SLAP Tears

What is a SLAP Tear?

A Superior Labrum Anterior and Posterior tear, is referred to a “SLAP” tear. This is a specific type of pattern in the labrum of the shoulder. The labrum is the tissue that lines the rim of the glenoid to help keep the ball in the socket through a large range of motion. You can think of this like a golf ball sitting on a golf tee.

The labrum tissue supports the ball and socket of the shoulder joint. The labrum serves as a protection for additional shoulder stability. There are many important shoulder ligaments that also attach to the labrum. In a SLAP injury, the top part of the labrum is injured which is actually the origin of the biceps tendon attachment. This complex is commonly injured in athletes and can be a common source of pain.

A. Arthroscopic image and illustration (B) demonstrating a type I SLAP tear characterized by biceps and labral fraying with an intact biceps tendon anchor. This is most commonly treated with labral debridement at the time of arthroscopic surgery.

(C) and (D) demonstrate a Type II SLAP tear in which the biceps anchor is detached, this is typically managed with arthroscopic SLAP repair.

(E) Arthroscopic image and illustration (F) show a Type III SLAP tear with a bucket-handle tear of the superior labrum with an intact biceps tendon anchor. Operative management for type III SLAP tears involves debridement of the flaps.

Arthroscopic image (G) and illustration (H) show a type IV SLAP tear in which the bucket-handle tear extends into the biceps tendon root. These injuries are often treated with a biceps tenodesis.

(B) Arthroscopic image from a left shoulder demonstrating detachment of the superior labrum (Type II).

(C) Arthroscopic repair of the type II SLAP tear using a knotless anchor technique.

How does this occur?

The labrum can tear by three mechanisms.

1. Overuse – We see this in patients who use their shoulder to make the same motion over and over again (repetitive motions such as a weightlifter performing a clean).
2. Injury – This is common in patients who fall with a stretched-out arm attempting to break their fall.
3. Degeneration (wear and tear) – Wear and tear are common in patients over the age of 40, in which labral tissue continues to fray or tear slowly over time.

What are the symptoms of SLAP tears?

In most cases, patients may not have any symptoms. Pain typically occurs when you use the shoulder with overhead activity. You may experience catching, locking, or grinding in the shoulder. In some cases, you may lose strength and range of motion.

How is this diagnosed?

Dr. Zahab Ahsan and Sincer Jacob have extensive experience in diagnosing SLAP tears. You can expect to have a physical examination, x-rays, and an MRI with or without contrast as indicated to assess the extent of the injury.

What is the treatment?

Treatment of a SLAP tear is dependent on the severity of the injury. We think broadly in our approach (non-surgical vs. surgical).

Non-Surgical

Initial treatments are focused on a customized treatment plan that will likely entail rest, anti-inflammatory medications, and a physical therapy program. The combination of these items leads to a decrease in pain and prevents further injuries in many cases.

Surgical

In more severe cases, a customized surgical approach may be recommended by Dr. Zahab Ahsan and Sincer Jacob. This decision is reached based on patient goals. Dr. Zahab Ahsan commonly uses arthroscopic surgery to repair the labrum. The surgery includes small incisions, a camera, and special surgical instruments resulting in a less-invasive surgery and an accelerated recovery time. In some cases, a biceps tenodesis (reattaching the anchor point of the biceps origin) may decrease the tension on the labrum. Surgery results are most effective and successful when patients follow a rehabilitation protocol provided by our team.

If you have any questions regarding SLAP tears please contact Dr. Zahab Ahsan or Sincer Jacob.