SLAP stands for Superior Labrum Anterior and Posterior. A SLAP tear is an injury to the labrum of the shoulder, which is a ring of strong, fibrous tissue that surrounds the socket of the shoulder joint. The labrum helps to deepen the socket and stabilize the shoulder joint by making a stronger fit. The labrum also serves as an attachment point for many shoulder ligaments and tendons from the biceps muscle in the arm.
In a SLAP injury, the top or superior part of the labrum is injured. This superior area is also where the biceps tendon attaches to the labrum. A SLAP tear affects both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can also be involved in the injury.
SLAP tears are usually caused by acute trauma like a fall from an outstretched arm or repetitive shoulder motion as seen with many athletes participating in repetitive overhead sports. Many SLAP tears, however, are the result of wear-and-tear of the labrum over a length of time.
The labrum deepens the socket of the shoulder joint, making it a stronger fit for the head of the humerus.
SLAT Tear Symptoms
SLAP tears share common shoulder injury symptoms such as the following:
- Pain with shoulder movement
- Locking, popping, grinding, catching sensation
- Decrease in shoulder strength and range of motion
- Pitchers often complain about a “dead arm” after pitching
Dr. Stowell will discuss your symptoms and ask when they first began to help him diagnose your shoulder problem. It is important for you to mention any work or sport activities that aggravate your shoulder and any treatments you may have already had. Dr. Stowell will check the stability of your arm, range of motion, and strength. He may also check your neck and head to make sure pain is not a result of a “pinched nerve.” He may order X-ray images or additional testing to make sure there are no additional problems in your shoulder like a fracture or arthritis. The labrum of the shoulder is made of soft tissue so it will not show up on an X-ray; however, MRI scans can better show the soft tissue of the labrum. To make a tear in the labrum show up more clearly on the MRI, a dye may be injected into your shoulder.
Initial treatments for SLAP tears are nonsurgical. Dr. Stowell may recommend nonsteroidal anti-inflammatory medication like ibuprofen and naproxen to reduce pain and swelling. Physical therapy can restore movement and strengthen your shoulder. Exercises will increase flexibility and range-of-motion stretching the shoulder capsule to prevent further injury. A regimented exercise program can last from 3 to 6 months working with a qualified physical therapist that Dr. Stowell recommends.
If nonsurgical treatments fail, Dr. Stowell may recommend surgery. Arthroscopy is a surgical technique that is most commonly used for treating SLAP injuries. During arthroscopy, Dr. Stowell inserts the arthroscope and small instruments into your shoulder joint to evaluate your SLAP tear. There are several different types of SLAP tears and Dr. Stowell will be able to determine how best to treat your SLAP tear once he sees it fully during arthroscopic surgery. He may remove the torn part of the labrum or reattach the torn part using sutures. Some SLAP tears do not require repair with sutures, but rather the biceps tendon attachment is released to relieve pain. Dr. Stowell will decide the best treatment option for you based on the type of tear you have as well as your age, activity level, and the presence of other injuries he may have seen during surgery.
Most patients do not experience complications with arthroscopic surgery. As with any surgery, complications exist like infection, excessive bleeding, blood clots, shoulder stiffness, and damage to blood vessels or nerves. Dr. Stowell will discuss with you possible complications before your surgery.
Your shoulder needs to be protected and stabilized as it heals. You will likely be in a sling for 2 to 6 weeks after surgery. Dr. Stowell will determine the length of time depending on the severity of your tear and complexity of your surgical procedure.
Once the swelling and pain is managed, Dr. Stowell will recommend a physical therapy program customized for you and your injury. Your rehabilitation will focus on flexibility and strength, typically 6 to 10 weeks after surgery. Dr. Stowell will inform you when it is safe to return to sports activity. Throwing athletes usually return about 3 to 4 months after surgery.
After surgery, most patients report improved shoulder strength and less pain. Recovery time varies with each patient due to varied health conditions. In complicated injuries and repairs, full recovery may take several months. A successful outcome hinges on your adherence to Dr. Stowell’s rehabilitation guidelines and plan for you.