Labral Tear/SLAP Tear

A SLAP tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint. The labrum helps hold the head of the humerus in place.

The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP tear, the top (superior) part of the labrum is injured. This part of the labrum is also where the biceps tendon attaches and a SLAP tear occurs both in the front (anterior) and back (posterior) of where the biceps attaches to the labrum. The biceps tendon itself can also be involved in the SLAP tear.

Your shoulder is a ball-and-socket joint made up of three bones: your humerus (upper arm bone), your clavicle (collarbone), and your scapula (shoulder blade).

The head of your humerus fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Surrounding the outside edge of the glenoid is a rim of strong, fibrocartilage (rubbery tissue) called the labrum.

Injuries to the superior labrum may be caused by sudden (acute) trauma or by repetitive shoulder motion. An acute SLAP injury may result from:

• A motor vehicle accident
• A fall onto an outstretched arm
• Forceful pulling on the arm, such as when trying to catch a heavy object
• Rapid or aggressive movement of the arm when it is above shoulder level
• A shoulder dislocation

Repetitive overhead shoulder motions can lead to trauma to the superior labrum over time and can gradually cause a SLAP tear. This is a common occurrence in throwing/overhead athletes such as volleyball, tennis, and baseball players and weightlifters.

For many patients over age 40, SLAP tears consisting of tearing or fraying of the superior labrum occur as the result of gradual wearing down of the labrum over time. This is a degenerative process that differs from an acute injury and is viewed as a normal process of aging.

The symptoms of a SLAP tear are similar to many other shoulder problems. If you are experiencing these symptoms associated with a labral tear/SLAP tear, call Dr. Sara Jurek for a consultation:

• A sensation of locking, popping, catching, or grinding
• Pain with movement of the shoulder or with holding the shoulder in specific positions
• Pain with lifting objects, especially overhead
• Decrease in shoulder strength
• A feeling that the shoulder is going to “pop out of joint”
• Decreased range of motion
• Pitchers may notice a decrease in throwing velocity and possibly the sense of having a “dead arm” after pitching

Medical History. Dr. Jurek will talk with you about your symptoms and when they first began. If you can remember a specific injury or activity that caused your shoulder pain, it can help in diagnosing your shoulder problem — although many patients may not remember a specific event. Any work activities or sports that aggravate your shoulder are also important to mention, as well as the location of the pain, and what treatment, if any, you have had.

Physical Exam. Dr. Jurek will check the range of motion, strength, and stability of your shoulder. She will perform specialized tests to reproduce your symptoms. The results of these tests will help Dr. Jurek determine if additional imaging of your shoulder is needed.

Imaging Tests. The labrum and a SLAP tear will not show up on x-ray, however, Dr. Jurek will likely order x-rays for you to make sure there are no other problems in your shoulder, such as arthritis or fractures. An MRI with contrast dye may be ordered to diagnose a tear in the labrum more clearly. (The dye is injected into the shoulder before the MRI is done.)

There are several different types of SLAP tears and Dr. Jurek will determine how best to treat your injury once she sees it fully during arthroscopic surgery. This may involve simply removing the torn part of the labrum, or reattaching the torn part using suture anchors. Some SLAP injuries are best treated by detaching the biceps tendon from its attachment to the superior labrum, shortening the tendon, and then reattaching it to the humerus (biceps tenodesis).

After surgery, you will need to wear a sling or shoulder immobilizer. Recovery time varies per patient, depending upon the extent of the injury and the specific surgery performed. Full recovery may take several months.

When your pain and swelling after surgery have diminished, Dr. Jurek will prescribe physical therapy protocol tailored specifically for you and your surgery. Your physical therapy regimen will start with range of motion exercises, followed by strengthening exercises as healing progresses. Strengthening exercises are usually added within 3-4 months after surgery.

Dr. Jurek will discuss with you when it is safe for you to return to your desired activities.

If you are interested in talking to Dr. Sara Jurek about the treatment for a labral tear/SLAP tear, call (206) 386-2600 to schedule an appointment. For your convenience, you may also request an appointment online.

Dr. Jurek performs many labral repair surgeries arthroscopically and has undergone specialized training specifically focused on these advanced techniques. If you are interested in seeing examples of what she sees and does during a shoulder arthroscopy surgery, check out her Instagram page for pictures and videos.