One of the most common types of labral tears of the shoulder is the SLAP tear, also known as a SLAP lesion.
SLAP stands for "superior labrum from anterior to posterior." This type of shoulder labral tear occurs at the top (“superior”) of the glenoid labrum where it connects to the biceps tendon, and it extends in a curve from the chest (“anterior”) to the back (“posterior”). SLAP lesions are considered as separate entities from other labral tears because the superior labrum is the attachment site of the long head biceps tendon. Injuries to the labrum in this region can result in labral symptoms, biceps symptoms or both. (Find an HSS doctor who diagnoses and treats SLAP tears.)
SLAP tears (also called SLAP lesions) vary in severity from minor fraying to complete detachment from the shoulder socket. They are common injuries among overhand athletes who make forceful arm movements, such as baseball players or tennis players.
The shoulder is a ball-and-socket joint. The head of the humerus (upper arm bone) functions as the ball and the glenoid cavity of the scapula (shoulder blade) functions as the socket. But this shoulder socket is shallow, leaving the joint relatively unstable. The shoulder labrum is a cup-shaped rim of rubber-like fibrous cartilage that lines the socket to help secure the humerus and reinforce the joint.
Also known as the glenoid labrum, it provides support and stability to the shoulder joint in conjunction with the rotator cuff tendons and muscles. The labrum is also the attachment site for the tendon that connects to the long head of the biceps muscle and for several ligaments.
SLAP tears can be caused by falling onto an outstretched hand, quickly lifting a heavy object or from a forceful, overhead arm motion during sports or work activity. More often, however, they result from repetitive stress on the shoulder which, over time, wears down the shoulder labrum.
In both cases, SLAP tears are most common among people whose daily activities require frequent upward arm movement, such as weightlifters, tennis players and factory or shipping workers.
SLAP tears are sometimes a result of or found in combination with biceps tendonitis or a biceps tendon tear. If a biceps tendon is torn away from where it connects to the scapula bone (shoulder blade), it can tear the glenoid labrum along with it.
SLAP tears can cause pain and range-of-motion problems in the shoulder labrum, the biceps tendon or both. Common symptoms of a SLAP tear include:
Diagnosing a SLAP tear is challenging, especially since they often occur in conjunction with other injuries to soft tissues of the shoulder and upper arm. A sports medicine physician will review your medical history, symptoms and the circumstances under which your injury occurred. If your doctor to suspects a SLAP tear, they will order soft-tissue radiological exams. This is usually an MRI (magnetic resonance imaging).
SLAP tears may be treated nonsurgically or surgically, depending on the patient’s individual condition. Conservative, nonsurgical treatments including rest and physical therapy are usually tried first, except in severe cases.
When surgery is warranted, the choice of the appropriate procedure will depend on a person’s age and the specific type of SLAP tear they have. The three most common surgeries for SLAP tears are:
SLAP repair is performed arthroscopically, using minimally invasive techniques. Depending on the severity of the tear, the labrum and ligaments may need to be reattached to the bone using sutures and anchors.
Patients who experience biceps tendonitis in conjunction with a SLAP tear may need their biceps surgically disconnected from the labrum to relieve the stress it places on it.
This surgery releases (detaches) the tendon from the labrum.
In this procedure, the biceps tendon is detached from the shoulder labrum and then reinserted lower down, directly onto the humerus (upper arm) bone, to retain function.
Whether you have surgery or not, rehabilitation for a SLAP tear focuses on restoring glenohumeral and scapulothoracic strength, endurance, and full, pain-free range of motion, while correcting any deficiencies in balance or rhythm throughout the overhead motion.
SLAP repair in athletes who perform frequent overarm movements have shown mixed results. This surgery is more successful in patients under age 40, but remains the treatment of choice for high-level overhead athletes. Older patients are more likely to have better outcomes from biceps tenodesis or tenotomy.
When applied to appropriate surgical candidates, newer surgical techniques are allowing competitive many athletes to return to their chosen sport and continue to perform at a high level.
While the surgery is typically done arthroscopically as an outpatient (meaning patients go home the same day), the recovery is the hard part. Most patients are in a sling for six weeks then get more aggressive in physical therapy to work on stretching and strengthening. Athletes gradually start returning to sport by about four months from surgery with full, unrestricted play on average by six months.
Learn about related shoulder labrum tear injuries in these articles.
Reviewed and edited by Joshua S. Dines, MD