SLAP Tears

A SLAP (Superior Labrum Anterior Posterior) tear is a particular type of labral tear. This happens when the long head biceps (LHB) tendon becomes detached from the ball and socket joint at the superior labrum, and it tears anteriorly and posteriorly.

These tears can vary in severity, and in more severe cases, they can extend into the biceps tendon, causing an unstable shoulder.

For more information on SLAP tears and your possible treatment options, call +44 (0) 203 195 2442 to arrange a consultation with the London Shoulder Specialists.

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What are the symptoms of a SLAP Tear?

A key symptom of a SLAP tear, generally experienced in young athletes, is a catching pain sensation in the shoulder, typically when throwing, which can extend into the back of the shoulder. When the biceps tendon is involved, pain is experienced in the front of the shoulder. It can be mistaken for rotator cuff tendonitis or arthritis in the shoulder.

Sometimes there is no pain experienced with a SLAP tear. In fact, SLAP tears in older people due to ageing are often not the cause of shoulder symptoms.

A physical examination can normally give a good indication of a SLAP Tear. Various tests, including the O’Brien or Crank tests, are considered good at detecting a SLAP tear. X-rays or an MRI scan can be used to assess the damage, although it can be inaccurate in diagnosing a SLAP tear.

What are the causes of SLAP Tears?

Due to the constant twisting of the LHB tendon as the shoulder rotates, SLAP tears are common in overhead throwing sports such as cricket, tennis or badminton and those who regularly weightlifting at the gym.

They can also be caused by a sudden injury to the shoulder when the arm is forced backwards over the head.

However, it is usually a chronic overuse injury caused by excessive throwing (such as tennis), worsened by degeneration over time.

Frequently Asked Questions on SLAP tears

The non-surgical treatment options for a SLAP tear are normally successful. This can include rest from activity and anti-inflammatory medicine. Physical therapy to regain strength and mobility in the shoulder can aid in a faster return to activity.

If pain and inflammation in the shoulder do not resolve, a London Shoulder Specialists consultant can assess the severity of the damage. Your consultant can advise you on the most appropriate treatment plan, including surgical and non-surgical options, to give you the best possible outcome. Cortisone injections into the shoulder may be an option to help relieve pain and to aid the progression of physical therapy.

Typically, only after non-surgical interventions have been unsuccessful after three to six months surgery may be recommended. Usually, depending on the extent of damage, an arthroscopic surgery (keyhole surgery) is performed, known as a SLAP tear repair. This involves repairing the labrum with sutures to secure it back to the bone. Sometimes the long head of the biceps tendon is treated by removing it from the labrum in a tenotomy before attaching it to a different bone (tenodesis).

Carrying out the surgery arthroscopically will avoid damage to the deltoid and restore function to the shoulder. However, the healing process following this surgery can be lengthy, especially for older patients with a degenerate labrum. For this reason, in older patients, the biceps tendon is often addressed first with a biceps tenodesis to treat the most likely cause of pain.

After surgery, you will typically wear a sling for four to six weeks. You will be provided with aftercare advice, including instructions about exercises to avoid, alongside a physiotherapy plan to help you regain strength and motion in the shoulder. It will normally take six months to recover, but it can take up to 12 months.