The shoulder is a mobile ball-and-socket joint, allowing for a wide range of arm movements. This mobility, however, also makes it susceptible to various injuries and conditions that can cause pain and limit daily activities. Shoulder pain is a common complaint, often stemming from athletic activities, accidents, or repetitive motions. Understanding shoulder injuries is helpful for effective management and recovery.
What is a SLAP Tear?
A SLAP tear (Superior Labrum Anterior Posterior) is an injury to the cartilage ring surrounding the shoulder socket. This cartilage, known as the glenoid labrum, deepens the socket, helping to stabilize the upper arm bone (humerus). The superior labrum, at the top of the socket, is where the biceps tendon attaches.
A SLAP tear involves a tear in the upper labrum, extending from the front (anterior) to the back (posterior) near the biceps tendon. This tear can range from minor fraying to a complete detachment of the labrum and biceps tendon. When the labrum tears, it can compromise the shoulder’s stability and affect biceps tendon function.
Common Causes
SLAP tears can result from acute trauma or from repetitive stress. Acute injuries often occur from a fall onto an outstretched arm, compressing the shoulder and tearing the labrum. Other incidents include a direct blow to the shoulder, a sudden pulling motion on the arm, or rapid, forceful movements of the arm above shoulder level. Shoulder dislocations are also associated with labral injuries.
Repetitive overhead activities are a common cause of SLAP tears, particularly in athletes. Sports like baseball, swimming, tennis, and weightlifting, which involve frequent and forceful overhead arm movements, can lead to microtrauma and gradual wearing down of the labrum. In individuals over 30 to 40 years of age, SLAP tears can also develop as a result of age-related degeneration and fraying of the superior labrum, even without a specific traumatic event.
Recognizing the Signs
Individuals with a SLAP tear often experience a persistent dull ache or sharp pain deep within the shoulder joint. This pain typically worsens with certain arm movements, especially overhead activities like lifting objects above the head or throwing. A common complaint is a popping, clicking, or grinding sensation within the shoulder when moving the arm.
Many also report a feeling of instability in the shoulder, as if it might “pop out” of its socket. Decreased range of motion and weakness in the affected arm are also frequent symptoms. Athletes, particularly pitchers, might notice a significant decrease in their throwing velocity or a sensation often described as a “dead arm” after pitching.
Confirming the Diagnosis
Diagnosing a SLAP tear can be challenging because its symptoms often overlap with other shoulder conditions. A healthcare professional typically begins with a detailed patient history, asking about the onset of symptoms and any specific incidents that might have caused the injury. This is followed by a physical examination to assess shoulder movement, stability, and to perform specific diagnostic tests.
Tests such as O’Brien’s test, Speed’s test, or the Biceps Load II test may be performed to try and provoke pain at the tear site or evaluate the biceps tendon, which is frequently involved in SLAP tears. While physical tests can provide strong indications, imaging studies are often used to confirm the diagnosis. Magnetic Resonance Imaging (MRI), especially with contrast dye injected into the joint (Magnetic Resonance Arthrogram or MRA), is considered effective for visualizing labral tears. An MRA provides more detailed images of the labrum and surrounding structures.
Treatment Options
Treatment for a SLAP tear depends on factors such as the severity of the tear, the patient’s age, activity level, and overall health. Initial management often involves conservative approaches to reduce pain and inflammation. This typically includes rest, avoiding activities that aggravate the shoulder, and using non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain.
Physical therapy is a common component of conservative treatment, focusing on strengthening the rotator cuff muscles and improving shoulder stability. Exercises aim to restore range of motion and overall shoulder function. If conservative measures do not provide sufficient relief or for more severe tears, surgical intervention may be considered.
Surgical options are typically performed arthroscopically, using small incisions and specialized instruments. Common procedures include arthroscopic SLAP repair, where the torn labrum is reattached to the shoulder socket using sutures or anchors. Another option is biceps tenodesis, where the biceps tendon is detached from the labrum and reattached to a different location on the upper arm bone, which can be preferred for older patients or those with concomitant rotator cuff tears. Post-surgical rehabilitation is important for restoring full range of motion, strength, and function, often involving a period of sling immobilization followed by structured exercises over several months.