FOOSH, or Fall on an Outstretched Hand/Arm, is one of the leading causes of acute SLAP Lesions. SLAP lesions are more likely to occur after a person stretches out the arm and hand in an attempt to stop a fall. The impact from the fall is often enough to generate the anterior to posterior force necessary to damage the soft connective tissue in the shoulder joint, leading to a SLAP Lesion.
Throwing motions repeatedly stretch the glenoid labrum, increasing the chance of a tear. This injury is common in some sports, such as football or baseball. However, SLAP lesions can also occur in other repetitive activities, such as cranking a lawn mower. Microtraumas can occur within the shoulder joint during forceful throwing motions due to shear forces between the connective tissue and surrounding bone structures. As these traumas continue to build, they increase the likelihood of a significant tear within the shoulder joint, ultimately causing a SLAP Lesion in some cases.
Lifting heavy objects or weights is a common cause of acute SLAP lesions. In these cases, the repetitive nature of weight lifting can stretch and strain the glenoid labrum. Overhead exercises have a higher incidence of causing SLAP lesions due to the angle of the force produced on the glenoid labrum.
Sports that rely on repetitive throwing or overhead motions, such as tennis, swimming, football, and baseball, increase the likelihood of SLAP lesions due to the amount of stress they place upon the superior labrum. The repetitive stress causes a buildup of microtraumas that, if not allowed to properly heel, can result in a “peel-back” effect of the glenoid labrum due to shear forces, sometimes resulting in SLAP Lesions.
After age 40, the superior glenoid labrum becomes less secure, most likely due to age-related changes altering the structural integrity of the connective tissue within the glenohumeral joint. As this accumulates, the likelihood of SLAP lesions increases, particularly if the individual is engaged in other behaviors such as heavy weight lifting or repetitive shoulder motion that further stresses the joint.
Patients with SLAP Lesions may complain of a clicking or popping sound during shoulder movement, as well as a grinding sensation. These sounds normally occur due to increased shoulder instability and are typically prominent during overhead motions of the shoulder.
Patients with SLAP Lesions often report pain in the anterior-superior region of the shoulder. This pain is more intense as the shoulder is placed into external rotation and horizontal abduction and often presents with a combination of instability and impingement symptoms with complaints of “catching” or joint laxity during the aforementioned positions.
Dead Arm Syndrome, also called recurrent transient subluxation, describes a marked reduction of the velocity and control of throwing ability due to pain, described as “paralyzing” and numbing. This injury is common in athletes such as pitchers who rely on continual throwing motions and is often a result of the shoulder joint being placed into maximum external rotation while being elevated or due to direct trauma or impact on the joint itself. The pain is often sudden upon onset and often significantly impacts the performance of patients afflicted with this issue.
SLAP lesions, specifically Type II and Type IV, can contribute to shoulder instability by compromising the stability of the labrum, which plays a crucial role in holding the humeral head securely in the glenoid socket. This instability can result in recurrent dislocations or subluxations, and it often requires a comprehensive evaluation and appropriate treatment, which may include physical therapy, surgical repair of the labrum, or other interventions to restore shoulder stability and function.
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