An Overview on Labral Tears & SLAP Tears
The labrum is a type of cartilage found in the shoulder that surrounds the glenoid (socket). It serves an important role in shoulder movement as it helps to keep the humerus (ball) in the socket. It also serves as an attachment site for the glenohumeral ligaments and the biceps tendon. When a shoulder dislocation or other shoulder injury occurs, the labrum can be peeled off of the rim of the socket. A labral tear in the shoulder is quite common and is usually caused from a fall with the arm outstretched or from repetitive work or overhead sports activities. A SLAP (Superior Labrum Anterior to Posterior) tear is a specific type of labral tear which is located at the top of the shoulder socket and involves the attachment site of the biceps tendon. A SLAP tear in the shoulder is commonly caused by acute trauma or overuse. Specifically SLAP tears can be seen in overhead athletes such as baseball players, volleyball players and tennis players. They can be associated with pain and loss of function including decreased sports performance.
The most serious labral tear is when the labrum is completely torn away from the bone. This acute, traumatic injury is associated with a dislocated shoulder. Older patients can experience a labrum injury from degeneration and a tear within the substance of the labrum itself. When this degenerative condition occurs, the labrum is left with a rough, unsmooth edge.
Symptoms of a Labral Tear or SLAP Tear
Symptoms most commonly associated with a labral or SLAP tear include:
- Deep shoulder pain, often in the back of the shoulder
- Pain with overhead motion
- Instability without joint dislocation
- Loss of normal shoulder motion
- Shoulder stiffness
- A “popping” or “clicking” sensation
- Decreased performance such as loss of control or velocity when pitching
Diagnosis of a Labral Tear or SLAP Tear
Dr. Waterman will perform a thorough physical examination to determine if there is a labral or SLAP tear present. X-rays and an MRI may be reviewed to rule out any underlying problems such as a fracture or impingement. When evaluating a patient for a SLAP tear, it is important to determine if the shoulder tear is associated with any type of pre-existing instability or if it is from a traumatic event. In some cases, dye is injected into the shoulder prior to an MRI scan to help identify the labrum and any possible tear.
Treatment of a Labral Tear or SLAP Tear
Dr. Waterman will discuss the treatment options after reaching a diagnosis. Several factors are taken into consideration such as age, athletic activity, prior treatement and type of tear.
If the injury is mild, the patient will most likely rest the shoulder, use ice and take anti-inflammatory medications. Physical therapy may also be recommended to help stretch and strengthen the shoulder.
If non-surgical treatments are not beneficial, Dr. Waterman may recommend shoulder surgery to correct the labral or SLAP tear. These tears are almost always treated with arthroscopic surgery. The exact type of surgery will depend on the severity of the tear, condition of the biceps tendon and any other associated injuries.
There are three main surgical options for a SLAP tear in the shoulder:
- Debridement: The torn labrum is smoothed out during a debridement procedure. This shoulder surgery is recommended for stable SLAP lesions that do not involve the biceps tendon.
- SLAP repair: The labrum is reattached to the socket using strong sutures. This surgical option is normally reserved for young, overhead athletes who want to remain active in sports. A SLAP repair is the most common procedure for symptomatic SLAP lesions.
- Labrum Repair: Most commonly in the setting of instability, the labrum may be torn in the lower half of the socket. In this case a repair of the labrum is carried out to restore stability to the shoulder.
- Biceps tenodesis: This involves removing the injured biceps tendon from the torn labrum and reinserting it into a different area of the shoulder. By decreasing the pulling forces in the SLAP region, the troublesome symptoms will be alleviated.