SLAP is an acronym that explains where and how one type of labral tear can happen. It stands for Superior Labrum from Anterior to Posterior. A SLAP tear is a tear in the labrum that occurs at the top or superior aspect of the shoulder socket and can extend further toward the back and/or toward the front of the shoulder joint.
The labrum surrounds the outside edge of the shoulder socket and has an important role in keeping the shoulder joint stable. It also serves as an attachment point for the capsule and ligaments of the shoulder joint, and the tendon of the biceps muscle.
Symptoms of a SLAP tear include locking, popping, clicking, or grinding in the shoulder. It can also cause pain when holding the shoulder in a specific position, pain when lifting heavy objects overhead, a decrease in shoulder strength, or a decreased range of motion. People with SLAP tears may also have pain running from inside the shoulder down the front of the arm, along the biceps muscle. Pain with overhead activities (without instability) is a common finding in patients with SLAP tears. A common symptom of SLAP tears in overhead throwers is that their arm feels dead after the throwing motion.
The injury involves the very top of the shoulder joint labrum (or the 12 o’clock position) and then can extend either toward the back (posterior—typical in baseball) or toward the front (anterior—typical with shoulder dislocations).
A SLAP injury can happen due to:
- Falling on an outstretched arm
- A strong downward pull of the arm (traction injury)
- Repetitive use in overhead throwing athletes
There are a few ways this area of the labrum can be torn. First is the sudden movement of the humeral head upward while the rotator cuff muscles are trying to hold it in place in the socket. Examples of this type of injury include falling onto an outstretched hand to break a fall or bracing the arms on the steering wheel during a car accident.
Another way SLAP tears can occur is when the arm is in a throwing position, and the humerus bone repeatedly rubs or impacts the superior labrum while the humerus is rapidly rotating forward. Finally, a sudden downward pull may act through the biceps tendon to tear the superior labrum, which partially attaches to this area of the shoulder.
In order to diagnose a SLAP tear, a doctor will first perform a physical examination to assess the shoulder’s range of motion and strength in the arm and shoulder. In addition, there are unique clinical exam tests that help to differentiate SLAP tears from other problems of the shoulder, including rotator cuff tears and biceps tendon injuries. Next, the doctor will likely order an MRI to confirm the diagnosis, which more closely looks at the soft tissue of the labrum and tendons.
Nonsurgical treatment options
Some SLAP tears have no symptoms and do not require surgery. Smaller tears can be treated with rest, physical therapy, ice, and over-the-counter pain medications like acetaminophen or ibuprofen. Exercises should focus on strengthening the muscles of the rotator cuff and shoulder blade. If your tear does not respond at this point, the good news is most SLAP tears can be repaired with an arthroscopic procedure. This is a minimally invasive surgery done on an outpatient basis.
How surgery is performed
A SLAP repair can be done arthroscopically (via keyhole surgery) in an outpatient setting. During the procedure, a tiny camera is inserted via a small cut in the back of the shoulder. This allows Dr. Romeo to accurately appraise the extent of the damage in real-time and confirm which type of repair is appropriate. The goal of the procedure is to trim away the damaged portion of the labrum and surgically sew up and reattach the torn labrum, if necessary.
In this video, Dr. Romeo performs an arthroscopic shoulder repair on former White Sox pitcher John Danks, demonstrating problems of the superior labrum, rotator cuff, and capsule. His comments will guide you through a better understanding of the day of surgery, from the preoperative assessment all the way to the recovery room.
After surgery, you will be sent home with a sling to wear for two to four weeks. Dr. Romeo will give you specific instructions for post-op pain management. Physical therapy often starts two to four weeks after surgery and will include a lot of stretching for flexibility and improved range of motion.
After six weeks, a strengthening program will be added. Even as you begin to stretch and strengthen your arm, Dr. Romeo recommends that you ease into physical activity gradually. Take care not to place excessive amounts of stress on the shoulder joint. Most people are back to many of their activities three months after surgery, with full participation in sports by six months and a return to pre-injury level of performance by nine to 12 months.
Are athletes especially prone to SLAP tears?
Because this injury is more likely when the arm is fully extended, athletes who perform repetitive overhead motions frequently develop SLAP tears. SLAP tears can occur from the labrum gradually wearing down over time.