Symptoms | SLAP lesion

Symptoms

If it is a chronically developed slap lesion, the patient may not notice anything at first. If the lesion is progressing and not treated, the patient will usually report pain when the strain is severe, while an acute slap lesion or lesions that have progressed far will report immediate pain. The character of the pain is described as biting or burning, it is localized in the area of the shoulder, but can also spread by pulling over the entire shoulder, up to the upper back.

The pain often causes patients to assume relieving postures to reduce the intensity of the pain. However, these relieving postures often result in the shoulder joint being incorrectly loaded, which in turn can lead to hardening of the muscles, bone wear and further pain. In addition to the pain that already occurs at rest when the slap lesion has progressed, movement can also be impaired, especially in severe cases.

These are caused on the one hand by the fact that the patient no longer performs the movements completely due to the pain. A further and perhaps more important reason is the instability that develops in the shoulder joint, which is caused by the fact that the shoulder joint stabilizing effect is no longer or only insufficiently given by the tear or rupture of the labrum-biceps complex. Sometimes this instability can be so severe that the patient can only lift the arm up to an angle of 90 degrees and then stops moving. The fear of a dislocation of the joint also means that the patient is very careful in the arm movements and is accordingly restricted in his everyday life.

Diagnosis of a SLAP lesion

The diagnosis of a slap lesion is not always easy. In any case, it is important to conduct a detailed patient survey to determine whether the patient is at risk for a slap lesion (incorrect loading, overloading, racket or ball sports).Then it should be asked exactly which complaints occur and especially with which movement. After the questioning, a detailed physical examination should be carried out, which should first explore an active movement in the shoulder joint (what can the patient do himself?

), then a passive movement by the examiner (the patient lets the arm hang, the movements are carried out by the examiner). If the suspicion of a slap lesion is thereby hardened, e.g. due to an identified instability, it should be considered which imaging technique should be used. Both ultrasound and classic x-rays can be used to visualize the shoulder joint, but are very limited in their ability to show the soft tissues in the joint.

Both methods of examination cannot or can hardly show a slap lesion. Often the SLAP lesion can only be visualized by MRI of the shoulder (magnetic resonance imaging shoulder), which can provide a clearer, if not 100% view. However, even MRI of the shoulder often cannot detect it without a contrast medium that has to be injected directly into the joint.

Since the injured biceps tendon anchor is very small, it is often not possible to reliably classify the SLAP lesion in the MRI of the shoulder even with a contrast medium. Today, the safest method to prove a slap lesion is arthroscopy. It is usually only carried out when previous examinations have not shown any evidence of a slap lesion but the symptoms are typical of a slap lesion.

During the examination, also known as arthroscopy, two small skin incisions are made on the disinfected shoulder joint, and a camera and examination equipment are inserted into the joint. The camera delivers live images and sends them to a monitor. With the help of the second instrument, smoothing devices, scissors and forceps can be inserted into the joint.