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.


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.

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15:02 02 Mar 23
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21:23 25 Feb 23
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20:20 19 Feb 23
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16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
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21:32 26 Oct 22
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19:01 25 Oct 22
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21:28 23 May 22
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23:31 19 May 22
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17:39 18 May 22
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Phoenix Rising
19:54 16 May 22
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00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
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19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
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19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
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Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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03:25 09 Apr 22
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22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
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14:53 03 Mar 22
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Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
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21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
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19:31 18 Nov 20
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18:17 17 Nov 20
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16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
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04:44 17 Nov 20
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Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
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Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18


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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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