SLAP Tear

A  SLAP tear occurs in the glenohumeral joint aka shoulder. 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. 

Shoulder labrum tears may develop may develop anywhere in the labrum, but SLAP tears are the most common.

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 resulting in biceps tendonitis. Excess fluid may also pool near the SLAP tear, forming a paralabral cyst.

There are a number of different types of lesion, depending on the nature and severity of the injury. The four most common types of SLAP tear are:

• Type 1 SLAP Tear: Degeneration (wear and tear) where the edges of the labrum fray, but stay attached to the glenoid rim. Biceps tendon is unaffected
• Type 2 SLAP Tear: The superior (top) part of the labrum and the biceps tendon are torn off the glenoid rim
• Type 3 SLAP Tear: 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 SLAP Tear: A bucket handle tear of the superior glenoid labrum which extends into the biceps tendon 

Type 1 and type 2 SLAP tears are the most common. Other parts of the shoulder are often damaged at the same time as a SLAP tears, such as:

• Bankart Lesions: damage to the bottom part of the glenoid labrum
• Rotator Cuff Tears: damage to one of the four main shoulder stabilisers
• Dislocated Shoulder: upper arm bone pops out of the shoulder socket

Acute SLAP tear injuries tend to affect younger people, under the age of 40 and are typically caused by:

• A Fall: most commonly onto an outstretch hand
  
  
• RTA: (road traffic accident) especially if you have pushed through your outstretched arms to brace yourself from the impact
  
  
• Shoulder Dislocation: when the head of humerus pops out of the glenoid socket
  
  
• Lifting: picking up a heavy object
  
  
• Sports Injury: such as a tackle, especially when your arm is above your head, or pulling down through the arm

Chronic Injuries

Chronic SLAP tears are usually caused by:

• Repetitive Movements: especially with the arm above the head such as throwing actions, racket sports or swimming
  
  
• 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, making it more prone to damage. 

The most common SLAP tear symptoms are:

• Pain: with shoulder movements or when lifting things above the head.  It tends to be a dull ache, rather than a sharp pain
  
  
• Weakness: decreased strength in the upper arm
  
  
• 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
  
  
• Difficulty Throwing: athletes may complain of a loss of strength and velocity (speed) when throwing
  
  
• Decreased Movement: range of motion at the shoulder may be reduced
  
  
• Catching Sensation: or a feeling of impingement (blocked movement) or shoulder clicking when moving the arm

Your doctor should be able to diagnose a SLAP tear from talking to you and examining your shoulder. They may also want to get x-rays or an MRI, often with contrast dye to get a clearer picture.

Surgical technique will depend on the type of tear. During SLAP tear surgery, the surgeon will debride (clean up) any frayed edges, remove any cysts and then either remove or reattach any 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. 

Recovering From Surgery

Following SLAP tear 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 and scapular stabilization exercises sections. It usually takes 4-6 months to return fully to sports after surgery.  

SLAP tear surgery is successful at reducing pain and instability and restoring function in most cases and complications are rare.