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SLAP Lesion

A SLAP tear, also known as a SLAP lesion, is a type of shoulder injury. It is a tear in the labrum, a piece of cartilage that rings the shoulder socket. SLAP stands for “superior labrum anterior to posterior,” meaning the tear is on the top of the labrum (superior) and runs from front (anterior) to back (posterior).

The shoulder is one of the most mobile joints of the body, but mobility in the shoulder comes at the price of stability. It is a meeting of three bones: the upper arm bone (humerus), the collarbone (clavicle) and the shoulder blade (scapula). The humerus fits into the shoulder socket (called the glenoid) on the shoulder blade. The labrum helps keep the head of the humerus in the glenoid and increases the joint’s stability.

SLAP Tear Causes

A SLAP tear can be an acute injury—meaning caused by a single event—or a chronic overuse condition. Acute injuries can come from:

  • Car accidents
  • Falls onto an outstretched hand
  • Pulling on the arm
  • Rapid overhead movement
  • Shoulder dislocation

SLAP tears resulting from overuse can be common in sports and activities that involve overhead movement, such as some forms of weightlifting, as well as sports like football or baseball that have an element of overhand throwing. However, the wearing down or fraying of the labrum is considered a normal part of aging. As a result, SLAP tears that are not associated with an acute injury generally occur in people over the age of 40.

A relatively rare feature of anatomy that some people have, called a Buford complex, is sometimes mistaken for a SLAP tear. People with a Buford complex are missing a section of labrum on the top and front. This can look like a SLAP lesion on an imaging study.

SLAP Tear Symptoms

A SLAP tear can be difficult to pinpoint for the injured person because it feels like many other shoulder injuries. Symptoms include:

  • Catching, locking, popping or grinding sensation in the shoulder
  • Decreased range of motion
  • Feeling of instability
  • Pain in certain shoulder positions or with arm movement
  • Pain with overhead lifting

Diagnosing a SLAP Tear

A SLAP tear diagnosis will start with a medical history and physical exam. A doctor will be listening for evidence of an acute injury or if the patient engages in activities that carry an increased risk of SLAP tears.

During a physical exam, a physician will check the shoulder’s stability and range of motion, as well as evidence of pain or other SLAP tear symptoms. The doctor may manipulate the shoulder into various positions to see if symptoms appear.

Imaging studies may be useful in confirming a SLAP tear diagnosis. The labrum is made of cartilage, which is considered soft tissue and will not show up on an X-ray. However, an X-ray can still be used to rule out other sources of shoulder pain, such as a clavicle fracture or shoulder dislocation. A magnetic resonance imaging (MRI) scan can show damage to the labrum itself.

SLAP Tear Treatment

Many SLAP lesions can be treated without surgery. Nonsurgical methods of treatment can include using nonsteroidal anti-inflammatory medications (NSAIDs) to control pain and swelling, and physical therapy to strengthen the muscles around the shoulder and preserve or restore range of motion.

Surgery for SLAP tears is usually done arthroscopically, meaning with small incisions, small tools and a flexible camera known as an arthroscope attached to a video monitor. Depending on the severity, location and type of SLAP tear, arthroscopic repair could involve sewing the torn parts together or removing the torn part of the labrum.

Like the treatment, torn labrum recovery time will vary based on the size and severity of the tear. After arthroscopic surgery the patient may need to keep the arm immobilized in a sling for two to four weeks. Physical therapy for a number of weeks will likely be necessary and can speed recovery from SLAP repair surgery. Athletes typically return to their sports in three to four months, but other people may be able to return to their jobs and engage in daily activities sooner.

If you are experiencing shoulder pain and suspect you may have a SLAP tear, request an appointment with one of our shoulder experts today. We can diagnose your problem and develop a treatment plan that’s right for you.

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