SLAP tears are among the most common shoulder injuries, especially for athletes who perform a lot of overhead arm motions like baseball, basketball and volleyball players. SLAP stands for “Superior Labrum Anterior and Posterior.” If that description doesn’t mean much to you, don’t worry. Read on to understand how these injuries occur, how they are diagnosed and finally, how they are treated.
We spoke with Daniel Heaston, MD, an orthopedic surgeon at Banner Health Clinic in Northern Colorado. As a team physician for the University of Northern Colorado’s sports teams and as an avid athlete himself, he has seen many SLAP tears over the years.
What causes SLAP tears?
The superior labrum connects at the top of your shoulder. It is a ring of cartilage that deepens the joint, allowing your humerus (upper arm bone) to fit tightly into your shoulder. When the labrum is torn in the anterior (front) or posterior (back) areas, you may experience a number of symptoms. For example:
- Diminished shoulder strength
- A feeling of instability in the joint
- Popping, grinding or locking in the shoulder
- Pain when lifting overhead
Athletes like baseball pitchers can become familiar with SLAP tears due to excessive repeat throwing motion. But athletes aren’t the only ones who can experience a SLAP tear. Dr. Heaston described two common symptomatic cases.
- SLAP tears in young patients are typically caused by a repeat motion or acute injury like a fall or accident. The labrum will naturally degenerate over the years, which means that patients under 35 years of age will experience a tear following trauma to the joint. Tears can also occur due to imbalance in the joint. Dr. Heaston described, “If there is tightness in the back of the shoulder that pushes the ball of the humerus forward, it will cause an imbalance putting the biceps tendon under more tension. If there is forceful movement of the muscle across that tendon it can pull on the superior labrum tearing the labrum from the socket.”
- Patients over 35 may have an easier time getting injured. In fact, many people over the age of 50 could have a SLAP tear simply as a result of age and regular use of the shoulder. As the labrum degenerates over time, it becomes more prone to injury. For this reason, maintaining a flexible and strong joint is especially important as we get older.
How is a SLAP tear diagnosed?
When meeting with your doctor, offer as many details as possible in addition to the symptoms you are feeling. If you can remember a specific moment when the injury may have occurred, this will help with your diagnosis. If you can’t pinpoint a cause for the injury, describe your day-to-day activities, including any work or sports activities that you participate in. Your doctor will weight this against a physical examination of the joint to better understand how the SLAP tear may have occurred.
X-rays and MRI scans can be helpful in identifying the specifics of your tear as well as showing any other contributing factors in your tear such as fractures or arthritis.
How is a SLAP tear treated?
“Most SLAP tears do not need surgery. In fact, surgery is typically reserved only for patients that fail conservative treatment,” commented Dr. Heaston. He went on to explain that patients, both young and old, often respond well to physical therapy to stretch out and relax the tendons and muscles of the shoulder. This allows the ball of the humerus to center in the joint, limiting the pull on your superior labrum.
In serious cases or when physical therapy isn’t effective, surgery may be necessary. Arthroscopy (minimally invasive surgery) is most commonly used in surgical treatments of SLAP tears. It leaves minimal damage and decreases recovery times significantly. Most patients will need to keep their shoulder in a sling for two to six weeks, depending on severity and what is fixed during surgery. As soon as about six months after surgery, patients may be able to resume sports activity.
Preventing reinjury
Dr. Heaston offered advice for patients who have recovered from a SLAP tear. “Keeping your shoulder loose and stretching out any areas of tightness will help to prevent pull on the labrum. Gentle, high repetition and low weight strengthening exercises, especially those including internal and external rotation of the shoulder will build proper support for the shoulder and help to prevent reinjury.” Work with your physician and physical therapists to create a rehabilitation routine and stick with it.
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