-of-motion (ROM) exercises for the elbow, wrist, and hands are acceptable. At 4 to 6 weeks, the sling is removed, and the active range of motion is often started with the surgeon’s recommended limits. Up to six months after surgery, it is permissible to restrict external rotation and abduction.

What our office can do if you have Superior Labrum Anterior and Poster (SLAP) Lesions

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.