Shoulder pain and weakness can greatly affect your quality of life, whether you’re an athlete in an overhead-throwing sport or simply an adult trying to stay active and independent. When you have a shoulder labrum tear, you can rely on the shoulder experts at The Ohio State University Wexner Medical Center in Columbus, Ohio, for an accurate diagnosis and customized treatment plan. Our orthopedic and sports medicine teams will work diligently to get you back to enjoying life and the sports you love.
What is a SLAP tear?
A SLAP tear occurs when you tear the cartilage that surrounds the inner part of the shoulder joint. This cartilage is called the labrum and is made up of strong fibrous tissue that connects many ligaments and tendons to the shoulder. The labrum works to stabilize the joint. A SLAP tear is one type of labrum tear.
SLAP stands for superior labral anterior-to-posterior (SLAP). The tearing injury happens at the top (superior) of the labrum, where the bicep tendon attaches to this cartilage. This type of tear extends from the front (anterior) to the back (posterior) of the superior labrum. Sometimes the bicep tendon is injured too, which is a condition called bicep tendonitis.
SLAP tears typically cause shoulder pain, popping and clicking sounds and a loss of shoulder function.
What causes SLAP tears?
There are various reasons why the labrum might tear in this location. Sometimes the condition develops over time but sometimes it is caused by a traumatic injury. Causes of a SLAP tear include:
- An overuse injury, typically in overhead-throwing athletes, such as those who play baseball, softball, tennis and volleyball
- A dislocated shoulder
- Forceful movement of the arm when it is extended in the air
- A car accident or fall onto an extended arm
This condition often occurs alongside other injuries, such as bicep tendonitis or a rotator cuff tear.
SLAP tear symptoms
For most people, the onset of symptoms for a shoulder labrum tear is subtle and progressively worsens over time. These symptoms might include:
- A sensation of popping or clicking when you move the shoulder
- Pain while moving the shoulder in different positions, especially lifting heavy objects
- Decreased strength and range of motion
- A snapping, or a feeling that the shoulder may pop out of the joint
- Decreased power and control when throwing overhead (what pitchers might call “dead arm”)
These symptoms are similar to those of other shoulder injuries, so it’s important to work with shoulder experts who can give you an accurate diagnosis.
How is a SLAP tear diagnosed?
Despite recent advances in imaging techniques for soft tissue, SLAP tears are still challenging to diagnose for several reasons, including nonspecific symptoms and coexisting conditions. To make an accurate diagnosis, we’ll use the following:
- A medical history and physical examination: Performing a physical examination can allow your shoulder doctor to determine tender spots and the location of the pain.
- Magnetic resonance imaging (MRI): An MRI can show injuries in the soft tissue. Sometimes a special type of MRI, called a SLAP arthrogram, is done to better identify a SLAP tear. During this type of MRI, dye is injected into the shoulder before the MRI is taken.
- X-rays: While X-rays won’t show soft tissues like the labrum, they are sometimes done to rule out other shoulder conditions.
- Arthroscopy: This is the only way to get a definitive diagnosis. During an arthroscopy, your shoulder surgeon will make an incision in the shoulder and insert an arthroscope (a thin tube with a light and camera on it). This allows your doctor to examine the tissue more closely. They can often repair the SLAP tear at the same time.
SLAP tear treatment
Most SLAP tears won’t heal on their own, but symptoms can lessen over time, especially when managed by shoulder experts like those at the Ohio State Wexner Medical Center. Your treatment plan will depend on a variety of factors, including the severity of the condition, your return-to-activity goals and whether there are other shoulder injuries or tears that also need repair.
For many people with SLAP tears, our shoulder specialists will first recommend nonsurgical treatment options to alleviate pain and restore shoulder function. If those therapies aren’t completely effective, surgery may also be an option.
Nonsurgical treatment options
Your doctor may recommend one or more of the following treatment options:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – Over-the-counter medications like ibuprofen and acetaminophen can ease pain. Your doctor might also prescribe other anti-inflammatory or pain-relieving drugs.
- Steroid injections – This is when we inject a powerful anti-inflammatory medication, like cortisone, into the shoulder.
- Physical therapy – This helps restore motion. You’ll meet regularly with a physical therapist who specializes in shoulder conditions, and it will be important to perform approved exercises at home.
- Slings or other devices – Immobilizing the shoulder, especially after an injury, may help improve symptoms.
Surgery for a SLAP tear
If your pain and symptoms don’t improve with nonsurgical treatments, your doctor may recommend shoulder surgery. If your SLAP tear occurs because of a shoulder dislocation or other traumatic injury, surgery is usually required.
Surgery typically begins with a minimally invasive shoulder arthroscopy to directly view these structures and see what’s torn or inflamed.
Depending on your condition and injury, surgical treatment could include:
- Biceps tenodesis, which is the most common type of surgery to treat SLAP tears, and it involves cutting the bicep tendon in the shoulder and reattaching it in a location outside the shoulder.
- Debridement, which means removing the rough edges or flaps of a torn superior labrum.
- Arthroscopic repair of the SLAP tear, which involves using absorbable anchors and stitches to reattach the torn labrum to the shoulder socket.
Other associated shoulder problems, such as rotator cuff injuries, other tears or shoulder impingement, can be repaired during the surgery addressing the SLAP injury.
How long does it take to recover from a labrum tear?
The recovery process for labral repair surgery includes wearing a sling for about six weeks and beginning gentle physical therapy two to three weeks after surgery. Physical therapy involves four to six months of therapy to continually strengthen the shoulder.
In general, throwing athletes can begin early throwing exercises three to four months after surgery. It’s important to listen to your doctor regarding your recovery and when it’s safe to return to physical activity, to avoid complications or further injuries.