Slap tear treatment

SLAP Tears: A Detailed Overview

A SLAP tear, short for Superior Labrum Anterior to Posterior tear, is a common shoulder injury that affects the labrum, a ring of cartilage that surrounds the shoulder socket. This type of tear can cause significant discomfort and impact shoulder function.

What is a SLAP tear?

A SLAP tear is a specific type of shoulder injury that occurs when the labrum, a rim of cartilage surrounding the shoulder socket, is damaged. The tear typically involves the top portion of the labrum, extending from the front to the back of the shoulder joint. SLAP tears can vary in severity, ranging from minor fraying to complete detachment of the labrum from the bone.

What causes a SLAP tear?

Several factors can contribute to the development of a SLAP tear, including:

  • Trauma: direct impact or trauma to the shoulder joint, such as a fall onto an outstretched arm or a sudden blow to the shoulder.
  • Repetitive overhead movements: athletes involved in sports that require repetitive overhead movements, such as tennis players, weightlifters, or cricket bowlers, are at increased risk of developing SLAP tears due to the repetitive stress placed on the shoulder joint.
  • Degenerative changes: wear and tear over time can lead to degenerative changes in the shoulder joint, weakening the labrum and making it more susceptible to tears.
  • Shoulder instability: individuals with shoulder instability, such as recurrent dislocations or laxity in the shoulder joint, are at higher risk of developing SLAP tears.

What are the symptoms of a SLAP tear?

The symptoms of a SLAP tear can vary depending on the severity of the injury and individual factors. Often, especially in younger athletes, there is a sensation of catching, popping, or grinding within the shoulder joint, typically during throwing movements which can extend into the back of the shoulder.

There can be persistent pain or discomfort in the shoulder, particularly deep within the joint or, when the biceps tendon is involved, at the front of the shoulder – which can be mistaken for rotator cuff tendonitis or shoulder arthritis

In older people, there may be a lack of painful symptoms, but they might have difficulty or experience some discomfort when reaching overhead or behind the back. There may be a feeling of instability or weakness in the shoulder, particularly during certain activities or when lifting objects.

How is a SLAP tear diagnosed?

A SLAP tear can be diagnosed by your London Shoulder Specialist, typically with a comprehensive physical examination, assessing the range of motion. They will talk through your symptoms and medical history including any precipitating factors or previous injuries.

An O’Brien test, or a Crank test, may be performed for detecting a SLAP tear. In some cases, an X-ray or ultrasound imaging may be used to visualise the shoulder joint, although these can be inaccurate for diagnosing a SLAP tear.

What are the treatment options for a SLAP tear?

Treatment for a SLAP tear depends on various factors, including the severity of the tear, symptoms, and individual lifestyle and activity level. In mild cases, the RICE protocol (rest, ice application and compression), along with anti-inflammatory medication can help alleviate pain and reduce swelling. After this, physical therapy is advised to strengthen the surrounding muscles and improve shoulder mechanics.

If conservative treatments do not relieve symptoms, your London Shoulder Specialist may recommend corticosteroid injections into the shoulder joint for alleviating pain and inflammation associated with a SLAP tear, providing temporary relief and enabling the progressions of physical therapy. Only when these measures have been unsuccessful after three to six months, surgery may be recommended.

Is surgery recommended for SLAP tears?

In cases where conservative measures fail to provide relief or for severe tears, surgical intervention may be recommended – especially for individuals with persistent pain, significant functional impairment, or large or complex tears, to restore shoulder stability and function. Surgical options include arthroscopic repair (keyhole surgery) of the labrum, called a ‘Slap Tear Repair’, where the torn tissue is reattached to the bone using sutures.

Sometimes, the long head of the biceps tendon is treated by cutting it off the labrum in a tenotomy, and then securing it to a different bone (tenodesis).

What is recovery like after a SLAP tear?

Recovery after a SLAP tear varies depending on the type and extent of the tear, the age and medical history of the patients, as well as the surgical approach used.

After surgery, the shoulder may be immobilised with a sling for four to six weeks to protect the repair and allow healing. Physical therapy is a crucial component of recovery, focusing on regaining shoulder strength, flexibility, and range of motion.

As healing progresses, individuals will gradually return to activities and sports, following a structured rehabilitation program. A full recovery can take between six and twelve months.

Can lifestyle changes help manage a SLAP tear?

Avoiding activities that exacerbate shoulder pain or put stress on the injured shoulder can help prevent further injury and promote healing.

Maintaining good posture and engaging in regular strength training exercises, particularly targeting the muscles around the shoulder joint, can help reduce strain, promote proper shoulder mechanics and improve shoulder stability.

A SLAP tear can be diagnosed by your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.