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While the shoulder is very important to perform a lot of athletic activities including throwing, swinging, and even playing lots of games, having issues with the Glenoid Labrum of the Shoulder has been the beginning of problems for a lot of athletes and the end of their career for professionals. It doesn't only affect athletes, it can also affect the ordinary person who just does their daily activities. This is known as **Slap tear**, and this condition is major as a result of the Glenoid labrum dislocating or tearing. SLAP refers to a tear of the superior labral tear from anterior to posterior.

At the shoulder, there is a joint known as the Glenohumeral joint, which we refer to as the bow and socket joint because of how the connecting bones look like as the humerus has a convex shape and the glenoid cavity has a concave shape known as the glenoid fossa. The connection of the joint isn't completely firm, as it is shallow and this allows for the movement of the arm in 360 degrees, making it the most mobile joint in the body and this allows for brachiation movement. This joint is supported by lots of tissues such as the Rotator cuff muscles, Biceps Brachaii, Infraspinatus, teres minor, and supraspinatus muscles. Also, the capsule (fibrous capsule) and lots of ligaments protect the joints. Between the Glenoid fossa, and the humerus bone is the Glenoid Labrum. The fibrous sleeve which is made up of collagens and elastin protein is found at the edge of the glenoid cavity in a circumferential direction where it then engulfs the humerus head. Inferiorly, the Glenoid labrum forms a continuation with the glenoid fossa creating a transitional zone of fibrocartilage that could be injured by a trauma inferior aspect of the labrum as a result of the negative intra-articular pressure allowing for the joint to key properly.

https://upload.wikimedia.org/wikipedia/commons/7/7b/SLAP-Lesion-side-2.jpg</div>

The biceps brachii are muscles which has a short head that originates from the coracoid process of the scapula and a long head that attaches at the supraglenoid tubercle above the glenoid cavity and blends with the superior quadrant of the glenoid labrum becoming the Biceps anchor. Both heads enter into the radial tuberosity of the radius inferior to the elbow. The bicep anchor helps to hold the glenoid labrum to the glenoid cavity. 

SLAP tears occur at the glenoid labrum, and there is twelve variety of SLAP tears which falls into four different varieties. These varieties include Type 1 SLAP tear which presents with the superior quadrant of the glenoid labrum fraying but still attached to the glenoid cavity. Type two SLAP tear occurs at that biceps anchor. Type three SLAP tear starts close to the superior and reaches the posterior inferior aspect of the cavity leading to a bucket handle tear of the superior labrum. Type four type of tear starts at the superior area of the glenoid cavity, and reaches the posterior superior area of the glenoid cavity and it affects the biceps tendon.


SLAP tear can occur through Traumatic or Atraumatic causes where with traumatic causes, there is a pull of the long head of biceps attachment away from the superior labrum, while atraumatic causes would be as a result of a repeated micro-trauma where the hand is in an overhead position. In people less than 40 years, the anchor (tendon) gets pulled away from the labrum with trauma, while in people above 40 years old, the trauma would lead to the tearing of the tendon while the anchor stays in place.



A SLAP tear occurs from continuous and repetitive shoulder activity, and that is why is common in athletes. It can also be caused by accidents in everyday people. People can experience different injuries including the Peel-Back injury where the glenoid labrum peels off the glenoid cavity during an abduction and external rotation position (that position you find your arm when you want to throw something). SLAP tear type 2 can also occur during an eccentric contraction in a deceleration phase.

People with slap tear experience deep-seated aches in the shoulder, Patients could report clunking and clicking in the shoulder, and instability. Patients could be tested objectively with Biceps load test 1, where the patient is placed in a supine position, where the shoulder is at 90 degrees abduction with external rotation, the elbow is placed at 90 degrees flexion, and the forearm in full supination (if the pain increases, then it is a positive sign for a SLAP tear). The other tests are Biceps load tendon test 2, and O'brien's active compression test. With Biceps load tendon test 2 is similar to test 1 but with 120 degrees of shoulder abduction, 90 degrees of elbow flexion, and full supination of the forearm where the examiner's hand is placed at the distal anterior forearm of the patient after which the patient is required to perform elbow flexion against the examiner. O'brien's active compression test requires the patient sitting, with their shoulder flexed 90 degrees with full internal rotation and approximately 15 degrees of horizontal adduction. With the examiner's hand at the distal part of the forearm, the patient is asked to lift their arm against the resistance of the examiner. If the patient feels pain, then this indicates a SLAP tear.

Minimal-invasive surgery can be used to repair the Glenoid labrum but then, the glenoid labrum does not have a robust vascularization so the patient might not see full recovery but then, rehabilitation can help improve the way the scar tissues would be formed helping the patient move their arms properly.


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#### <center>Reference</center>

*American Journal of Roentgenology. (2012). Superior Labral Anteroposterior Lesions of the Shoulder: Part 2, Mechanisms and Classification. American Journal of Roentgenology. 2011;197: 604-611. 10.2214/AJR.11.6575. [Link](https://www.ajronline.org/doi/full/10.2214/AJR.11.6575)*

*Gittins, J. T., Ganjianpour, M., & Snyder, S. J. (Year). Treatment of SLAP Lesions. In Book Title (pp. 59-60). Springer. doi:10.1007/978-0-387-21689-8_7. [Link](https://link.springer.com/chapter/10.1007/978-0-387-21689-8_7)*

*American Journal of Roentgenology. (2003). MR Imaging of Glenohumeral Instability. American Journal of Roentgenology, 181, 203-213. doi:10.2214/ajr.181.1.1810203. [Link](https://www.ajronline.org/doi/full/10.2214/ajr.181.1.1810203)*

*Kim, S.-H., Ha, K.-I., Ahn, J.-H., Kim, S.-H., & Choi, H.-J. (2001). Biceps Load Test II: A Clinical Test for SLAP Lesions of the Shoulder. The Journal of Arthroscopic and Related Surgery, 17(2), 160-164. [Link](https://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=CDFD74945230497730E9CA4F1A3CF51E?doi=10.1.1.471.1235&rep=rep1&type=pdf)*

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<center>Image Reference</center>

* *Wikimedia Commons. (n.d.). SLAP-Lesion-side-2.jpg [Photograph]. Wikimedia Commons. Retrieved from [https://commons.wikimedia.org/wiki/File:SLAP-Lesion-side-2.jpg](https://commons.wikimedia.org/wiki/File:SLAP-Lesion-side-2.jpg)*