New York State Medical Treatment Guidelines for Superior Labrum Anterior and Poster (SLAP) Lesions in workers compensation patients

The guidelines established by the New York State Workers Compensation Board are crafted to assist healthcare professionals in delivering appropriate treatment for lesions of the superior aspect of the glenoid labrum.

Tailored for medical practitioners, these Workers Compensation Board guidelines provide support in determining the right level of care for individuals with lesions of the superior aspect of the glenoid labrum.

It’s crucial to note that these guidelines do not substitute clinical judgment or professional experience. The ultimate decision on care should be a collaborative one, involving the patient and their healthcare provider in consultation.

Lesions of the Superior Aspect of the Glenoid Labrum (SLAP Lesions):

Types of SLAP Lesions:

  1. Type I: Fraying of the superior labral edge without detachment from the glenoid rim.
  2. Type II: Detachment of the biceps anchor from the glenoid. Three distinct subtypes: anterior only, posterior only, or combined anterior and posterior.
  3. Type III: Bucket handle tear in the superior labrum only, with stable attachment of the biceps tendon and the remainder of the superior labrum.
  4. Type IV: Bucket handle tear similar to Type III but with extension of the tear into the biceps tendon. Additional lesion types include extensions of the described types or extensions of Bankart lesions.

 History and Mechanisms of Injury:

 Mechanism of Injury:

  • Common mechanisms contributing to SLAP lesions:
    • a) Compression injury (e.g., fall on an outstretched arm with the shoulder in forward flexion and abduction or a direct blow to the glenohumeral joint).
    • b) Traction injury (e.g., repetitive overhead throwing, attempting to break a fall from a height, sudden pull when losing hold of a heavy object).
    • c) Motor Vehicle Accident.
    • d) Repetitive overhead motions with force (e.g., pitching).
    • e) Fall on an adducted arm with upward force directed on the elbow.
  • In some cases, no identifiable mechanism of injury.

History may include:

  • a) Symptoms with overhead throwing motions.
  • b) Dislocation, subluxation, or subjective sense of instability.
  • c) Poorly localized shoulder pain exacerbated by overhead activities.
  • d) Catching, locking, popping, or snapping.
  • e) Subtle instability.


Physical Findings (SLAP Lesion):

The physical examination:

  • Is often nonspecific due to other associated intra-articular abnormalities.

No one test or combination of tests:

  • Has been shown to have acceptable sensitivity, specificity, or positive predictive values for diagnosing SLAP lesions.
  • Sensitivity and specificity are relatively low for individual tests and combinations.

Overall physical examination tests for SLAP lesions:

  • May be used to strengthen a diagnosis, but the decision for operative management should not be based on the physical examination alone.
    • Tests include:
      • Speed Test.
      • Yergason’s Test.
      • Active Compression (O’Brien) Test.
      • Jobe Relocation Test.
      • Crank Test.
      • Anterior Apprehension Maneuver.
      • Tenderness at the bicipital groove.
      • Anterior Slide (Kibler) Test.
      • Compression Rotation Test.
      • Pain Provocation Test.
      • Biceps Load Test II.


Diagnostic Testing Procedures (SLAP Lesion):


  • Are usually normal in isolated SLAP lesions.
  • Can be useful in identifying other sources of abnormalities.

Magnetic resonance imaging (MRI) with arthrogram:

  • Has the highest reported accuracy for both diagnosis and classification of SLAP lesions.
  • May be difficult to differentiate SLAP lesions, especially Type II lesions, from normal anatomic variants and asymptomatic age-related changes.

c.iii Arthroscopic evaluation:

  • Is the most definitive diagnostic test.


Non-Operative Treatment Procedures (SLAP Lesion):

  • Most SLAP lesions are associated with other pathology, and treatment should consider protocols for these conditions.


  • Such as analgesics and anti-inflammatories may be helpful.

Therapeutic procedures:

  • May include instruction in therapeutic exercise, proper work techniques, and evaluation of the occupational workstation.

Benefits may be achieved through therapeutic rehabilitation:

  • And rehabilitation interventions including range of motion (ROM), active therapies, and a home exercise program.
  • Passive and active therapies may be used for pain and swelling control.
  • Therapy should progress to strengthening and an independent home exercise program targeting further improvement in ROM and strength of the shoulder girdle musculature.

 Subacromial bursal and/or glenohumeral steroid injections:

  • May decrease inflammation and allow progress with functional exercise and ROM.
    • Time to Produce Effect: One injection.
    • Maximum Duration: Three injections in one year at least 4 to 8 weeks apart.
  • Steroid injections should be used cautiously in diabetic patients, and blood glucose levels should be monitored daily for two weeks after injections.

 Return to work:

  • With appropriate restrictions should be considered early in the course of treatment.

Other non-operative therapies:

  • May be employed in individual cases.


Surgical Indications:

  • There is a significant amount of normal anatomic variation in the superior glenoid labrum and the origin of the long head of the biceps tendon.
  • Differentiation between normal variation and pathology is crucial.

 If a SLAP lesion is suspected:

  • An arthroscopic exam should be performed in conjunction with the primary surgical procedure.
  • An appropriate repair should be performed if necessary. or

When no additional pathology is identified:

  • And there is an inadequate response to at least three months of non-operative management with active patient participation.
  • Evidenced by continued pain with functional limitations and/or instability significantly affecting daily activities or work duties.


Prior to surgical intervention:

  • The patient and treating physician should identify functional operative goals.
  • The likelihood of achieving improved ability to perform daily living or work activities should be assessed.
  • The patient should agree to comply with the pre- and post-operative treatment plan and home exercise requirements.
  • The patient should understand the expected length of partial and full disability post-operatively.
  • The patient should also understand that non-operative treatment is an acceptable option, and a potential complication of surgery is shoulder stiffness with pain and possibly decreased function.


 Operative Procedures (SLAP Lesion):

  • Operative treatment depends on the type of lesion present and the presence of other intra-articular abnormalities.

 Type I:

  • Debridement is reasonable but not required.

Type II:

  • Repair via suture anchors or biceps tenotomy/tenodesis are reasonable options.

Type III:

  • Debridement or excision of the bucket handle component alone or repair via suture anchors or biceps tenotomy/tenodesis are reasonable options.

Type IV:

  • Debridement and/or biceps tenotomy or tenodesis are reasonable options.


Post-Operative Treatment (SLAP Lesion):

  • Post-operative rehabilitation programs should be individualized based on whether other intra-articular abnormalities were operatively treated.
  • Limited information is available on the rehabilitation of isolated SLAP lesions.
  • Common post-operative care involves wearing a sling without active shoulder motion for 4 to 6 weeks.
  • Elbow, wrist, and hand range-of-motion (ROM) exercises may be used during this time.
  • The sling is removed at 4 to 6 weeks, and active ROM is usually initiated with restrictions directed by the surgeon.
  • It is reasonable to restrict external rotation and abduction for up to six months post-operatively.


Skip to content