The shoulder joint, a ball-and-socket joint, allows for extensive arm motion. It is formed by the humerus fitting into the glenoid, a shallow socket on the shoulder blade. The glenoid labrum, a rim of fibrocartilage, deepens the socket and enhances joint stability. The labrum also provides an attachment point for various ligaments and tendons, including one of the biceps tendons.
What a SLAP Tear Is
A SLAP tear (Superior Labrum Anterior Posterior) is an injury to the upper part of the labrum, extending from front (anterior) to back (posterior). The long head of the biceps tendon attaches to the superior labrum, so injuries here can affect both.
Type 2 SLAP tears are the most common. In a Type 2 tear, the superior labrum completely detaches from the glenoid rim, often along with the biceps tendon anchor point. This detachment creates a gap between the labrum and the underlying glenoid cartilage. Other SLAP tear types exist, such as Type 1 (fraying without detachment), Type 3 (a “bucket-handle” tear where a portion of the labrum hangs into the joint), and Type 4 (tear extending into the biceps tendon itself).
Common Signs and Causes
Individuals with a Type 2 SLAP tear often report a persistent dull ache or sharp pain deep within the shoulder, which intensifies with movements like raising the arm overhead or stretching it behind the head. Mechanical symptoms like clicking, popping, or grinding sensations are common, as is a feeling of instability.
SLAP tears can result from acute traumatic events. Causes include falling onto an outstretched arm, direct shoulder impact, or a sudden, forceful pull. Repetitive overhead activities, common in athletes like pitchers or swimmers, can also wear down the labrum over time. Degenerative changes associated with aging, especially in individuals over 40, can also contribute.
How a SLAP Tear Is Diagnosed
Diagnosis typically begins with a clinical evaluation, including medical history and symptoms. A physical examination assesses range of motion, strength, and stability. Specific physical tests reproduce symptoms, but clinical findings alone may not definitively confirm a SLAP tear due to overlapping symptoms with other conditions.
Imaging confirms diagnosis and determines injury extent. MRI is commonly used to visualize soft tissues. An MRI arthrogram, involving contrast dye injected into the joint, enhances tear visibility by highlighting the space between the detached labrum and glenoid. X-rays rule out other issues like fractures or arthritis, but do not visualize soft tissue injuries.
Treatment Options
Treatment for a Type 2 SLAP tear involves non-surgical and surgical approaches, often starting conservatively. Non-surgical options include rest, ice, and NSAIDs to manage pain and inflammation. Physical therapy guides exercises to restore range of motion, strengthen rotator cuff muscles, and improve scapular stability. This approach may be pursued for 6 weeks to 3 months before considering surgery if symptoms persist.
If non-surgical methods fail, surgery may be recommended. Arthroscopic surgery, a minimally invasive procedure, commonly repairs Type 2 SLAP tears. A small camera and instruments are inserted through tiny incisions to visualize and address the injury. Techniques include debridement (removing damaged labral tissue) or repair (suturing the detached labrum back to the glenoid bone with anchors). In some cases, especially in older patients or those with significant biceps pathology, a biceps tenodesis or tenotomy may be performed, detaching the biceps tendon from the labrum and reattaching it elsewhere or releasing it.
Recovery After Treatment
Recovery, especially after surgery, typically involves a structured rehabilitation program. Physical therapy guides the patient through progressive healing stages. Initially, the shoulder may be immobilized in a sling for four to six weeks to protect the repair and allow healing. Passive range-of-motion exercises may be initiated during this period to prevent stiffness.
As healing progresses, the program advances to active range-of-motion exercises, followed by gradual strengthening exercises for the shoulder and surrounding muscles, typically starting around 12 weeks post-surgery. Full recovery can take six months to a year, depending on adherence to the rehabilitation plan and tear complexity. Return to activities, including sports, is often allowed between 14 to 20 weeks, based on clinical evaluation and therapy progress.