SLAP Tear Specialist Singapore

Dr. Bryan Tan

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?

In this condition, the part of the labrum that is directly underneath the attached long head of biceps, together with part of the labrum to the front as well as to the back, becomes detached from the underlying socket.

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 are most common amongst 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.

What Causes a SLAP Tear?

  • Overuse of the shoulders
  • Excessively forceful and explosive overhead movements of the shoulder (eg when doing a hard tennis serve or throwing a ball forcefully during sport)
  • Sudden twisting injuries to the shoulder (eg during weight lifting accidents)
  • Shoulder dislocation 

Symptoms Of SLAP Tear

The most common complaints are pain and clicking. However, most patients do not have much pain at all with activities of daily living. They can actually go about their lives absolutely pain free and that includes lifting heavy loads.

However, they will get pain when they participate in sports that involve throwing like baseball, handball, dodgeball, water polo etc. They will also have pain with sports that involve a lot of overhead movements like tennis, badminton, volleyball etc.

Sometimes, patients may find that they pain is most bothersome when they first start playing. It may then mellow down a little throughout the game, but they may get a sore shoulder that lasts for a few days after the game. Others may find that they are no longer able to serve or throw as hard as they used to.

Many will also experience a clicking or clunking sensation with certain movements. In rare cases, patients may even get pain with daily activities.

How Is SLAP Tear Diagnosed?

MRI scans are required to diagnose SLAP tears. Other investigations are either woefully inaccurate or outright useless! MRI scans are not elaborate at all and are actually extremely commonly performed these days.

Some doctors still prefer an invasive form of MRI scans known as MR arthrography. In an MR arthrography, the radiologist first injects a dye into the shoulder prior to performing the MRI scan.

While an MR arthrography does increase the accuracy of the scan slightly, I do not find it absolutely necessary. A “normal” MRI scan will suffice. This is especially true since MRI scans have a tendency to over-diagnose SLAP tears due to the fact that there are some anatomical variants in this area of the shoulder and some normal variants may mimic the appearance of a SLAP tear on MRI scans.

It is hence, very important, to see a doctor who is familiar with shoulders and shoulder surgery as a misdiagnosis will result in wrong treatment being advised! To learn more about MRI scans, please read the section on Investigations.  

​​Is SLAP tear affecting your quality of life, and your ability to perform everyday activities such as working, playing sports and wearing your clothes?
Dr. Bryan will assess your symptoms in detail before recommending the right treatment plan for your condition.

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. 

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).

 
Movements around the shoulder involve 3 separate articulations: the glenohumeral joint, the acromioclavicular joint and the scapulothoracic articulation. When the arm is raised, the majority of movement occur at the glenohumeral joint and the scapulothoracic articulation.

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?

Billing & Payment

Medisave & Insurance Claims

The following are accredited For Singaporeans, Singapore Permanent Residents and Foreigners. If your insurance is not listed, you will still be able to make claims for eligible procedures! We have experience processing claims from many other various insurance providers. Please contact us if you have any queries.

WHAT’S THE FIRST STEP?

Embark on Your Road to Recovery With Dr Bryan Tan

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STEP 1

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STEP 2

Initial Consultation & Diagnosis of your Condition

During your consultation, Dr. Bryan will evaluate your medical history and the pain you are experiencing. You may also ask Dr. Bryan any questions you may have about your condition.

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STEP 3

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