SLAP TEAR

SLAP tears happen when you tear cartilage in the inner part of your shoulder joint. The tears can be caused by injury or overuse and make it painful or difficult for you to move your shoulder and arm. Left untreated, these tears can cause chronic pain, limit how much you can use your arm and shoulder and lead to more serious shoulder problems.

 

What is SLAP tear?

There are many different kinds of shoulder labrum tears. A labrum SLAP tear covers a specific area.

The upper, or superior, part of your labrum attaches to your biceps tendon. In a labrum SLAP tear, SLAP stands for superior labrum anterior and posterior. This means your labrum is torn at the top in both the front (anterior) and back (posterior) of where it attaches to the biceps tendon.

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What causes SLAP tears?

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

People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears as a result of repeated shoulder motion.

 

Many SLAP tears, however, are the result of a wearing down of the labrum that occurs slowly over time. In patients over 30 to 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 younger person.

 

What are SLAP tear symptoms?

In most cases, a labrum SLAP tear doesn't hurt all the time. The pain usually happens when you use your shoulder to do a task, especially an overhead activity. You may also notice:

• 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

 

How is SLAP tear diagnosed?

There are different ways to tear your labrum and different places where it can tear. A labrum SLAP tear is just one of those ways, and the symptoms are often similar, so it can be hard to diagnose.

 

Before a physical exam, your doctor will ask questions about your symptoms, pain level, and where it hurts. If there's a specific injury or event that changed the way your shoulder feels, tell your doctor.

 

During the physical exam, your doctor will move your arm and shoulder into different positions.

If your doctor rules out inflammation or a pinched nerve, an X-ray or MRI is the next step. An X-ray can't see your labrum, but it can show fractures that might cause the pain. Your labrum will show up on an MRI. You might need to get a shot of dye in your shoulder for contrast.

 

How are SLAP tears treated?

Surgery is usually not the first treatment option. Doctors often start by prescribing anti-inflammatory drugs for pain and swelling. Once that's under control, your doctor may recommend working with a physical therapist or show you specific exercises to build your muscles back up.

 

If medication and exercise don't help enough, surgery may be your next step. The kind of operation depends on your injury, age, and how active you are.

 

Surgeons often repair labrum SLAP tears with arthroscopy, in which the doctor makes and works through small cuts in your shoulder. They place a tiny camera in your shoulder joint. This sends images to a bigger screen in the operating room. Using small tools, your surgeon can trim the torn part of your labrum, and then repair or reattach it.

 

Biceps Tenodesis is another common surgical approach for SLAP tears. The surgery relocates your biceps tendon to your upper arm bone (humerus). It may be done depending on the age and activity level of the patient.

 

What happens after SLAP tear surgery?

Expect to be in a sling for a month or so to keep your arm still. After the swelling has gone down, you can move it again with guidance from a physical therapist.

 

Depending on your age and the extent of your tear, it could take 2 months for your labrum to heal and another 2 months to build up the same strength you felt before the tear.