SLAP Tear

synonyms: SLAP lesion, SLAP tear, superior labral anterior posterior tear, biceps anchor tear

SLAP tears are injuries to the superior labral tissue in the shoulder. This area is were the long head of the biceps tendon inserts inside the shoulder. SLAP lesions general occur in overhead athletes such as baseball and volleyball players. They may also occur from falls or trauma.

In overhead athletes acquired posteroinferior capsular contracture leads to high torsional and shear stress on the posterosuperior labrum in the late-cocking phase of throwing, which can produce a posterior SLAP lesion. Throwers may feel sharp pain in the extreme abduction/ER position followed by "dead arm" sensation and loss of throwing velocity.

SLAP tears may also occur from falls directly on the shoulder, downward force on an outstretched arm, or sudden eccentric force on a contracting biceps muscle.

People with SLAP tears typically complain of a vague discomfort in the shoulder, and/or a sliding sensation with overhead use. They may have a painful clicking or popping sensation with shoulder motion, especially overhead activity. Throwing athletes report deep shoulder pain in the late cocking position and loss of throwing velocity.

Treatment

Initial treatment or SLAP tears includes ice, activity modifications, NSAIDs and physical therapy focusing on strengthening the dynamic stabilizers of the shoulder.  If non-op treatment fails to eliminate symptoms surgical treatment determined by SLAP lesion classification is indicated. Surgical treatment can be SLAP lesion repair, biceps tenodesis or biceps tenotomy. Which surgery is best is dependent on the type of SLAP tear, and the patients age and activity levels.

Risks of surgery include but are not limited to: Recurrence / failure, Hardware failure / Anchor pull-out, Infections, Stiffness, CRPS, Nerve or vascular injury, Fluid Extravasation, Chondrolysis,  DVT/PE, Hematoma, Chondral Injury / arthritis. Medical and anesthesia risks of surgery include heart attack, stroke and death.. Although complications can occur most patients are satisfied with their surgical outcomes.

Following surgery patients are placed in sling. Active wrist, hand ROM and Pendulum shoulder exercises are started immediately. Patients must avoid any active elbow flexion and supination.

Patients follow-up in the clinic 10 days after surgery to start PT, the sling is continued for 4 weeks. Patients must avoid any active elbow flexion/supination and excessive external rotation, especially in abduction to limit shear forces on the repair.

The sling is discontinued sling at 6 weeks and a progressive strengthening program is begun. At 3-6 months patients begin sport-specific rehabilitation. Return to sport / unrestricted activity is typically allowed at 6 months. Studies have shown that approximately 75% of athletes return to pre injury competition and function.

Further information about SLAP Tear can be found at the following sites:

• AAOS
• eOrthopod

Every person and their particular circumstances are different so the treatment for your shoulder may be different than those discussed above. Please read this information carefully. Write down any questions that you have about your injury and its treatment and discuss them with Dr. Grutter. Working together you and Dr. Grutter will determine the best treatment for you.