Superior Labrum Anterior Posterior Lesions

Superior labral anterior to posterior (SLAP) lesions constitute a recognized clinical subset of complex shoulder pain pathologies.  SLAP lesions demonstrate a predilection for young laborers, overhead athletes, and middle-aged manual laborers. In 1985, Andrews first described superior labral pathologies, and Snyder later coined the term “SLAP lesion” because of the location and characteristic tear extension patterns.  Snyder developed the initial 4-subtype classification of these lesions.  In the ensuing decades, other groups, including Morgan et al. and Maffet et al. further subdivided the SLAP classification schemes to ultimately delineate ten different types of SLAP tear patterns, including combined SLAP- and Bankart-type injuries seen in specific associative patterns. Advances in contemporary diagnostic capabilities and arthroscopic management techniques have led to evolving management paradigms since the original descriptions of SLAP-type lesions.  These injuries are not solely limited to young throwing athletes as originally described, and SLAP tears commonly can be seen in various patient populations with varying degrees of actual clinical relevance. There is increasing evidence that SLAP tears are frequently present on MRI in asymptomatic overhead athletes. Thus, clinicians should remain cognizant of the known clinical ambiguity that may present with SLAP lesions recognized in isolation or association with other shoulder pathology.