A SLAP tear is an injury of the labrum of the shoulder joint. The shoulder joint is a ball and socket joint, and inherently unstable. To compensate for the shallow socket, there was a ring of fibrocartilage structure called labrum around the socket (glenoid of the shoulder blade). A specific type of labral tear called SLAP tear, which stands for Superior Labrum from Anterior to Posterior. The SLAP tear occurs at the point where the biceps tendon inserts on the labrum.
Common causes for a SLAP tear include:
- Falling onto an outstretched hand;
- Lifting heavy objects; and
- Throwing athletes with repetitive overhead throwing, such as pitchers.
The area of the labrum where the SLAP tear is an area of relatively poor vascularity compare with other parts of the labrum, with continuous traction force of the bicep tendon, and therefore tends not to heal by itself. Chronic shoulder pain can result.
Symptoms
Typical symptoms of a SLAP tear include catching, locking or popping feeling. There is pain with overhead activities, loss of strength and ability to throw. There may be a sense of instability in the shoulder joint.
Diagnosis
A series of clinical tests can be done to diagnose SLAP. A SLAP tear can be hard to confirm because it may not be revealed on MRI scans. SLAP tears can be seen best on MRI with an injection of contrast. A contrast MRI is performed by injecting a dye called gadolinium into the shoulder. The gadolinium helps to highlight the tears. Ultimately, the diagnosis can be made with an arthroscopic surgery.
Treatment
Rest for a period of time is advisable to allow the injured tissue to cool down and help to reduce the symptoms. Rehabilitation exercises with a physiotherapist to strengthen the rotator cuff muscles may help.
An arthroscopic shoulder surgery is recommended for those patients who have continued symptoms despite conservative treatments. It is a type of minimally invasive surgery whereby a few small incisions on the shoulder are made. The type of surgery is based on the extent of the tear. For a minor tear, the torn portion is debrided. For a major tear, a SLAP repair is performed, in which the torn labrum is sutured back to the glenoid. SLAP repair is best suited for patients who would like to remain active in sports or daily activities.
Post-operative rehabilitation
It is vital to keep the operated shoulder in a sling for 3 weeks post-surgery. Some gentle, passive, pain-free range-of-motion exercises will also commence. When the sling is removed, motion and flexibility exercises and then gradually strengthening exercises to assist the biceps will begin. Table work can usually be done in a few days. The shoulder will take 3 to 4 months to fully recover. Throwing sports are recommended to start after 6 months.
Risk factors
Most patients do not experience complications from shoulder arthroscopy. Potential problems with arthroscopic SLAP repair includes very small risk of wound infection, bleeding, blood clots, nerve injury and stiffness. Some residual pain may also be present but pain relief is usually good.
Written by Dr. Benjamin Chow
