A SLAP tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint.
Other popular names
Who does it affect?
People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears as a result of repeated shoulder motion.
Injuries to the superior labrum can be caused by acute trauma or by repetitive shoulder motion. An acute SLAP injury may result from:
- A motor vehicle accident
- A fall onto an outstretched arm
- Forceful pulling on the arm, such as when trying to catch a heavy object
- Rapid or forceful movement of the arm when it is above the level of the shoulder
- Shoulder dislocation
Many SLAP tears, however, are the result of a wearing down of the labrum that occurs slowly over time. In patients over 40 years of age, tearing or fraying of the superior labrum can be seen as a normal process of aging. This differs from an acute injury in a person under the age of 40.
Why does it happen?
The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.
The common symptoms of a SLAP tear are similar to many other shoulder problems. They include:
- A sensation of locking, popping, catching, or grinding
- Pain with movement of the shoulder or with holding the shoulder in specific positions
- Pain with lifting objects, especially overhead
- Decrease in shoulder strength
- A feeling that the shoulder is going to "pop out of joint"
- Decreased range of motion
- Pitchers may notice a decrease in their throw velocity, or the feeling of having a "dead arm" after pitching
- X-rays. This imaging test creates clear pictures of dense structures, like bone. The labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. However, your consultant may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures.
- Magnetic resonance imaging (MRI) scan. This test can better show soft tissues like the labrum. To make a tear in the labrum show up more clearly on the MRI, a dye may be injected into your shoulder before the scan is taken.
In many cases, the initial treatment for a SLAP injury is nonsurgical. Treatment options may include:
Non-steroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
Physical therapy. Specific exercises will restore movement and strengthen your shoulder.
Flexibility and range-of-motion exercises will include stretching the shoulder capsule, which is the strong connective tissue that surrounds the joint. Exercises to strengthen the muscles that support your shoulder can relieve pain and prevent further injury. This exercise program can be continued anywhere from 3 to 6 months, and usually involves working with a qualified physical therapist.
Your consultant may recommend surgery if your pain does not improve with non-surgical methods.
The surgical technique most commonly used for repairing a SLAP injury is arthroscopy. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and these images are used to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
There are several different types of SLAP tears. Your consultant will determine how best to repair your SLAP injury once he or she sees it fully during arthroscopic surgery. This may require simply removing the torn part of the labrum, or reattaching the torn part using stitches. Some SLAP injuries require cutting the biceps tendon attachment.
Your consultant will decide the best repair option based upon the type of tear you have, as well as your age, activity level, and the presence of any other injuries seen during the surgery.
At first, the repair needs to be protected while the labrum heals. To keep your arm from moving, you will most likely use a sling for 2 to 4 weeks after surgery. How long you require a sling depends upon the severity of your injury.
Once the initial pain and swelling has settled down, your consultant will start you on a physical therapy program that is tailored specifically to you and your injury.
In general, a therapy program focuses first on flexibility. Gentle stretches will improve your range of motion and prevent stiffness in your shoulder. As healing progresses, exercises to strengthen the shoulder muscles and the rotator cuff will gradually be added to your program. This typically occurs 4 to 6 weeks after surgery.
Your consultant will discuss with you when it is safe to return to sports activity. In general, throwing athletes can return to early interval throwing 3 to 4 months after surgery.
The majority of patients report improved shoulder strength and less pain after surgery for a SLAP tear. Because patients have varied health conditions, complete recovery time is different for everyone. In cases of complicated injuries and repairs, full recovery may take several months. Although it can be a slow process, following your consultant's guidelines and rehabilitation plan is vital to a successful outcome.
Most patients do not experience complications from shoulder arthroscopy. However, as with any surgery, . These are usually minor and treatable.
Potential problems with arthroscopy include:
- excessive bleeding
- blood clots
- shoulder stiffness
- damage to blood vessels or nerves.
Your consultant will discuss the possible complications with you before your operation.