Shoulder Labral Tear - SLAP Tear: Causes, Symptoms, and Treatment

What is a SLAP Tear?

A SLAP tear refers to a tear in the superior labrum (the top part of the cartilage) that runs from the front (anterior) to the back (posterior) of the shoulder. The labrum plays an important role in stabilizing the shoulder joint, and a tear in this region can cause pain, instability, and weakness.

SLAP tears are classified into different types based on the extent and location of the damage, but the general cause is usually a sudden or repetitive force on the shoulder, especially in sports that involve overhead motions (such as swimming, baseball, or tennis) or traumatic events like falls or accidents.

Causes of SLAP Tears

SLAP tears are often caused by trauma or repetitive overhead activities that place stress on the shoulder. The most common causes include:

• Repetitive Overhead Movements: Athletes involved in sports such as baseball, swimming, tennis, and weightlifting are at higher risk due to the repetitive overhead motions.

• Shoulder Dislocations: A traumatic dislocation of the shoulder joint can result in a SLAP tear due to the forceful stretch of the labrum.

• Falls or Accidents: Falling onto an outstretched arm or sustaining a blow to the shoulder can cause a SLAP tear.

• Aging: Over time, the labrum can wear down, making it more susceptible to tears, especially in individuals over the age of 40.

• Instability or Hyperlaxity: People with naturally loose or unstable shoulder joints (due to genetic factors or conditions like hypermobility) are at an increased risk for SLAP tears.

Symptoms of a SLAP Tear

The symptoms of a SLAP tear can range from mild discomfort to severe pain and shoulder instability. The most common symptoms include:

• Shoulder Pain: A deep, aching pain in the shoulder joint, often felt in the front or top of the shoulder. Pain may worsen with overhead activities, lifting, or throwing motions.

• Instability: A feeling that the shoulder is unstable or "slipping" out of place, especially during specific movements or overhead activities.

• Clicking or Popping: A clicking, popping, or grinding sensation in the shoulder when moving it, which may indicate a tear or damage to the labrum.

• Weakness: Weakness in the shoulder, particularly when lifting the arm overhead or performing activities that require strength or stability.

• Limited Range of Motion: Difficulty moving the arm fully, especially in overhead or rotational movements.

• Pain with Specific Movements: Certain movements, such as throwing, reaching behind the back, or overhead lifting, may provoke pain.

• Loss of Strength: A decrease in strength or control of the arm during certain activities.

Diagnosing a SLAP Tear

A SLAP tear is diagnosed through a combination of physical examination, patient history, and imaging tests.

• Physical Exam: The healthcare provider will conduct tests to assess the stability and function of the shoulder joint. One common test is the O'Brien’s test, which involves placing the arm in a specific position and applying pressure to reproduce pain or instability.

• Imaging Tests: While X-rays can help rule out bone fractures, they cannot detect soft tissue damage like a SLAP tear. For this, an MRI (Magnetic Resonance Imaging) or MRI Arthrogram (injection of contrast dye into the joint) is typically used to get clear images of the labrum and identify any tears.

• Arthroscopy: In some cases, a minimally invasive procedure called arthroscopy is used for both diagnosis and treatment. During arthroscopy, a small camera (arthroscope) is inserted into the joint to view the labrum and assess the tear.

Treatment for a SLAP Tear

The treatment for a SLAP tear depends on the severity of the tear, the patient's activity level, and whether other shoulder structures are involved. Treatment can generally be divided into non-surgical and surgical options.

Non-Surgical Treatment

For mild to moderate SLAP tears, especially in patients who are less active or do not experience significant instability, non-surgical treatments may be sufficient. These may include:

• Rest and Ice: Resting the shoulder and applying ice can help reduce pain and inflammation, especially after acute injury or flare-ups.

• Physical Therapy: A physical therapy program is essential for restoring strength, stability, and mobility to the shoulder. The focus is on strengthening the rotator cuff and scapular muscles, improving range of motion, and stabilizing the shoulder.

• Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce inflammation.

• Corticosteroid Injections: In some cases, a corticosteroid injection may be administered into the shoulder joint to reduce pain and inflammation, allowing for more effective rehabilitation.

• Activity Modification: Avoiding movements that exacerbate pain, such as overhead lifting or throwing, can give the labrum time to heal.

Surgical Treatment

In more severe cases, or for individuals who continue to experience significant pain and instability despite non-surgical treatments, surgery may be necessary. Surgical options for a SLAP tear include:

• Arthroscopic SLAP Repair: The most common surgical procedure for a SLAP tear involves arthroscopic repair, where the torn labrum is reattached to the shoulder socket using sutures. This is minimally invasive and typically requires small incisions.

• Biceps Tenodesis: If the SLAP tear is associated with damage to the biceps tendon (as the tendon attaches near the labrum), a procedure called biceps tenodesis may be performed. This involves reattaching the biceps tendon to the upper arm bone.

• Open Surgery: In rare cases, an open surgical procedure may be needed if the tear is more complex or if there are other associated shoulder injuries.

Rehabilitation and Recovery

After surgery, a structured rehabilitation program is critical for restoring shoulder function. The recovery process typically includes several phases:

• Phase 1: Immobilization (1-2 weeks): After surgery, the shoulder is usually placed in a sling to immobilize the joint and protect the repair. During this time, pain management and gentle passive range-of-motion exercises may be initiated.

• Phase 2: Range-of-Motion Restoration (2-6 weeks): As healing progresses, passive and active range-of-motion exercises are introduced to regain flexibility and mobility in the shoulder joint.

• Phase 3: Strengthening (6-12 weeks): Strengthening exercises targeting the rotator cuff and scapular stabilizers are introduced to support shoulder function and prevent further injury.

• Phase 4: Return to Activity (3-6 months): Gradual return to overhead activities and sports-specific movements is included in the final rehabilitation phase. Athletes are typically cleared for full activity after 4-6 months, depending on their progress.

Total recovery time from a SLAP tear repair can range from 4 to 6 months, with some athletes requiring longer to fully return to their sport or previous activity level.

Prevention of SLAP Tears

Although it is not always possible to prevent a SLAP tear, several strategies can reduce the risk:

• Strengthening the Shoulder Muscles: A strong rotator cuff and scapular muscles can help stabilize the shoulder joint and prevent excess stress on the labrum.

• Proper Technique: Athletes who perform overhead movements, such as throwing or lifting, should ensure that they use proper form to minimize strain on the shoulder.

• Warm-Up and Stretching: Proper warm-up and stretching exercises before physical activity can help prepare the shoulder joint for movement and reduce the risk of injury.

• Avoid Overuse: Taking rest periods and avoiding repetitive overhead motions, especially in sports like baseball or tennis, can help prevent overuse injuries.

• Use Proper Equipment: In contact sports, wearing appropriate shoulder protection can reduce the risk of traumatic injuries that lead to SLAP tears.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, our team of expert physiotherapists can assist you in recovering from a SLAP tear. We provide a comprehensive treatment plan that includes pain management, rehabilitation, and prehabilitation techniques to strengthen the shoulder and prevent re-injury. Whether you need conservative treatment or are preparing for surgery, we’re here to guide you every step of the way.