Shoulder SLAP Tear
The shoulder joint is a ball and socket joint, with the ball in the upper arm bone (humeral head) fitting into a socket in the shoulder blade (glenoid). The labrum, a strong and fibrous tissue, surrounds the socket to deepen and stabilise the shoulder joint. However, it is susceptible to injuries like a SLAP tear, also known as a superior labrum, anterior to posterior tear. Here is everything you need to know about a shoulder SLAP tear.
OVERVIEW
What is a SLAP tear?
A shoulder SLAP tear is an injury to the upper part of the labrum and can affect the front and back of the attachment point where the long head of the biceps tendon meets with the labrum. Sometimes, the biceps tendon can get affected too. There are several ways one can tear the top of the labrum; while the condition is especially common in athletes, it can also occur in older people.
SYMPTOMS AND CAUSES
There are three main causes of a shoulder SLAP tear – chronic injury in patients who play sports or do exercise that requires significant overhead motion; acute injury due to abrupt jerking movements; and ageing which results in natural wear and tear of the biceps tendon, typically seen in patients 40 years old and above. However, it can occur in patients of all ages, so do seek prompt medical attention if you suspect you are suffering from a shoulder labral tear.
Common symptoms of a shoulder SLAP tear include pain in the front and side of the shoulder when lifting objects overhead, locking or clicking sensation, decreased range of motion, decreased shoulder strength, and feeling like your shoulder might pop out of the joint. It is important that you seek prompt medical attention if any of these symptoms are present for an accurate diagnosis of your condition and the appropriate treatment.
DIAGNOSIS
When you visit an orthopaedic clinic for a shoulder SLAP tear, your doctor will start off by asking you about the nature of your pain, and checking if you had any previous sports injury or trauma. Your orthopaedic surgeon will also perform a physical examination to check your shoulder’s range of motion, stability and strength. Provocative tests may be done to try to reproduce your pain. Further imaging tests like an MRI scan may be needed to confirm the diagnosis of a SLAP tear, look at the extent of the labral tear, and check if there is associated cartilage or muscle injury.
TREATMENT
A shoulder SLAP tear usually does not heal on its own but non-invasive treatments can help to control symptoms. Conservative treatments include pain relievers, anti-inflammatory medications, activity modification and physical therapy to maintain flexibility of the shoulder and strengthen the surrounding muscles. If the pain continues to persist, you may consider a steroid injection performed under ultrasound control.
If conservative treatments prove to be ineffective or your tear is extensive, your orthopaedic specialist may recommend surgery. Most shoulder SLAP tears can be treated with shoulder arthroscopy (keyhole shoulder surgery), where small incisions are made and a camera and specialised instruments are used to enter your shoulder joint. During the procedure, the torn labrum is repaired with sutures (SLAP repair). If the labral tear is severe or extensive, your surgeon may choose to detach the superior labrum and reattach the long head of the biceps tendon further down the upper arm bone (biceps tenodesis). If the long head of the biceps tendon is too degenerated, as may occur in older people, the tendon may also be released from its attachment for pain control (biceps tenotomy). Compared to open surgery, the keyhole procedure results in less pain and joint stiffness and shortens the recovery time for patients. In good hands, most patients can expect to return to their regular activities including sports.
What is it like after treatment?
Most patients do not experience complications after a shoulder SLAP tear surgery although it is still important for you to note the possible risks such as infection and shoulder stiffness. You will have to wear a sling following surgery to protect your shoulder repair and may be started on physical therapy after the initial pain and swelling have settled. Rehabilitation helps you to regain flexibility, strength and range of motion of the shoulder, enabling you to return to sports.
PROGNOSIS
What is the outlook for someone who has had a shoulder SLAP tear?
Each individual’s body is unique and hence, no recovery process is exactly the same. If you have chosen conservative treatment methods, then it means leaving the tear alone but working towards decreasing pain; sometimes, additional treatments may be needed in the future. Most patients who have opted for a shoulder SLAP tear surgery reported an improvement in shoulder strength and less pain.
When should I consult my doctor about my shoulder SLAP tear?
Although shoulder pain is not a life-threatening condition, ignoring the signs and symptoms may result in your condition worsening and affecting your quality of life. Do not hesitate to reach out to an orthopaedic doctor should you be experiencing any of the symptoms mentioned above. Prompt treatment is the key to helping you get back to doing what you love.