What is a slap tear?
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What is a SLAP tear?
A SLAP tear is a cause of shoulder pain. The labrum is a cartilage ring which surrounds the shoulder socket. The biceps tendon, which comes from the muscle on your arm, goes through the shoulder joint and attaches to the top of the labrum. A SLAP (Superior Labrum Anterior to Posterior) tear occurs when there is damage to the labrum where the biceps tendon attaches.
How does a SLAP tear occur?
Many times, a SLAP tear occurs from repetitive trauma in overhead throwers, such as baseball or volleyball. It can also occur from a traction injury to the arm, such as lifting a heavy object off the ground, or getting your arm jerked.
How do I know I have a SLAP tear?
Many patients with a SLAP tear have pain in the front of the shoulder or deep inside the joint. There also may be a feeling of catching or grinding in the joint. The examination in the office usually confirms the presence of a SLAP tear.
Do I need x-rays, an MRI, or any other test?
A set of x-rays is usually ordered to make sure there are no fractures in the shoulder. An MRI is helpful to confirm the tear of the labrum or biceps tendon, and evaluate other areas of the shoulder like the rotator cuff. My preference is to order something called an MRI Arthrogram. This is an enhanced MRI were they inject fluid into your shoulder, and if there is a tear the fluid will like into areas it does not belong. This is the best test for the confirmation of SLAP tears.
Is there other damage to the shoulder in cases of SLAP tears?
There can be other damage to the labrum seen with SLAP tears, usually in the cases of shoulder instability. The biceps tendon itself can also be frayed or torn. Typically there is not a rotator cuff tear associated with this, but it is possible depending on how the injury occurred.
What are the treatment options for SLAP tears?
The treatment primarily depends on your activity level and symptoms. Since SLAP tears can often be difficult do diagnose, they are often first treated with physical therapy. The therapy is designed to restore range of motion and strength to the shoulder. SLAP tears untreated do not heal because of the lack of blood supply in the area. In cases of persistent pain and disability, surgery is recommended.
How are SLAP tears treated with surgery?
SLAP tears are repaired arthroscopically. The arthroscope is a fiber optic instrument (narrower than a pen) which is put into the joint through small incisions. A camera is attached to the arthroscope and the image is viewed on a TV monitor. The arthroscope allows me to fully evaluate the entire shoulder joint, including the ligaments, the labrum, the biceps tendon, the rotator cuff, and the cartilage surface. Small instruments ranging from 3-5 millimeters in size are inserted through additional incisions so that I can feel the joint structures for any damage, diagnose the injury, and then repair, reconstruct, or remove the damaged tissue. With SLAP tears, the damaged labrum and biceps tendon are identified and then repaired back to the socket. This usually performed by using suture anchors to sew the labrum back in place. Occasionally, the biceps tendon is too damaged to repair. In this case, the tendon is cut and reattached in the upper arm (biceps tenodesis). This requires a small 2 inch incision.
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