What is a SLAP tear?
Superior labrum, anterior and posterior (SLAP) lesions are common in the shoulder. A SLAP injury is injury to the top part of the labrum where the biceps tendon attaches to the labrum. The biceps tendon can also be damaged due the injury as well. The labrum is a ring of cartilage that surrounds the shoulder socket, helping to stabilize the joint.
SLAP tears are identified in up to 26% of shoulder arthroscopies. They are the most common shoulder injury in overhead athletes, caused by repetitive motions.
SLAP tears can be caused by:
- Acute trauma: Like a fall onto an outstretched arm, a sudden pull, or a direct blow to the shoulder.
- Repetitive shoulder motion: Often seen in athletes, especially those involved in overhead sports like baseball, tennis, or swimming. The velocity achieved by overhead throwing athletes subjects the shoulder to extreme forces and can result in a SLAP tear and can generate significant pain.
- Degenerative changes: As one ages, the labrum can become more brittle, leading to increased susceptibility to tears.
Common symptoms of a SLAP tear include:
- Pain with certain shoulder movements or when lifting objects overhead.
- A sensation of locking, popping, catching, or grinding in the shoulder.
- Decreased range of motion or strength in the shoulder.
- A feeling of instability in the shoulder.
Dr. Masi Reynolds will ask about your symptoms, past shoulder injuries and your current activity level. He will perform a thorough physical examination and order imaging studies like an MRI to confirm the diagnosis and assess the extent of the injury. With this information he will make a diagnosis and may recommend shoulder arthroscopy so that he can view the inside of the shoulder to assess the damage. During arthroscopy he may also perform the necessary surgical repairs.
Factors to consider when thinking about treatment options include the patient’s age, type of sports activity, level of participation, and the degree of symptoms. Symptomatic patients are typically treated with physical therapy and activity modification. These conservative measures include rest, avoidance of aggravating factors, injections, and physical therapy focusing on restoring range of motion and strength and evaluating the biomechanical throwing motion.
However, after the failure of non-operative measures or when activity modification is precluded by athletic demands, SLAP tears have been managed with surgical methods including debridement, repair, biceps tenodesis or biceps tenotomy.
SLAP repair is a surgical procedure used to fix a torn labrum in the shoulder. There are different techniques for SLAP repair, but many of them are done arthroscopically. During arthroscopic surgery, small incisions are made around the shoulder, and a camera (arthroscope) is inserted, allowing the surgeon to view the inside of the joint on a screen and perform the surgery with specialized instruments.
The exact nature of the repair depends on the type and extent of the tear. Common procedures involve:
- Debridement is the surgical removal of the frayed or torn portions of the labrum or other injured soft tissue within the shoulder joint.
- Re-attaching the torn labrum to the bone using sutures.
- Biceps tenodesis is a surgical procedure where the biceps tendon might be released or re-attached elsewhere if it contributes to the problem. A biceps tenodesis may be performed as open surgery.
- Biceps tenotomy is an alternative procedure where the bicep tendon is cut off the labrum and is not reattached to the upper arm bone.
Recovery from SLAP repair surgery varies based on the extent of the injury and the specific surgical procedure, but it often involves a period of immobilization to allow for healing followed by structured physical therapy to restore strength and mobility. Athletes or those involved in heavy physical activities might require up to a year before they can return to their previous levels of performance.