Shoulder SLAP Tears: An Injury Guide

February 29, 2020

Shoulder SLAP Tears: An Injury Guide

 

In a perfect world, a SLAP tear would hurt as much as a slap on the wrist - the pain takes you by surprise then leaves as fast as it came.

Unfortunately, a SLAP tear feels more like deep pain in the shoulders which can radiate from the front to the back area for a prolonged period of time. 

 

What is a SLAP Tear

SLAP Tear stands for Superior Labrum Tear Anterior and Posterior. In English, that's a tear on the upper part of your labrum, the soft fibrous cartilage located around your glenoid cavity. The glenoid cavity, in turn, puts the "socket" in the ball-and-socket joint of your shoulder. (Still a bit lost? Here's a refresher).

The ‘A’ and ‘P’ in SLAP (Superior Labrum Tear Anterior and Posterior) refer to where the tear is located, which in this case, can be in front (anterior) or further back (posterior). In some cases, the tear can run from the front to the back.

To give you a clearer picture of where the labrum is, what it does, and why a tear can wreak havoc to your everyday life, let’s back-track a bit and revisit the anatomy of the shoulders. 

Here’s a quick look into your shoulder’s anatomy: 

Your shoulder joint (glenohumeral joint) is a joint with a ball and socket mechanism. The ball is the humeral head (your arm) and the socket is the shallow cavity wherein the humeral head is nestled. 

The glenoid cavity or the socket is shallow and small. On its own, it can’t secure the humeral head in place. This is where the labrum comes in. 

The labrum surrounds the glenoid cavity. It provides more cushion to the socket which makes it deeper and allows the humeral head to stay snug and secure to move around. 

By nature, the labrum is a piece of rubbery tissue to make it flexible, but it also becomes vulnerable to tears.

The labrum can be torn in two ways: the SLAP tear and the Bankart lesion. The SLAP tear is the lesion found in the front and the back of the upper labrum, while the Bankart lesion is the lesion in the lower labrum. 

For younger individuals, injuring your labrum isn’t as common as othershoulder injuries. Given its location, it takes a lot of impact to tear the labrum. SLAP tears often occur after a sports injury or a high trauma accident. 

However, once we reach 40 years old and above, our labrum naturally frays so SLAP tears become more common as we age.


Types of SLAP Tears

There are 4 types of SLAP tears, classified according to their severity and cause. They can manifest as one or a combination of the following symptoms: a fraying labrum, tear to the biceps anchor, or bucket-handle tears.


Type I

Type I SLAP tear manifests as a frayed or torn labrum. This type is common among middle-aged or senior patients and is caused by the wear and tear of the labrum. As mentioned previously,  SLAP tears aren’t as common in younger individuals but older individuals are more likely to develop a Type I SLAP tear. 

Type I SLAP Tear


Type II

Type II SLAP tear manifests as a tear (or full detachment) to the biceps anchor. This type is a common result of high impact injuries. If you’re wondering how the biceps are involved in a labral tear, it’s because the back part of your labrum is connected to the biceps tendon. Once your labrum is torn, its attachment to the biceps tendon can tear, too. 

Type II SLAP Tear

Type III

Type III tear manifests as an extensively frayed labrum that forms a bucket handle tear, with an extension into the bicep tendon. A bucket handle tear runs from the front to the back of the labrum. Because of the extent of the tear, it droops and forms a bucket handle, thus the name. Type III tears often need surgery in order to remove the bucket handle. 

Type III SLAP Tear


Type IV

Type IV SLAP tear is the most severe type as it is a combination of a bucket handle tear paired with a bicep tendon tear.

Type IV SLAP Tear


Causes and Risk Factors

SLAP tears are often caused by three factors: acute injury, chronic injury, and aging. 

  • Acute Injury

The labrum keeps the humeral head snug and secure, and it takes an intense hit to the shoulder for the labrum to tear. Accidents like a forceful pull on the arm when trying to catch an object (like in football or softball), a motor vehicle accident, or a rapid, forced movement to the arm can cause a SLAP tear. 

  • Repetitive Use

Athletes who engage in overhead sports are at a high risk of developing a SLAP tear. Swimming, weightlifting, baseball, and softball are some of the sports that leave you vulnerable to this injury because they expose your arms to high impact trauma for a prolonged period of time.

  • Aging

The labrum, by nature, degenerates over time, which is why tearing or fraying of the labrum can occur. Torn labrum can occur as early as 30 years old, but it is more common in individuals older than 40 years old. 


Diagnosing a SLAP Tear

Diagnosing a SLAP Tear is a little tricky since its symptoms are almost similar to other shoulder injuries. Initial symptoms can include: 

  • Decreased range of motion
  • Pain when moving the shoulders or lifting 
  • Decrease in shoulder strength
  • Popping, grinding, cracking, or “giving out” sensation
  • Decrease in throw velocity or feeling of a “dead arm” after activity for athletes

To accurately diagnose a SLAP Tear, your physician will most likely take three steps: determine your medical history, conduct physical examinations, and run imaging tests. 

 

Medical History

A patient’s medical history probes into the factors that may cause SLAP tears such as the sports one plays, the location of the pain, and genetics. This can give your physician a look into the possible causes of your pain. 


Physical tests 

Physical tests like the O’Brien Test or the Active Compression Test is done to test for a SLAP tear. A word of warning - in order to safely test yourself of a SLAP injury, perform this physical test with caution or with the help of a physician. 


 



Magnetic Resonance Imaging

Imaging tests like the MR arthrogram is the most accurate way to diagnose a SLAP tear. Knowing your medical history and doing physical tests can be insufficient and confusing since the symptoms of SLAP tears are almost the same as other shoulder injuries. We want to catch a SLAP tear early on and not mistake it for a sprain or strain. An MRI scan is the best option for this, and will accurately show any complications in the labrum tear. 


Treatment

The treatment for SLAP tears vary from case to case, depending on the severity of the injury, the patient’s level of activity, and age.

Overhead athletes who would like to return to their respective sports after a SLAP injury would most likely need surgery, while individuals over 40 would more likely opt out of it (although surgery is always an option).

That being said, it is best to talk with your physician about possible courses of treatment and surgical procedures. In the meantime, let’s dive into how you can manage your symptoms and the different options for surgical treatment.

 

How do you deal with SLAP tear pain?

Shoulder pain is the most apparent symptom of a SLAP tear. While it can be annoying and disruptive, there are a couple of things you can do to manage it. 

  1. Rest your shoulders from repetitive overuse, especially for throwing athletes. Don’t push past the pain, trooper. It will get worse. 
  2. Use ice packs to ease inflammation. Cold therapy, by use of gel or ice packs, is effective for any swelling and redness. A cold compress restricts the blood flow to the affected area, thus relieving all symptoms of inflammation. You can ice the affected area for 20 minutes at a time whenever you experience pain or discomfort. 
  3. Take nonsteroidal anti-inflammatory medications (NSAIDs) like Ibuprofen or Naproxen to relieve yourself of pain. 

 

When do you need surgery? 

Surgical treatments would be relevant for the following cases:

  • Overhead athletes
  • Severely compromised range of motion
  • Presence of bone spurs 

The most common surgical procedure for SLAP tears is arthroscopy. Arthroscopy makes use of a device with a small camera (called an arthroscope) which is inserted into the shoulder joint. The arthroscope then partially removes the fraying in the labrum for Type I or II tears. For Type III or IV, your surgeon may reattach the torn portion of the labrum, or reattach the biceps tendon to relieve pain. 

The procedure is highly dependent on the type of SLAP tear you have, age, activity level, and other injuries that may be present. 

Surgery After-care

After the surgery, your shoulder will need to be protected using a sling. On average, it takes 2 to 6 weeks before you can proceed to physical therapy. Depending on the complexity of your surgery, you may be advised to wear a sling for longer. 

Physical therapy

Physical therapy with a physiotherapist will bring back your full range of motion 6 to 10 weeks after surgery. The focus of a therapy program is flexibility and prevention of any stiffness in your shoulders. 

For athletes or those who use their shoulders repetitively, it can take up to 3 - 4 months after surgery before they can return to their usual sports activity. 

Whatever the best treatment option for you may be, you will greatly benefit from cold therapy that also provides reliable support. Shoulder compression wraps are available in the market which provide support and relief, and aids in the recovery process when used in conjunction with physical therapy. IceWraps.com carries a heat and cold compression therapy pack that fits your criteria. 

 

IceWraps 12x21" Reusable Clay Pack

$23.99

 

IceWraps Extra Large Neck Ice Pack

$ 24.99

 



These compression therapy packs help minimize inflammation by keeping fluids from gathering at the affected area. It is the best option for first aid, surgery after-care, and support while in physical therapy. 


Final Thoughts

Your shoulders are the most mobile part of your body. It allows you a wide range of movement so much so that once they’re injured, it greatly affects the quality of your life. 

Addressing your symptoms early on can prevent further injuries down the road, so take care of your shoulders. Shoulder pain can indicate a number of conditions ranging from mild injuries to severe tears. It can be tricky to accurately determine your injury so don’t hesitate to visit your doctor should your symptoms persist. 


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