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Slap Tears

by dr kalman piper

What Is A Slap Tear?

The shoulder is a ball and socket joint; however the socket is very shallow, allowing a large range of motion of the shoulder. Surrounding the socket (glenoid) is a tough ring of fibrous tissue called the labrum. The labrum helps stabilise the shoulder joint and prevent the head dislocating, while still allowing freedom of movement. One of the biceps tendons (the long head of biceps) also attaches to the labrum. The tendon enters the shoulder joint over the top of the humeral head and attaches to the labrum at the top of the ring (superiorly). This region is called the biceps anchor. The labrum can be damaged in an injury (usually a shoulder dislocation, fall onto an outstretched hand or while lifting a heavy object) or in repetitive movements that cause strain on the labrum (overhead throwing). A dislocated shoulder usually damages the labrum at the front of the shoulder joint (anteriorly), whereas the other injuries tend to damage the labrum in the region of the biceps anchor. Injuries in this region are known as SLAP tears. SLAP actually stands for “Superior Labrum, Anterior to Posterior” and is a way of describing the anatomical location of the injury, rather than any specific structure. SLAP tears often occur with other injuries to the shoulder such as rotator cuff tear. An isolated SLAP tear is actually fairly rare – occurring in only 10% of cases.

How Is A SLAP Tear Diagnosed?

There are several treatment options available for SLAP tears. These include:
The best treatment choice will be determined by several factors including the type of SLAP tear, the nature of the injury, the involvement of the biceps tendon, other associated injuries to the shoulder, your functional (sporting) demand and your age. If you are having surgery – the exact treatment is determined during the surgery, after a thorough assessment of the injury. Also, SLAP tears often occur with other injuries to the shoulder, and treatment choice may be determined by the other injuries.

What Is The Recovery Time From A SLAP Repair?

Rehabilitation and recovery time will depend on the type of SLAP tear, the extent of the damage and treatment received. Generally, is the SLAP tear is being treated without surgery or the tear has been repaired, 6 weeks in a sling is required to allow enough time for the labrum to heal back to the bone. During this time passive exercises (movement, without using the shoulder muscles) are performed to prevent excessive shoulder stiffness. After the labrum has healed to the bone, the sling can be removed and active exercises can commence. Exercises should never cause excessive shoulder pain.

What Are The Risks Associated With SLAP Repair?

As with any surgery there are associated risks. Results of SLAP repair will depend on the extent of the injury and the treatment received, and makes final outcome difficult to predict accurately in all patients. In general, complications related to SLAP repair include:
  • Post operative shoulder pain
  • Shoulder stiffness
    1. Most patients have a period of stiffness after SLAP repair, which improves with physiotherapy once it commences. Most patients will not notice and permanent loss of range of motion of the shoulder. Some elite level sportsmen involved in throwing sports such as baseball and water polo may have difficulty with full cocking of the shoulder during a throw.
  • Recurrence of the tear
    1. A SLAP repair is never as strong as it was prior to the injury and tears can happen again. This usually occurs if the biceps anchor is strained before it has completely healed back to the bone.
  • Biceps tendonitis
    1. A common source of pain after SLAP repair is inflammation within the biceps tendon. This will settle with time and may require an injection or anti-inflammatory medication. If there was pre-existing damage to the biceps tendon in association with the SLAP tear, it may go on to rupture completely.
  • Loss of throwing strength and delay or inability to return to sports
    1. In general, it takes 6 months to return to sports, however full throwing strength can often take longer to recover (one year or longer).
  • General Surgical Complications
    1. Infection – very rare with arthroscopic shoulder surgery.
    2. DVT – very rare with surgery of the upper limb.
    3. Allergic reactions to anaesthetic drugs or pain medications.
    4. Anaesthetic Complications – discuss with your anaesthetist.