SLAP Tear

SLAP is an acronym that stands for Superior Labral Tear from Anterior to Posterior. A SLAP tear is also referred to as a labral Tear or SLAP Lesion. It is an injury to the labrum of the shoulder. As we know, the shoulder is a ball and socket joint. The labrum is a cartilage lining around the socket of the shoulder. The labrum helps to deepen the socket and stabilize the shoulder joint. SLAP lesion is a damage to the top of the labrum, or where the biceps tendon connects to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment. Depending on the type of injury, the SLAP tears are classified into several types:

Front view of shoulder joint showing SLAP lesion

Types of SLAP Tear

There are several types of Slap Tears:

Type 1 SLAP Tear

Involves isolated fraying of the labrum, but it is still attached to the Glenoid. Generally, does not show any symptoms. It is said that most of the people have a Type 1 SLAP tear that they would not know of.

Type 2 SLAP Tear

This is the most common type of SLAP Tear. Involves detachment of labrum from the Glenoid causing instability of the biceps-labral anchor. They can be further classified as anterior, posterior or a blend of the two.

Type 3 SLAP Tear

Involves bucket-handle tear of the labrum. Biceps anchor are attached. Labrum droops into the shoulder joint. Often treated with Arthroscopy

Type 4 SLAP Tear

This is again a bucket-handle tear of the labrum however it extends upto the biceps tendon in varying degrees. It also involves instability of the biceps-labrum anchor. Depending on the extent of biceps tendon involved, treatment options are selected.

Causes of SLAP Tear

SLAP tears are generally caused by repeated motions or acute trauma. Athletes have high chances of getting a SLAP tear. The main causes are:

Due to an injury – fall or sudden force
Wear and tear due to age
Repeated overhead motions like in volleyball, swimming
Lifting heavy objects too often or suddenly

Symptoms of SLAP Lesion

Pain with specific movements of shoulder.
Decreased strength in the shoulder
Limited range of motion
Popping, clicking or catching sensation in the shoulder
Inflammation in the shoulder

Diagnosing a shoulder labral tear

A Shoulder Specialist will evaluate the patient’s medical history which includes discussing the symptoms, current occupation, previous treatments, medications etc. Evaluating medical history of the patient along with physical examination plays a very important and intricate part of diagnosing the problem. In many cases, doctor diagnoses the problem based on medical history and physical examination which is then validated using x-rays or imaging technologies.

Treatment of SLAP Tear

Like other shoulder conditions, treatment starts with the following standard non-surgical methods:

Non-steroidal anti-inflammatory medications
Physical Therapy
If the symptoms persist even after taking standard non-surgical treatment for a considerable period of time, based on the case a surgery will be recommended.

Surgical Treatment

Arthroscopy

The technique commonly used to correct a SLAP tear is shoulder arthroscopy where very small incisions are made in the shoulder. Best repair option through arthroscopy is determined depending on the type of SLAP tear a patient has.

Rehabilitation

Depending on the severity of the SLAP injury, a sling will be recommended for a particular duration. Once the pain and swelling subsides, doctor will recommend customized physical therapy sessions. The aim is to regain the strength of the shoulder and resume normal shoulder functions.

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Q&As on SLAP Tear

What causes a SLAP tear?

There are 3 causes of SLAP (Superior Labrum, Anterior to Posterior) tears, and they range in severity. The 3 causes are:

Acute physical injury – SLAP tears can be caused by acute physical trauma like a road traffic accident, blocking a fall with an outstretched arm, shoulder dislocation, or abrupt jerking movement of the arm while it is above the shoulder.
Chronic injury – People engaged in sports or physical activities that require a lot of overhead movements can develop SLAP tears over time. It is the most common cause of SLAP tears. Athletes who play throwing sports like baseball, cricket, basketball, etc., or athletes who perform overhead movements like swimmers and weight lifters are also susceptible to SLAP tears.
Normal aging process – The labrum wears down as a part of the body’s normal wear and tear process. This is due to a normal part of aging. This also causes some minor tears in the upper portion of the labrum.

Can a SLAP tear heal on its own?

Unfortunately, no. A SLAP tear does not heal on its own. Although it may not always require surgical treatment, a SLAP tear will not heal itself over time.
A few nonsurgical approaches are considered and tried before opting for invasive surgical treatment.
The non-surgical options for a SLAP treatment consist of:

Giving rest to the affected shoulder/arm.
Applying cold compression or ice.
Non Steroidal Anti-inflammatory Drugs (NSAIDs) painkillers like naproxen or ibuprofen help with pain relief and swelling.
Physical therapy

What is the treatment for a SLAP tear?

The treatment of a SLAP tear consists of non-surgical and surgical approaches. The non-surgical options include rest, cold compression, painkillers, and physical therapy.
For physical therapy, it is best to have a therapist tailor the exercises to an individual’s injury and recovery. Specific exercises slowly increase the range of movement and strengthen the shoulder. Depending on how severe the tear is, these exercises need to be carried out for 3 or 6 months.
Arthroscopy is the most common surgery recommended for treating a SLAP tear. An arthroscope is a small camera inserted into the shoulder through an incision. The surgeon can repair the labrum using microscopic instruments after viewing the actual damage through an arthroscope camera.

How painful is a SLAP tear?

Mostly, a SLAP tear is not very painful and does not cause pain all the time. Pain in a SLAP tear is usually due to specific shoulder joint movements. Most of these movements are overhead movements.
Most patients report a feeling that their shoulder is about to pop out. There is also a sensation of grinding, locking, or popping.
Pain due to a SLAP tear can be managed with over-the-counter painkillers like naproxen and ibuprofen until more permanent treatment is provided.

How long does it take to recover from a SLAP tear surgery?

A successful arthroscopy surgery, followed by proper rehabilitation, can help regain full range of motion and strength.
Recovery from a SLAP tear injury depends on age, the severity of injury, activity level, overall health, and history of previous shoulder injuries.
A full recovery can take anywhere from 6 months to a year after a SLAP tear surgery. Doctors advise a shoulder sling to prevent movement in the shoulder joint and provide support.
Over the next few weeks, the exercises are increased to improve the range of motion. Later, strengthening exercises are added.