Joint Knowledge: SLAP Tears

You may have heard about an injury known as a SLAP tear. This is an injury to the shoulder joint. The acronym SLAP stands for superior labrum anterior posterior. Let’s break this down to understand precisely what it means, and then we’ll look at symptoms, causes, treatment, and prevention of SLAP tears.

 

What is a SLAP Tear?

The shoulder is a ball-and-socket joint. Specifically, the head of the humerus (the bone in your upper arm) fits like a ball into the open socket of the shoulder blade. The head of the humerus is bigger than the shoulder blade’s socket, making the shoulder a loose-fitting joint with significant free motion of the arm.

That’s where the labrum comes in. Because the shoulder joint isn’t a perfect fit, it needs additional support. The labrum provides that support. The labrum is a band of cartilage that surrounds and cushions the shoulder. It also connects the biceps to the shoulder.

So, a SLAP tear is an injury to this cartilage, the labrum. The rest of the acronym contains three position words: superior, anterior, and posterior—if you aren’t familiar with medical terminology, that’s okay! Superior means top, anterior means front, and posterior means back.

Let’s add that all up. A SLAP tear is an injury to the labrum (the cartilage that cushions the shoulder joint). It occurs in the top portion of the labrum and extends from the front to the back.

 

Symptoms of SLAP Tears

As you might imagine, a SLAP tear can be painful, as most joint injuries are. Because the labrum protects the joint and supports the movement of the arm, other symptoms include:

• A locking feeling in the joint
• Instability, especially during movement or when lifting heavy objects
• Difficulty lifting the arm overhead
• Inability to control the arm while throwing (especially for athletes, such as pitchers)

Many of these symptoms are similar to other shoulder injuries, so it’s important to see a medical professional to diagnose an injury accurately. Diagnosis can include a physical exam and/or imaging (e.g., X-Ray or MRI).¹

 

Causes of SLAP Tears

Like most injuries, a SLAP tear can be caused by overuse or a sudden impact or trauma.²

Athletes may develop a SLAP tear after performing repetitive motions with significant force. Baseball pitchers often perform overhead throws with incredible force, putting them at greater risk for a SLAP tear. Likewise, tennis players strike the ball with an outstretched/overhead motion that can increase their SLAP tear risk.

Many SLAP injuries may also result from sudden impact, as in a car accident or a hard fall. A SLAP tear can also occur in conjunction with a dislocated shoulder. When the head of the humerus slips out from the shoulder socket, other structures can be damaged, including the labrum and supporting tendons.

 

Treatment of SLAP Tears

Treatment depends on the severity of the injury. For any minor injury (including a mild SLAP tear), PRICE is a great at-home treatment that can accelerate healing. Make sure to protect the injured area and refrain from using the joint in any way that causes pain or discomfort. Ice and non-steroidal anti-inflammatory drugs (NSAIDs) can help alleviate some of the pain.

If the injury is still bothering you, it’s time to see a medical professional. Your doctor will first need to diagnose the injury and determine the severity. Most treatment plans will initially be noninvasive.³ Aside from rest and NSAIDs, your doctor will likely recommend physical therapy. This will help to strengthen your muscles and tendons without causing further damage to the joint.

However, in the case of a persistent or severe SLAP tear, your physician may recommend surgery.^2,3 To repair the labrum, your surgeon will stitch the tear. For some SLAP tears, your doctor can also detach the biceps tendon⁴ from the labrum to relieve some of the pressure against the labrum. They will then reattach the tendon below the labrum without restricting your range of motion. Most procedures can be performed arthroscopically.

 

Prevention of SLAP Tears

While it’s good to know treatment options are out there, most of us would prefer to avoid injury in the first place! While it’s impossible to prevent all injuries completely, there are actions you can take to minimize your risk.

Limiting strenuous activity can reduce excessive force on joints. Many of us enjoy sports in our free time, and we would never want to give up all forms of exercise entirely. Just don’t overdo it!

Protecting your joints by stretching and exercising is also important. Make sure you take time to work on each muscle group. Strengthen and lengthen each to keep your muscles and joints strong and supple. Finally, be sure to warm up before any sports or strenuous exercise.

References

1. Shoulder pain: Raising the level of diagnostic certainty about SLAP lesions. Mayo Clinic. https://www.mayoclinic.org/medical-professionals/orthopedic-surgery/news/shoulder-pain-raising-the-level-of-diagnostic-certainty-about-slap-lesions/mac-20431091. Accessed 12/3/2020.
2. Shoulder – SLAP repair. Orthopaedic and Neurosurgery Specialists. https://onsmd.com/treatment/shoulder-slap-lesion-repair. Accessed 12/3/2020.
3. Comprehensive care for the most complex SLAP lesions. University Hospitals. https://www.uhhospitals.org/services/orthopedic-services/conditions-and-treatments/shoulder-and-elbow-services/slap-lesions. Accessed 12/3/2020.
4. Hurley ET, Pauzenberger L, Mullet H. Editorial commentary: Which to fix-the biceps or the labrum? The shoulder SLAP tear is still controversial. 2019;35(6):1939-1940. DOI: 10.1016/j.arthro.2019.02.026.