What is a SLAP tear?
A SLAP tear or Superior Labral Anterior Posterior tear affects the top part of the glenoid labrum (typically at the 11o’clock to 1o’clock position). The long head of biceps tendon originates from the labrum at this position and its anchor is torn off its attachment to the bony socket (glenoid). Sometimes the tears extend anteriorly (in the front) or posteriorly (backwards) and may have complex patterns.
How does a SLAP tear occur?
A SLAP tear may occur as a result of the arm being bent inwards and twisting at the shoulder. The humeral head acts a lever and tears the biceps tendon anchor. This can occur in sportsmen with a pull on the arm, a throwing injury or tackle or even weightlifting.
How do SLAP tears present?
Pain and clicking deep within and at the top of the shoulder especially with overhead activities.
How are SLAP diagnosed?
This is based on the history, mechanism of injury and careful physical examination of the patient. An MRI or MR Arthrogram (MRI scan with special dye injected into the joint) is often used to confirm the diagnosis.
How are SLAP tears treated? Surgical vs Non-Surgical Management
Physiotherapy and analgesia will help improve symptoms. Certain types of throwing sports such as the pitcher in baseball develop some type of superior labral “tear” in order to achieve an effective throw. These SLAP tears often do not cause pain and allow the pitcher to generate enough coiled energy (like a spring about to be released) to allow them to throw the ball at incredible speeds.
If a patient complains of pain and /or clicking with overhead activities then an arthroscopic (keyhole) SLAP repair can be performed via two very small incisions in which the biceps anchor is reattached to the glenoid socket with special stiches. Postoperatively the shoulder is immobilised for a period in a sling and then started on a physiotherapy rehabilitation programme.
As surgical techniques have improved significantly over the last decade, complications are reduced and recovery much quicker than in the past.
Following surgery, a rehabilitation program with physiotherapy is commenced to help you return to your normal day to day activities. The progress of this is dictated by patients meeting milestones and is run under the supervision of the surgeon and specially trained physiotherapist.