A SLAP tear is when there is damage to the ring of cartilage on the socket of the shoulder joint, known as the labrum. It stands for “superior labral anterior to posterior tear”, meaning a tear of the upper rim of the labrum from front to back. It is most commonly injured by a fall or from repetitive overhead movements, such as racket sports or throwing activities.
Symptoms of a SLAP lesion include pain, weakness, instability and a catching sensation in the shoulder. Treatment usually involves medication and physical therapy, but in some cases, surgery will be advised.
Here, we will look at the common causes, symptoms and treatment options for a SLAP tear.
A SLAP tear occurs in the glenohumeral joint. This is where the top part of the arm bone (the head of humerus), which is shaped like a ball, fits in a socket on the front of the shoulder blade (glenoid fossa). The shoulder socket is very shallow, similar to a golf tee, to allow for lots of movement. To improve the stability of the shoulder, there is a ring of cartilage, known as the glenoid labrum, which helps to deepen the socket without restricting movement. The glenoid labrum is reinforced by the tendons of various muscles of the shoulder.
With a SLAP tear, the top part of the glenoid labrum, which is reinforced by one of the biceps tendons, is torn. This top part of the labrum tears from away from the glenoid socket from front to back (anterior to posterior), often damaging the biceps tendon as well.
There are a number of different types of SLAP lesion, depending on the
nature and severity of the injury. The four most common types are:
Type 1: Degeneration (wear and tear) where the edges of the labrum fray, but stay attached to the glenoid rim. Biceps tendon is unaffected
Type 2: The superior (top) part of the labrum and the biceps tendon are torn off the glenoid rim
Type 3: A bucket-handle tear of the labrum where part of the rim detaches forming a flap which can get caught in the joint, causing locking or catching sensations. The biceps tendon is unaffected
Type 4: A bucket handle tear of the superior glenoid labrum which extends into the biceps tendon
Type 1 and type 2 tears are the most common.
Slap tears can also be associated with a Bankart Lesion, where there is damage to the bottom part of the glenoid labrum, or a rotator cuff tear, damage to the shoulder muscles. You can find out more in the Bankart Lesion and Rotator Cuff tear sections.
SLAP tears can develop suddenly through a one-off event, known as an acute injury, or gradually from repetitive movements, known as a chronic injury.
1) A Fall: most commonly onto an outstretch hand
2) RTA: especially if you have pushed through your outstretched arms to brace yourself from the impact
3) Shoulder Dislocation: when the head of humerus pops out of the glenoid socket
4) Sports Injury: such as a tackle, especially when your arm is above your head, or pulling down through the arm
5) Lifting: picking up a heavy object
Acute injuries tend to affect younger people, under the age of 40.
1) Repetitive Movements: especially with the arm above the head such as throwing actions, racket sports or swimming
2) Repetitive Heavy Lifting: which pulls down on the arm e.g. weight lifting
Chronic tears tend to occur in people over the age of 40, and degeneration of the glenoid labrum is often seen as part of the normal aging process.
The common symptoms of a SLAP tear include:
1) Pain: with shoulder movements or when lifting things above the head. It tends to be a dull ache, rather than a sharp pain
2) Weakness: decreased strength in the upper arm
3) Instability: it may feel as if the shoulder is going to “pop-out”. Often affects sleep as it can be difficult to get into a comfortable position as the shoulder drops slightly when lying on it due to the instability
4) Difficulty Throwing: athletes may complain of a loss of strength and velocity (speed) when throwing
5) Decreased Movement: range of motion at the shoulder may be reduced
6) Catching Sensation: or a feeling of impingement (blocked movement) when moving the arm
Your doctor should be able to diagnose a SLAP tear from talking to you and examining your shoulder. He may also want to get x-rays or an MRI, often with contrast dye to get a clearer picture.
Treatment will depend on the type of SLAP lesion and the associated symptoms. Generally, conservative (i.e. non-surgical) treatment is tried first and if this fails, surgery will be considered.
Conservative treatment for a SLAP lesion will likely include:
1) Medication: pain-relief and anti-inflammatories such as naproxen and ibuprofen
2) Rest: from aggravating activities
3) Physical Therapy: exercises to regain the strength, stability and movement of the shoulder - visit the rotator cuff exercises section to find out more
If you are still having problems after three to six months of rehab,
SLAP repair surgery may be advised. This is usually done
arthroscopically (keyhole surgery). A small camera (arthroscope) is
inserted into the shoulder joint so the surgeon can see exactly what
damage has been done.
Surgical technique will depend on the type of tear. The surgeon will debride (clean up) any frayed edges, and then either remove or reattach and torn parts of the glenoid labrum. When reattaching torn segments, anchors are inserted into the bone of the shoulder socket and the torn glenoid labrum is sewn back together and held in the correct place with sutures attached to the anchors.
Following surgery, you will need to wear a sling initially for a few weeks (including in bed) to allow the shoulder to heal. You will work with a physical therapist on a progressive rehab programme to regain the movement, strength and stability of your shoulder - you can find examples of helpful exercises in the rotator cuff exercises section. It usually takes 4-6 months to return fully to sports.
SLAP tear surgery is successful at reducing pain and instability and restoring function in most cases and complications are rare.
There are other problems that can affect the glanoid labrum as well. A Bankart lesion is commonly associated with shoulder dislocations and is where the bottom part of the labrum get torn. There tends to be more shoulder instability associated with it than with SLAP lesions. You can find out more in the Bankart Lesion section.
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