What are SLAP Tears?
The glenoid labrum is a rim of fibrous cartilage that surrounds the glenoid or shoulder joint socket. Think of it as being like a bumper. It helps to deepen the otherwise shallow socket and enhances shoulder stability. The term SLAP Lesion or SLAP Tear refers to an injury of the superior labrum of the shoulder. The long head of the biceps tendon blends with the upper labrum at its point of attachment to the glenoid.
“SLAP” is an acronym that for Superior Labrum Anterior Posterior. It refers to a tearing away of the labrum and or biceps tendon from their attachment to the upper rim of the glenoid. The SLAP tear can be classified according to the precise location and extent of the tear.
What are the Causes of SLAP Tears?
The shoulder is referred to as a “ball and socket” joint. The shallow nature of the socket allows the ball to translate or slide within the socket during normal shoulder function. This translation with repetitive activities or with a more violent sudden translation can cause tearing of the labral attachment. Common causes of a SLAP tear include a fall on to the outstretched arm. Repetitive forces on the joint such as with overhead sports or throwing sports may result in a tear. Repetitive overhead employment tasks may also be a factor.
How are SLAP Tears Diagnosed?
The symptoms due to a SLAP tear may be non-specific. The way in which the symptoms have come on, such as repetitive overhead tasks or single more significant injuries, may give a clue. You may notice that the pain is consistently reproduced by a particular shoulder movement such as a throwing action.
There may not be any characteristic features when the shoulder is physically examined either. Some clinical features may raise a suspicion of a SLAP tear but not necessarily confirm the diagnosis. Mr Lyons looks for pain when passively taking the shoulder in to a throwing type of posture. Manual translation of the humeral head on the glenoid may also cause pain. The response to tests that load the biceps tendon might also help.
An MRI Scan may help to confirm the diagnosis. But even this sensitive test may not necessarily provide a firm diagnosis. Final confirmation of a SLAP tear may sometimes occur when a patient with symptoms unresponsive to non-surgical treatments undergoes an arthroscopic examination of the shoulder. This will provide visual confirmation.
What are the Treatment Options for SLAP Tears?
Milder symptoms may respond to non-surgical treatment such as anti-inflammatory medication. Stretching and shoulder stretching exercises under the guidance of a physiotherapist may help.
However higher grade SLAP tears may be resistant to simple treatments. The severity of the pain symptoms balanced against your desire to continue your sport will help in deciding whether a surgical treatment is indicated. The surgical treatment of a SLAP tear involves an initial arthroscopic examination of the shoulder to confirm the extent of the problem. Then, depending upon the configuration of the tear and the condition of the labrum, a decision can be made at the time of the arthroscopy whether an arthroscopic repair of the tear is technically possible. Soft tissue anchors and sutures are used to hold the labrum in postion while it heals.
A chronic and very extensive tear may lead to the labrum being of very poor quality. Under these circumstances a removal of the torn segment of labrum might be just as effective as a repair. Trying to repair tissue of poor quality carries a risk of re-tearing. The biceps tendon has pulled well away from the glenoid along with the labrum. If so, removal of the segment of the biceps within the shoulder joint and attaching the remaining biceps tendon to the biceps groove at the front of the shoulder may be abetter option. This is a surgical technique referred to as Biceps Tenodesis.
Surgery will be followed by a rehabilitation program. This will involve an initial period of rest in a sling for several weeks. Graduated mobilising and strengthening exercises will follow. It commonly takes several months for the shoulder to recover sufficiently to make a return to sport.