Labral SLAP Tear
What does SLAP mean and what is its role in the shoulder?
SLAP stands for Superior Labrum Anterior Posterior. The Labrum is a set of ligaments that surround the shoulder joint and is responsible for stability of the shoulder as well as serves as an attachment point for the Biceps tendon. In a SLAP injury, the superior (top) portion of the labrum is injured.
What causes a SLAP tear?
SLAP tears can either be acute and secondary to trauma or chronic and the result of repetitive stress. Acute causes include, but are not limited to, a fall onto an outstretched hand, motor vehicle accident, forceful pulling on the arm, and shoulder dislocation. Chronic SLAP tears are usually secondary to repetitive overhead activities commonly performed by throwing athletes and weightlifters.
Patients normally complain of a vague and deep shoulder pain. Mechanical symptoms (catching/popping) may or may not be present. Pain may furthermore be severe with certain movements such as overhead positions or the position the arm is in just before throwing a ball. Throwing athletes may specifically complain of decreased pitch velocity and control. Also patients frequently complain of pain when activating the biceps muscle, or when sleeping.
An x-ray is usually ordered first to evaluate the joint and to rule out other diagnoses. An MRI is usually ordered to definitely diagnose a SLAP tear. If the MRI is equivocal, an MRI with contrast might be added.
Non-operative treatment is often the first line for SLAP tears and usually consists of Physical Therapy and anti-inflammatory medications (if not contraindicated). Activities such as bench press, push-ups, overhead presses, and bicep curls are usually discouraged. Physical therapy aims to emphasize stretching of the ligaments and strengthening of the rotator cuff tendons. Throwing athletes are usually instructed to refrain from throwing for 6 weeks and then begin an interval throwing program.
Surgery is normally indicated in patients with severe symptoms that have failed non-operative treatment. Dr. Steven Lee either debrides (removes damaged pieces) or repairs the superior labrum dependent on the severity of the tear. Dr. Lee uses suture anchors to repair the superior labrum. These anchors are drilled into the glenoid bone (shoulder socket). The suture strands attached to the anchor are then used to repair the superior labrum back down to the shoulder socket, creating a very strong repair.
Both debridement and repair of the superior labrum are performed arthroscopically. Arthroscopy involves making a very small incision over the shoulder and introducing a small video camera into the shoulder joint. The image is then projected onto a monitor in real time so that the labrum and surrounding structures can be examined. Additional small incisions are then made in order to introduce other small arthroscopic instruments to either debride or repair the labrum. Shoulder arthroscopy is minimally invasive and can result in less soft tissue disruption, less pain, and minimal scar formation.
Dr. Steven Lee is an expert arthroscopist who regularly instructs sports medicine fellows and other sports medicine physicians on how to perform arthroscopy. SLAP tears typically take Dr. Lee about 20 minutes to perform, and is usually performed as an outpatient. Learn more about scheduling surgery.
The patient's incision sites are sutured and dressed and they are placed into a shoulder sling after surgery. Patients are instructed to stay in the sling until their first post-op appointment 7-10 days after surgery. The patient's sutures are usually removed at their first post-op appointment and they are instructed to remain in the sling for an additional 3 weeks. Patient's are then usually instructed to wean down sling use and start Physical Therapy 4 weeks after surgery. Depending on the sport or activity, patients can usually expect to return to sports 4-6 months after surgery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.