The shoulder is the most mobile joint in your body and as such, is dependent on strong muscles, ligaments, and a rim of cartilage on the shoulder’s socket called the ‘labrum’ in order to stabilise it during movement. The labrum is a rubber-like tissue which cups the ball-shaped joint at the top of your upper arm bone, connecting the two joints in order to hold it in place. The rotator cuff which consists of four muscles helps the labrum keep the ball in the socket. This in turn allows your upper arm to rotate.
What is a SLAP Tear?
SLAP stands for ‘superior labrum anterior and posterior’. There are many different labrum tears, but a SLAP tear is a common shoulder injury which occurs in the top (superior) area of the labrum, where the biceps tendon is attached. The tear happens in the front (anterior) and back (posterior) of the attachment, often causing pain.
What Causes the Condition?
SLAP tears are common in those who participate in sporting and non-sporting activities which involve repetitive overhead arm motion. This kind of labrum tear is often seen in sports people such as tennis players, weight lifters and baseball players. They can also occur through injury, such as a sudden fall where the shoulder is extended to break the fall, dislocation of the shoulder and general wear and tear. If you are 40 or over, the condition is a common issue.
SLAP Tear Symptoms
Symptoms from a SLAP tear can vary depending on its severity, but typically include:
- An unstable feeling in the shoulder
- Decreased range of motion
- A popping, locking, grinding or catching feeling
- Loss of strength in the shoulder
- Pain at night or while doing daily activities
Pain from a SLAP tear is usually intermittent, but is generally worse when you carry out a task, especially an overhead activity.
Diagnosing a SLAP Tear
Your doctor will ask you a number of questions about your symptoms, where it hurts and if there has been a specific injury or event which has resulted in the pain you are currently experiencing. Try to provide as much information as possible to assist with the diagnosis. Your doctor will carry out a physical examination of the shoulder to determine its stability, strength, range of motion and pain level.
If inflammation or a pinched nerve is ruled out, you are likely to be referred for an X-ray and MRI scan. Although an X-ray cannot pick up a labrum tear because it consists of soft tissue, it can highlight a possible fracture which could be the cause of your pain. An MRI scan is often performed to diagnose a SLAP tear, along with other possible injuries to the tendons, ligaments, muscles and cartilage in the shoulder.
Treatment for a SLAP Tear
There are two approaches for the treatment of a SLAP tear. These consist of non-surgical (conservative) and surgical treatment. Surgery is very rarely the first option as doctors will usually commence treatment with non-surgical techniques. These can include the following:
Anti-inflammatory medications
Over the counter or prescribed medication may be taken to decrease pain and swelling in the shoulder. Cortisone injections can also help with pain relief.
Physiotherapy
You may be assigned certain exercises by a physiotherapist to help strengthen the shoulder muscles – especially the rotator cuff, and improve range of motion through stretching. You may also be given manual therapy or massages during your visits. Your physiotherapist will show you what positions and activities to avoid, as well as gentle stretches and exercises which can be performed at home.
Physical therapy usually lasts between 3 – 6 months, depending on the severity of the tear.
If medication and exercise does not help, then surgery may be your next step.
SLAP tear repairs are usually treated with minimally invasive arthroscopic (keyhole) surgery. The surgeon places a small camera in your shoulder joint which sends images to a bigger screen in the operating theatre. By using small tools, the surgeon can remove and repair the damaged part of the labrum. This can include cutting off any flaps of damaged cartilage which are preventing full range of motion.
Post-Operative Recovery
After surgery, you will be expected to wear a sling for the first 4 weeks in order to keep your shoulder immobilised. Once the swelling has gone down, you can then begin to move it again with guidance from your physiotherapist.
You will be given a programme of physical therapy which will start with range of motion exercises, and gradually progress to stretching and strengthening.
Labrum surgery typically takes 6 – 9 months to completely heal, depending on the severity of the tear. Most patients regain full use of their shoulder and are able to return to their normal level of physical activity.
Need Help?
If you are experiencing pain in your shoulder and you think it could be a SLAP tear, you can be seen by a Consultant Orthopaedic Shoulder Surgeon at One Ashford Hospital, usually within 48 hours. One Ashford Hospital is well placed to see patients with knee injuries from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages. To book an appointment, call the hospital direct on 01233 364 022 or email here.
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