SLAP Tears (Superior Labrum Anterior to Posterior)
The labrum is a fibrous bumper that helps to stabilize the shoulder joint. It provides an attachment site for a variety of other shoulder structures including the capsule, ligaments and biceps tendon. When the superior labrum is detached or torn at the site of the biceps tendon insertion, it is termed a superior labrum anterior to posterior tear (SLAP). A variety of injuries may cause damage to the superior part of the labrum where the biceps tendon inserts. The most common type of injuries are repetitive over arm motion such as throwing a ball, falling on an outstretched arm or lifting a heavy object.
Overhead athletes or patients involved in repetitive overhead work can damage the superior labrum. This often generates a deep or posterior pain in the shoulder joint accompanied by a clicking, catching or popping sensation. There may be weakness with overhead activity. The throwing athlete often notices diminished velocity and control with throwing a ball. A thorough evaluation by your sports medicine physician is most appropriate to confirm this diagnosis. Plain x-rays may be obtained in order to rule out any type of bony damage. An MRI may also be obtained in order to determine the degree of superior labral injury as well as the existence of any injury in the adjacent capsule, ligaments or biceps tendon.
Non-operative treatment may help a large percentage of patients with a superior labral tear. This non-operative treatment requires avoiding the offending sport or activity for 3 to 6 weeks in combination with ice and a non-steroidal anti-inflammatory (if your medical history allows it). A structured physical therapy program is also initiated to restore range of motion as well as strength. In addition rehabilitation of the leg, hip, abdominal and back musculature enhances recovery. When the athlete is pain free and has near full range of motion and strength, a sport or work simulation is carried out. If an athlete has persistent pain, weakness, clicking and catching which prevent return to sport, work or sleep then surgical treatment may be necessary.
Surgical treatment of a SLAP tear is arthroscopic, and involves a repair of the labrum using small anchors that are placed in the socket of the shoulder. Patients are typically in a sling for 4-6 weeks, followed by physical therapy for several months.