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Superior Labral Tear (SLAP Tear)

The shoulder joint is formed where three bones meet: the humerus (long bone that forms the upper arm), the scapula (shoulder blade), and the clavicle (collarbone). The head of the humerus bone fits inside of a cavity of the scapula called the glenoid fossa. Inside the glenoid fossa is a ring of cartilage, called the labrum. When the top (superior) portion of the labrum tears, this is referred to as a SLAP tear

Superior Labral Tear (SLAP Tear) Hero Image 2

The shoulder joint is formed where three bones meet: the humerus (long bone that forms the upper arm), the scapula (shoulder blade), and the clavicle (collarbone). The head of the humerus bone fits inside of a cavity of the scapula called the glenoid fossa. Inside the glenoid fossa is a ring of cartilage, called the labrum. The labrum serves multiple important functions for the shoulder, like:

• Providing stability for the shoulder joint by “hugging” the head of the humerus
• Providing cushion for the shoulder joint, protecting the humerus bone and the scapula from grinding against each other
• Serving as a connection point for various shoulder ligaments
• Serving as a connection point for the long head of the bicep tendon

When the top (superior) portion of the labrum tears, this is referred to as a SLAP tear. The superior portion of the labrum is where the long head of the bicep tendon attaches. This tendon may also be injured in a more severe SLAP tear.

A SLAP tear can occur either in the front (anterior) or back (posterior) portion of the labrum.

What causes Superior Labral Tear (SLAP Tear)?

SLAP tears can occur due to a traumatic event, like a fall, or by repetitive overhead motion. Common causes of SLAP tears include:

• Falling onto the arm when it’s stretch out, like when diving to catch a baseball
• Repetitive, forceful overhead movement, like a hang snatch movement in Olympic weightlifting
• Repetitive overhead motions required in activities like swimming or throwing a ball

SLAP tears are categorized by severity, and involve four stages of tearing:

• Type I: The labrum is starting to fray, but is still attached to the glenoid fossa.
• Type II: The labrum, along with the bicep tendon, detaches from the glenoid fossa. The bicep tendon is still connected to the labrum.
• Type III: The labrum is significantly torn, so much so that the superior portion of the labrum that has detached could possibly droop or fall into the shoulder socket. This type of tear is often referred to as a “bucket-handle” tear. The bicep tendon is still connected to the labrum in a type III SLAP tear.
• Type IV: The labrum has suffered a “bucket-handle” tear and the bicep tendon has also torn away from the labrum.

SLAP tears are common in these sports:

• Baseball
• Football
• Swimming
• Weightlifting

Symptoms

If you have a SLAP tear, you may not have symptoms all the time. You may only experience pain or other symptoms when doing certain movements with the shoulder. If you have a SLAP tear, you may experience one or more of the following symptoms:

• Pain when performing overhead movements
• Popping or grinding sound when moving the shoulder
• A decrease in range of motion in the affected shoulder
• Loss of strength in the affected arm

When to see a doctor

If you’re experiencing symptoms of a SLAP tear, make an appointment to see an orthopedic specialist. During your appointment, your doctor will ask you about your symptoms and your pain. If you experienced a traumatic injury to the shoulder, mention this to your doctor. Your doctor will begin to move your shoulder to assess range of motion, strength, and pain.

In order to make a diagnosis, your doctor may prescribe one or more of the following imaging tests:

• MRI
• X-ray

Non-operative treatment

Treatment for SLAP tears will vary depending on the severity of the tear and what type of tear (I, II, III, or IV) occurred.

Type I SLAP tears can generally be treated using non-operative treatments. If you’ve been diagnosed with a type 1 SLAP tear, non-operative treatments that can help you recover from a SLAP tear include:

• Avoiding overhead motions, like throwing
• Non-steroidal anti-inflammatory medications, like naproxen or Ibuprofen to reduce inflammation and relieve pain
• Physical therapy with a qualified professional in order to strengthen the muscles around the shoulder and to stretch the shoulder in order to restore full range of motion

You can also try these exercises at home to stretch and strengthen the muscles surrounding the shoulder:

Superior Labral Tear (SLAP Tear)

Surgical Treatment

If non-surgical treatments do not alleviate pain, your doctor may suggest surgical treatment. The type of surgery your doctor suggests will depend on the severity of the tear and whether the tear occurred in your dominant arm or your non-dominant arm.

If the tear is minimal, your surgeon may decide to either remove the torn tissue (this is called a debridement procedure) or reattach the torn portion of the labrum.

 

If a SLAP tear is a high-grade tear, your surgeon may decide to detach the bicep ligament from the labrum and attach it to the humerus. This procedure is called a biceps tenodesis.

 

Recovery

Depending on the severity of the tear and the type of treatment used, you can expect to return to play three to six months from the time you begin treatment.

Immediately following surgery, your arm will be placed in a sling, which you’ll be required to wear for two to four weeks. This allows the shoulder to heal and reduces the risk of complications. When directed by your doctor, you will remove the sling and begin a physical therapy program to regain range of motion and increase flexibility in the shoulder.

Once healing has progressed to an appropriate point, you’ll begin working with your physical therapist to strengthen the muscles of the shoulder and the rotator cuff.

It’s important to follow all directions given to you by your orthopedic specialist and your physical therapist. Your orthopedic specialist will closely monitor your progress after surgery and will inform you when you can return to playing sports — this is typically once you have regained full range of motion and strength without experiencing pain.

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