What is a slap tear?
A slap tear is a fairly common injury in athletes of all sports and ages, in those who exercise vigorously and amongst laborers.
A slap tear is an injury to the top portion of the glenoid labrum, which is a band of soft tissue that sits around the rim of the glenoid or socket of the shoulder joint.
Causes and Symptoms of Slap Tears
The function of the labrum is to help stabilize the ball of the shoulder joint within the socket. SLAP is an acronym that stands for “superior labral tear from anterior to posterior," or in more common terms, an injury to the top portion of the labrum, which can extend from the front to the back.
The biceps' tendon attaches to the top portion of the labrum, and an injury is caused by excessive pull of the biceps' tendon or by an excessive force of the top of the humerus bone in a front to back direction.
Common presenting symptoms include:
- shoulder pain, which can be located on either the front or the back. The pain tends to occur with the throwing motion with overhead activities or with heavy lifting.
- Patients may also feel popping or clicking within the shoulder joint, which may or may not be painful.
- There also may be a history of instability with shoulder dislocations or subluxations.
Slap Tear Diagnoses and Slap Tear Treatment Options
A SLAP tear is diagnosed both on physical exams, as well as MRI imaging. In order to accurately diagnose a SLAP injury, dye may be put into a patient's shoulder at the time of the MRI to enhance visualization of the labral tissue.
Treatment of SLAP tears is based on a variety of different factors. The type SLAP may determine the type of treatment that is recommended, as well the odds of obtaining a good outcome with non-operative measures.
- A TYPE 1 SLAP, which is "wear and tear" fraying of the superior labrum in the area that the biceps' tendon attaches, may be successfully treated with physical therapy, anti-inflammatory medications, and possibly a cortisone injection.
- TYPE 2, 3, & 4 SLAP injuries, which are larger tears of the labrum with detachment of portions of the tissue, may also be treated conservatively based on their size, location and on patient factors. The conservative measure for these SLAP injuries are the same for a TYPE 1.
Patient factors to be taken into consideration when determining an optimal treatment for a SLAP tear include age, activity level and sports status. For example, overhead athletes, heavy weightlifters and laborers tend to be high demand in terms of their shoulder function and may be more likely to require surgery.
Surgical Options for Slap Tears
Several surgical options exist in regard to treatment of a SLAP tear. Surgical treatment typically is done arthroscopically.
For fraying and small tears, a shoulder scope with debridement of the injury may be all that is necessary to allow for adequate healing. For larger unstable tears, surgical options include repair of the labrum and biceps' tenodesis.
Repair of the labrum is performed arthroscopically with the insertion of anchors with sutures attached that are used to repair the labrum back to its normal position.
The biceps tenodesis procedure involves releasing the biceps tendon at its attachment, which removes the distraction force from the superior labrum. The biceps' tendon is then typically reattached a little lower down where it still provides the same strength and function but allows for pain relief, and lets the labral tissue heal.
Both of these surgical options have been proven to provide pain relief and return of shoulder function. Just as important in the surgical treatment of a SLAP tear is the post-operative rehabilitation period.
Depending on what procedure is performed, the rehabilitation period can last from six weeks to four months. Performing physical therapy and rehabilitation faithfully is key in obtaining an optimal outcome after surgical treatment.
Mountainstate Orthopedic Associates
If you think you have a SLAP tear, SLAP tear treatment options in Morgantown can be discussed at Mountainstate Orthopedic Associates.
MOA has been providing quality care to its patients since 1977. Give us a call at 304-599-0720 to make an appointment today. No referral necessary.