SLAP Lesions in Overhead Athletes

Abstract

Superior labral anterior to posterior (SLAP) tears in overhead athletes can be a career-ending injury because of the high failure rates with surgical intervention. There are many factors for this including the failure to establish the correct diagnosis, inadequate nonoperative management, the repair of normal variants of the superior labrum by inexperienced surgeons, and improper poor surgical technique. SLAP lesions rarely occur in isolation and can be associated with other shoulder disorders. The mechanism of injury can be an acute episode of trauma or a history of repetitive overhead use as in baseball pitchers or volleyball players. The physical exam findings can be confusing as these injuries often occur with other shoulder pathology. There is no single physical exam finding that is pathognomonic for SLAP tears. Nonoperative treatment should always be undertaken for a minimum of 3 months before surgery is recommended. If this fails to return the overhead athlete to competitive participation, a diagnostic arthroscopy with SLAP repair can yield excellent results if the proper technique is employed. The technique that we describe can be technically demanding but can be reproduced and give excellent results with a predictable return to play for overhead athletes.