SLAP Injury: Symptoms, Diagnosis, and Treatment

What Does a SLAP Bruise Look Like?

A SLAP (Superior Labrum Anterior to Posterior) injury is an internal tear of the shoulder's glenoid labrum, and as such, it does not typically present as a visible "bruise" or discoloration on the skin. Instead, its presence is indicated by a specific set of internal symptoms and functional limitations.

Understanding SLAP Injuries: The Basics

To comprehend why a SLAP injury doesn't manifest as an external bruise, it's crucial to understand its anatomical location and nature. The shoulder is a ball-and-socket joint, where the head of the humerus (upper arm bone) fits into the glenoid fossa of the scapula (shoulder blade). The glenoid labrum is a ring of cartilage that surrounds the glenoid, deepening the socket and providing stability for the joint.

A SLAP injury specifically refers to a tear in the superior (upper) part of the labrum, where the long head of the biceps brachii tendon attaches. These tears can vary in severity and type, from fraying to complete detachment. They are often caused by:

• Acute trauma: Falling onto an outstretched arm, a direct blow to the shoulder, or a sudden, forceful pull (e.g., trying to lift a heavy object).
• Repetitive overhead activities: Common in athletes who engage in throwing sports (baseball, javelin) or professions requiring frequent overhead arm movements (painters, construction workers).
• Degenerative changes: Gradual wear and tear over time, particularly in older individuals.

The Misconception: Why You Won't See a "Bruise"

The term "bruise" typically refers to a contusion, which is a superficial injury to soft tissues that causes blood vessels to break, leading to visible discoloration (black, blue, purple) on the skin. This happens when the injury is external and close to the skin's surface.

A SLAP injury, however, is entirely internal. The glenoid labrum and the biceps tendon anchor are deep within the shoulder joint, protected by layers of muscle, fascia, and skin. Therefore, a SLAP tear, regardless of its severity, will not result in any external visible signs like bruising, swelling, or redness on the surface of the shoulder. The damage is confined to the joint's internal structures.

What a SLAP Injury Feels Like: Common Symptoms

While you won't see a bruise, a SLAP injury will certainly make its presence known through a variety of distinct symptoms. These can vary based on the tear's severity and the individual's activity level, but commonly include:

• Deep, Aching Shoulder Pain: Often difficult to pinpoint, felt deep within the joint, and may worsen with overhead activities or specific arm movements.
• Clicking, Popping, or Grinding Sensation: These mechanical symptoms are frequently reported, especially during shoulder movement.
• Catching or Locking: A sensation that the shoulder is getting "stuck" or momentarily locks during movement.
• Decreased Range of Motion: Difficulty moving the arm fully, particularly overhead or across the body.
• Weakness: A noticeable reduction in shoulder strength, especially when performing overhead tasks or lifting.
• Instability Sensation: While not always true instability, some individuals may feel a sense of apprehension or looseness in the joint.
• Pain with Specific Movements: Activities like throwing, lifting, or reaching overhead often exacerbate symptoms.

How SLAP Injuries Are Diagnosed

Given the lack of external signs, diagnosing a SLAP injury relies heavily on a thorough clinical assessment and advanced imaging.

• Comprehensive Physical Examination: An experienced clinician will perform specific orthopedic tests designed to stress the labrum and biceps anchor. These include tests like O'Brien's test, Speed's test, and the Compression-Rotation test, which aim to reproduce the patient's symptoms.
• Imaging Studies:
  • X-rays: Primarily used to rule out other bone-related issues, such as fractures or arthritis, but cannot visualize soft tissue tears like SLAP lesions.
  • Magnetic Resonance Imaging (MRI): While a standard MRI can sometimes show a SLAP tear, an MRI arthrogram is considered the gold standard. This involves injecting a contrast dye into the shoulder joint before the MRI, which helps to outline the labrum more clearly and highlight any tears where the dye leaks into the defect.
• Diagnostic Arthroscopy: In some cases, if diagnosis remains uncertain after imaging, or if surgical repair is planned, an arthroscopic procedure may be performed. This minimally invasive surgery allows the surgeon to directly visualize the labrum and confirm the presence and type of SLAP tear.

When to Seek Medical Attention

If you experience persistent shoulder pain, particularly if it's accompanied by clicking, catching, weakness, or difficulty with overhead movements, it is crucial to seek professional medical evaluation. Early and accurate diagnosis is key to developing an effective treatment plan and preventing potential long-term complications.

Management and Treatment Approaches

Treatment for SLAP injuries depends on the severity of the tear, the patient's activity level, and their symptoms.

• Conservative Management: For less severe tears or those not involving significant functional limitation, initial treatment often includes:
  • Rest and activity modification: Avoiding movements that aggravate the shoulder.
  • Ice and anti-inflammatory medications (NSAIDs): To manage pain and inflammation.
  • Physical therapy: A structured program to improve shoulder range of motion, strength (especially rotator cuff and scapular stabilizers), and neuromuscular control.
• Surgical Intervention: If conservative measures fail or for more significant tears (e.g., complete detachment of the biceps anchor), surgery may be recommended. Common surgical procedures include:
  • SLAP Repair: Reattaching the torn labrum to the glenoid bone.
  • Biceps Tenodesis or Tenotomy: If the biceps tendon is significantly involved or degenerative, the surgeon may detach it from the labrum and reattach it to a different part of the humerus (tenodesis) or simply cut it (tenotomy), which can relieve pain and improve function.
  • Debridement: Removing frayed or unstable portions of the labrum.
• Rehabilitation: Following surgery, a comprehensive rehabilitation program is essential to restore full shoulder function, strength, and mobility. This typically involves several phases of physical therapy over many months.

Conclusion

In summary, a SLAP injury is an internal tear of the shoulder labrum that does not present with external visual signs like a bruise. Its presence is characterized by specific internal symptoms such as deep pain, clicking, catching, and weakness, particularly with overhead activities. Accurate diagnosis requires a thorough clinical examination and advanced imaging, often an MRI arthrogram. If you suspect a SLAP injury, consult with a healthcare professional for proper evaluation and guidance on the most appropriate treatment strategy.