SLAP Tear

Anatomy

The shoulder is a complex, ball-and-socket joint made up of three bones: the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The ball, or head, of the upper arm bone fits into a rounded socket in the shoulder blade called the glenoid.

Surrounding the outside edge of the glenoid is a rim of cartilage (labrum) that helps to deepen the shoulder socket and stabilize the shoulder joint. The labrum also serves as an attachment point for many of the shoulder ligaments, as well as one of the tendons from the biceps muscle in the arm.

Description

A SLAP (Superior Labrum Anterior and Posterior) tear is an injury to the top (or superior) part of the labrum.

Symptoms

The common symptoms of a SLAP tear are similar to many other shoulder problems. They include:

• A sensation of locking, popping, catching or grinding
• Pain associated with shoulder movement or when holding the shoulder in specific positions
• Pain with lifting objects, especially overhead
• Decreased shoulder strength
• Decreased range of motion
• A feeling that the shoulder is going to "pop out of joint"
• Pitchers may notice a decrease in their throw velocity, or a sensation of having a "dead arm" after pitching

Causes

SLAP tears can be the result of acute trauma, and those who participate in repetitive overhead sports, such as throwing athletes or weightlifters, have an increased risk of injury to the superior labrum. Many SLAP tears are the result of a wearing down of the labrum that occurs slowly over time. In patients over 40 years of age, tearing or fraying of the superior labrum can be seen as a normal process of aging.

Other common causes include:

• Motor vehicle accidents
• Falling onto an outstretched arm
• Forceful pulling on the arm, such as when trying to catch a heavy object
• Rapid or forceful movement of the arm when it is above the level of the shoulder
• Shoulder dislocation

Nonsurgical Treatment

• Nonsteroidal anti-inflammatory medication (NSAIDS)—Drugs such as ibuprofen or naproxen may help relieve pain, inflammation and swelling. Most people are familiar with nonprescription NSAIDS such as aspirin and ibuprofen, however, whether using over-the-counter or prescription strength, they must be used carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Physical therapy—Specific exercises or a shoulder conditioning program will help restore range of motion. Physical therapy may be used under the supervision of a physical therapist or a home program.

Surgery

If symptoms are not relieved by medication and physical therapy, your orthopaedic surgeon may recommend surgery. Shoulder arthroscopy (also known as minimally invasive surgery), is the most commonly used surgical technique for repairing a SLAP injury.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.

VIDEO: Throwing Injuries with Kirk Cousins & Dr. Bruce Stewart, Holland Hospital Sports Medicine