A SLAP tear is an injury to the connective cartilage surrounding the shoulder joint, or labrum. SLAP stands for Superior Labrum Anterior and Posterior, indicating the location of the injury. In a SLAP injury, the top part of the labrum is injured, with tears either in front of (anterior) or behind (posterior) the top attachment point of the shoulder. The labrum acts as the connective cushion surrounding the socket joint of the shoulder. It also acts as a stabilizer of the shoulder joint and attachment point for the ligaments of the shoulder as well as the biceps tendon in the arm.
To better understand a SLAP injury, it is important to consider your shoulder’s anatomy. The shoulder has three bones: the shoulder blade (scapula), upper arm bone (humerus), and the collarbone (clavicle). These bones move through a ball-and-socket joint that is cushioned by the labrum. When the labrum tears in a SLAP injury, there is not enough cushion between the bones, causing pain in the shoulder blade, collarbone, and upper arm.
What Causes a SLAP Tear?
SLAP injuries are most commonly caused by acute injury and over-use. Certain sports, such as baseball, tennis, volleyball, and swimming present a greater risk of SLAP injuries because of consistent, repetitive overhead movements of the shoulder. Weightlifters are also susceptible to SLAP injuries because they consistently lift a barbell over their head and the force can cause premature wear-and-tear on the labrum.
However, not all SLAP injuries are acute in nature. They are often caused by degenerative wear-and-tear on the labrum over time. Adults in their 40s and 50s commonly experience SLAP injuries because the labrum has become worn down. Certain types of arthritis can also contribute to SLAP tears by degenerating the cartilage surrounding the shoulder joint. Your doctor will look at your medical history and evaluate your physical symptoms to accurately determine the cause of your SLAP injury.
Specific scenarios that commonly cause SLAP injuries include:
- Shoulder dislocation
- Falling onto an outstretched arm
- Falling onto the shoulder
- Repetitive use of the shoulder or consistent throwing motions
- Motor vehicle accident
- Forceful pulling of the arm
- Lifting heavy objects
- Rapid overhead movement
Signs & Symptoms to Look for
A SLAP injury will cause a range of specific symptoms in both acute or chronic injury. Labrum wear-and-tear is a common complaint among older adults and those with osteoarthritis. Since the labrum is soft tissue cartilage, it can become worn down over time and with repetitive motions and symptoms can develop over time. Those who experience sudden symptoms, however, most likely have an acute injury.
Symptoms of SLAP injury include:
- Deep pain within the shoulder joint
- Clicking, catching, or popping sound when moving the shoulder
- Decreased range of motion
- Decreased strength and mobility
- Shoulder instability
- Pain when lifting or carrying objects
- Pain when moving the arm, especially overhead
- Pain when holding the shoulder in specific positions
- Feeling the shoulder is popping out of its joint
- Pain when lying on the affected shoulder
- Pain at night
How Is a SLAP Tear Diagnosed?
SLAP injuries are most often diagnosed with imaging tests, such as X-rays or MRIs, but your doctor will also consider your medical history and conduct a thorough physical examination to make the diagnosis. By thoroughly examining your injury from every angle, your doctor can make the most accurate diagnosis.
First, your doctor will talk with you about your pain, where it is located, and when it first began. While some patients may recall a specific event or activity that triggered their pain, SLAP injuries commonly present without an obvious cause. In that case, your doctor will talk to you about your daily activities, sports you play, and what you do for work to determine the cause of your SLAP injury. They will also run certain blood tests if they suspect arthritis might be to blame.
Your doctor will test the strength, mobility, and range of motion in your affected shoulder by taking your arm through a series of movements to reproduce your symptoms. SLAP injuries will predictably cause pain in certain positions and with certain movements, and testing positive for pain during these tests will help your doctor determine if additional testing or imaging is needed. It is also common for SLAP injuries to appear in conjunction with other shoulder pathologies, and your doctor may look for signs of other abnormalities as well for a thorough work-up.
Doctors will use a combination of X-rays and MRIs (magnetic resonance imaging) to assess your injury. X-rays provide clear pictures of dense structures like the bone. X-rays are ordered if your doctor suspects other problems, such as arthritis or a fracture, may be contributing to your symptoms. MRIs show clear pictures of the soft tissues like the labrum and are most commonly used to diagnose a SLAP injury. Sometimes a dye is used to more clearly see a SLAP injury.
Can You Heal a SLAP Tear Without Surgery?
SLAP injuries cannot be healed naturally, and often times surgery is needed to make a full recovery. However, patients usually begin treatment with 6-12 weeks of physical therapy to see how their shoulder responds. Typically, patients with SLAP injuries that are less severe, involving either a partially torn labrum or frayed labrum, will find that physical therapy alone will improve their symptoms. However, if symptoms do not resolve after 6-12 weeks of physical therapy, surgery is necessary for a full recovery.
Why Surgery Can Be Crucial
To better understand why surgery is often needed to recover from a SLAP injury, it is important to cover the different ways the labrum can tear and the location of the tear itself. The labrum can tear in 3 different ways: completely off the bone, just where the bicep tendon is attached, and along the edge of the labrum. Tears along the edge of the labrum may or may not need surgery depending on the location and severity of the tear. Tears completely off the bone and where the bicep tendon is attached will usually need surgery to make a full recovery.
Tears can also occur due to an injury such as a shoulder dislocation or pre-existing shoulder instability. In this case, surgery is required to reattach the labrum to the rim of the socket. Your doctor will discuss your options with you to determine a treatment plan that works for you. In most cases, surgery will be required to make a full recovery.
When Surgery Is Required
Typically, your doctor will be able to tell if you need surgery depending on specific factors or if you do not respond to conservative treatment methods. Those who fall into the following category usually need surgery to repair their SLAP injury:
- Older patients
- Those with bone or Bennett spurs
- Those with a severely limited range of motion
- Those with chronic shoulder pain
- Anyone with tears of the articular-side rotator cuff
What Happens If a SLAP Tear Goes Untreated?
SLAP injuries that are left untreated can wreak havoc on your mobility, strength, and range of motion. Without proper treatment and physical rehabilitation, SLAP injuries can cause chronic stiffness, pain, and weakness in the affected arm. Many labral tears can also lead to joint degeneration, which will just cause you more pain in the long run. While not all SLAP injuries need surgery, they do require medical attention. If you suspect you have a SLAP injury, it is important for you to get it checked out immediately to avoid long-term consequences.
Recovering From a SLAP Tear: What Are Your Options?
SLAP tears vary in severity and, depending on the location and severity of your tear, you have a variety of treatment options available to you. Typically, your doctor will try to treat your injury conservatively first to see how you respond before recommending surgery. Usually, a prescription for physical therapy, pain medications, and/or cortisone injections are recommended before surgery is deemed the best option.
Nonsurgical options such as physical therapy are usually the first treatment method employed in repairing a torn labrum. Physical therapy focuses on strengthening the muscles in the arm while increasing mobility and range of motion in the affected shoulder. A minimum of three months of physical therapy is usually prescribed for a labral tear, with a focus on strengthening the upper body.
Your physical therapist can also assess the severity of your injury based on your response to treatment. If you find yourself feeling improvements within three months of physical therapy, chances are your labral tear can be managed without surgical intervention. However, if you find yourself feeling worse or with little to no improvement with physical therapy, surgical intervention will be required to restore your shoulder back to its previous capabilities.
Cortisone or Other Medication Based Injections
In addition to physical therapy, cortisone injections can be used to both assess the nature of the injury and to treat the pain in the area. Cortisone helps decrease inflammation in the shoulder for months at a time. It is often used in combination with physical therapy to ensure you have a pain-free recovery. Cortisone injects can help you effectively recover by increasing your ability to move your shoulder without pain, aiding in physical rehabilitation.
Pain medications, like cortisone injections, are often used in combination with physical therapy and rehabilitation to conservatively treat SLAP injuries. Anti-inflammatory NSAIDs are the most common prescription for SLAP injuries and will help reduce pain in the area by eliminating inflammation. Pain medications increase the patient’s ability to perform physical therapy exercises and increase their chances of regaining mobility and strength with physical therapy alone.
Surgical treatments are required if the patient does not respond to conservative treatments, including physical therapy, pain medication, and/or cortisone injections. Many doctors will attempt these conservative therapies first before sending their patients in for surgery. However, surgery is necessary in some patients to ensure they completely recover without complications.
What to Expect If You Need Surgery
Your doctor may advise you that surgery is the best option for your SLAP injury if your injury is severe in nature or does not respond to conservative physical therapy. Surgery may sound intimidating, but with innovative, minimally invasive technology, you will feel like yourself again in no time. Keep reading to find out what to expect from your labral repair.
During the Procedure
With minimally invasive arthroscopic techniques, your doctor is able to repair your labrum tear without the stiffness and pain associated with open surgery. Arthroscopic surgeries allow doctors to make small incisions in the injured area as opposed to larger incisions in open surgeries. They are also able to see your shoulder with a small camera to most accurately assess and treat your injury. Arthroscopic surgeries afford patients a better range of motion during the recovery time, resulting in a faster, more efficient recovery time.
Your recovery time will depend on the severity and location of the tear. Typically, it takes 4 to 6 weeks for the labrum to reattach itself to the bone, with another 4 to 6 weeks to regain strength. You will have to be patient with yourself and your body during this time to make sure you do not re-injure the labrum while it is healing. Your doctor will tell you what to expect with your specific injury, including what movements to avoid during the healing process.
For those that play sports, it is important to give your body a chance to fully recover before jumping back onto the court. Contact sports, such as wrestling and football, present a greater chance of injuring the labrum repair. While you may be eager to get back into the game, giving your body time to heal properly is incredibly important and will prevent you from getting injured again in the future. Typically, once you are able to regain full strength and function of the shoulder, you can return to your sport with the same level of intensity.
Most patients are able to make a full recovery with few or no limitations following their surgery. Physical therapy will help you regain strength safely and at a pace that will support the healing process.
Physical therapy and rehabilitation is a critical step in the healing process. During your sessions, your physical therapist will take you through exercises that strengthen your muscles, while also increasing the range of motion and mobility in the shoulder to ensure the healing process runs as smoothly as possible.
It is important that you remain consistent with your physical rehabilitation even after your appointment ends. Doing the at-home strengthening exercises recommended by your physical therapist will help you recover quickly and protect you from future injuries.
If you suspect you have a SLAP injury, call Plymouth Bay Orthopedic Associates in Plymouth, MA to schedule your initial consultation today. You don’t have to live in pain forever. Let us help you get on the road to recovery so you can get back to doing the things you love.