SLAP Tear
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
SLAP (Superior Labral Anterior Posterior) lesions have become rather well described in the last few years. SLAP tears were only described in the late 20th century and became more established as a condition in early 2000s.
In the world of medicine, that’s a rather short amount of time! They are a very common cause of shoulder pain in athletic individuals and are one of the most common conditions that I treat.
What Is A SLAP Tear?
A SLAP (superior labrum from anterior to posterior) tear is a type of shoulder injury that affects the labrum, the cartilage ring attached to the rim of the shallow socket (glenoid) of the shoulder joint.
The shoulder labrum helps to provide stability to the shoulder joints by improving the fit between the ball and socket of the shoulder joint. It is also the attachment point of various ligaments and a tendon. SLAP tears, also known as SLAP lesions, are most common among athletes who consistently engage their shoulders in overhead movements.
It is crucial to understand your symptoms and seek medical treatment as soon as you can, as early diagnosis and treatment can reduce the complications of a SLAP tear.
Who gets SLAP lesions?
Sports injuries are the leading cause of shoulder dislocation. They are often seen in either throwing or overhead athletes. In countries where sports like baseball or handball are popular, these athletes often suffer SLAP lesions.
In Singapore where these sports are not so popular, I tend to see overhead athletes presenting with this condition. People who play sports such as tennis, badminton and volleyball are the most common patients I see with SLAP lesions.
Common causes of SLAP tears:
Overuse of the Shoulders
Repeated shoulder use, especially during activities that involve frequent overhead motions, can lead to a SLAP tear.
Forceful Overhead Movements
Powerful overhead movements, like a hard tennis serve or a strong throw, can stress the shoulder and cause a SLAP tear.
Sudden Twisting Injuries
Quick, twisting shoulder motions, often from accidents during weightlifting or similar activities, can result in a SLAP tear.
Shoulder Dislocation
When the shoulder becomes dislocated, it can damage the labrum and potentially cause a SLAP tear.
Common Symptoms of SLAP Tear
SLAP tears can lead to pain and reduced motion in the shoulder labrum, biceps tendon, or both. Symptoms include:
- Pain with sports involving throwing, such as baseball or handball.
- Discomfort in sports with overhead movements, like tennis or volleyball.
- Pain at the start of activity that may ease during play but result in soreness afterwards.
- Reduced strength, making it hard to serve or throw with previous force.
- Clicking or clunking sensations with certain shoulder movements.
- In rare cases, pain during daily activities.
Types of SLAP Tears
1. Type I SLAP Tear
This type involves fraying of the labrum without detachment from the shoulder socket. It often results from the gradual wear and tear due to ageing or repetitive overhead activities. It is more common in middle-aged and older individuals.
2. Type II SLAP Tear
Type II tears are characterised by the detachment of the labrum and the biceps tendon from the shoulder socket. This type is commonly caused by repetitive overhead movements or acute injuries and is the most frequently seen SLAP tear.
3. Type III SLAP Tear
Known as bucket-handle tears, these involve a crescent-shaped tearing or fraying of the labrum but do not affect the biceps tendon. Type III tears are rare and usually occur after a fall on an outstretched arm.
4. Type IV SLAP Tear
This type combines bucket-handle tears with detachment of both the labrum and the biceps tendon. Like Type III, it is often caused by a fall on an outstretched arm.
How Is SLAP Tear Diagnosed?
SLAP tears are primarily diagnosed using MRI scans, which are common and not overly complex. Some doctors prefer MR arthrography, where a dye is injected into the shoulder before the MRI, slightly increasing accuracy. However, regular MRI scans usually suffice, as they can sometimes over-diagnose due to anatomical variants. It is crucial to consult a doctor familiar with shoulder injuries to avoid misdiagnosis and incorrect treatment.
How To Treat SLAP Tear?
The treatment options depend on the severity of the tear. There are generally two types of methods: Non-surgical and surgical treatment. It is important to note that non-surgical treatments often do not result in healing of the tear. However they can help to reduce pain and improve function of the shoulder in some instances.
These methods may include:
- Physical therapy such as simple stretching and strengthening exercises.
- Nonsteroidal anti-inflammatory medications like ibuprofen,naproxen and etoricoxib can reduce pain and inflammation.
In severe SLAP tear cases, surgical repair is recommended. A minimally invasive arthroscopic surgery will be performed to reattach the torn labrum. This is highly effective and patient satisfaction and eventual return to sport is excellent.
How to Prevent SLAP Tears
While some SLAP tears might be unavoidable, you can take steps to reduce the chances of getting one:
- Warm Up Properly: Stretch and warm up your shoulder muscles before participating in sports or activities involving overhead movements to help prevent injuries.
- Monitor Shoulder Health: Pay attention to any shoulder pain or stiffness. If you notice any changes, consult a healthcare provider to address issues early.
- Use Proper Technique: When lifting or performing activities involving the shoulder, use correct techniques to avoid jerking movements that can strain the labrum.
- Strengthen Shoulder Muscles: Incorporate exercises to strengthen your shoulder muscles, which can help support the joint and lower the risk of injury.
Anatomy of the Shoulder Joint
The shoulder joint is made up of 3 bones: the shoulder blade (scapula), the humeral head and the collar-bone (clavicle).
The glenohumeral joint is a ball and socket joint, comprising the socket (the glenoid) and the ball (the humeral head). Both surfaces of the joint are covered with an extremely smooth and rubbery cartilage (known as articular cartilage). The smooth surfaces create a frictionless articulation when lubricated with a small amount of joint fluid.
The glenoid is really a rather shallow socket. In fact, a dish is probably a more accurate description! This, however, is a design which is intended to allow the shoulder joint to have great range of movement. Unfortunately, the price of big range of movement is stability. You can probably image that a big ball sitting on a shallow dish will fall off very easily.
While that is true to a certain extent, the body has ways of preventing this from happening. A ring of cartilage attached to the rim of the glenoid helps to not only deepen the socket, but also serves as the attachment point of ligaments that help to hold the humeral head in place. This ring of cartilage is known as the labrum.
Frequently Asked Questions
How does a SLAP lesion occur?
Is a SLAP tear serious? When should I visit the doctor?
Will the SLAP tear heal by itself?
What does SLAP repair surgery entail?
What is the success rate of the surgery?
Will I be able to participate in sports after the surgery?
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