SLAP is an acronym that explains where and how one type of labral tear can happen: Superior Labrum from Anterior to Posterior. A SLAP tear is a tear in the labrum which occurs at the top or superior aspect of the socket. The labrum surrounds the outside edge of the shoulder socket and has an important role in keeping the shoulder stable. It. also serves as an attachment point for the capsule and ligaments in the shoulder joint.
The injury involves the very top of the shoulder joint labrum (or the 12 o’clock position) and then can extend either towards the back (posterior-typical in baseball) or towards the front (anterior—typical with shoulder dislocations).SLAP stands for Superior Labrum Anterior and Posterior, and a SLAP
A SLAP injury can happen due to:
- falling on an outstretched arm
- a strong pull of the arm
- a shoulder dislocation
When the top (superior) part of the labrum is injured, the injury is typically referred to as a SLAP tear. There are a few ideas on how this area of the labrum can be torn, including the sudden movement of the humeral head upwards while the rotator cuff muscles are trying to hold the humeral head (ball) in the socket.
Examples of this type of injury causing a SLAP tear include falling onto an outstretched hand that is trying to break the fall or bracing the arms on the steering wheel during a car accident. Another idea is that it can occur when the arm is a throwing position, and the humerus bone rubs or impacts the superior labrum while the humerus is rapidly rotating forward. Finally, a sudden downward pull may act through the biceps tendon to tear the Superior Labrum which partially attaches to this area of the shoulder.
Because this injury is more likely when the arm is fully extended, athletes who perform repetitive overhead motions frequently develop a SLAP tear. SLAP tears can wear down the labrum slowly over time.
Symptoms of a SLAP tear include locking, popping, clicking or grinding in the shoulder. It can also cause pain when holding the shoulder in a specific position, pain when lifting heavy objects overhead, a decrease in shoulder strength, or a decreased range of motion. One clue that the tear is a SLAP is when a patient feels pain when extending an arm upward.
Do SLAP tears require major surgery?
Sometimes. Some patients with SLAP tears have no symptoms and do not require surgical intervention. Some mild tears can be treated conservatively, with rest, exercise, ice packs and over-the-counter pain medication. If your tear does not respond at this point, the good news is most SLAP tears can be repaired with an arthroscopic procedure. It is a minimally invasive procedure done on an outpatient basis.
A SLAP Repair can be done arthroscopically in an outpatient environment. The goal is to repair or trim the labrum or remove the damaged portion.
During the procedure, a tiny camera is inserted at the end of a flexible tube via a small incision. This allows experienced orthopaedic surgeon Dr. Anthony Romeo to accurately appraise the extent of the damage in real-time and confirm which type of repair is appropriate. With severe tears, sutures may be used to reattach the torn portion of the tendon.
Physical Therapy Protocols
After surgery, you will be sent home with a sling to wear for two to four weeks. Dr. Romeo will give you specific instructions for post-op pain management. Physical therapy often starts seven to ten days after surgery and at first it will include a lot of stretching for flexibility and improved range of motion.
After four to six weeks, a strengthening program will be added to regain full strength. Even as you begin to stretch and strengthen your arm, Dr. Romeo recommends that you ease into physical activity gradually. Take care not to place excessive amounts of stress on the shoulder joint. Most patients are back to many of their activities three months after surgery, with a full recovery expected by six months.
For more information on causes and treatment of SLAP tears, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.
Want to know more? In this video, Dr Romeo presents on the topic of treating SLAP injuries that have had surgery, but still cause problems:
In this video, Dr. Romeo performs an arthroscopic shoulder repair on former White Sox pitcher John Danks, demonstrating problems of the superior labrum, rotator cuff, and capsule. His comments will guide you through a better understanding of the day of surgery, from the preoperative assessment all the way to the recovery room.
Want to know more? Here a few of Dr. Romeo’s recent medical journal articles about slap tears:
Anatomy of the Shoulder as it relates to Surgery
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.