The most common type of labral tear is a SLAP tear. Superior Labral Anterior Posterior tears or SLAP refers to the specific area of damage within the shoulder socket. A SLAP tear is an injury to the labrum or fibrous tissue at the top (superior) of the shoulder socket. This portion of the shoulder is significant as this is also where your bicep tendon attaches within the shoulder complex. Many of these tears are a result of overuse with repetitive activities or jobs requiring overhead lifting and reaching.
Symptoms can range from decreased range of motion, pain, and instability, catching, popping and grinding. Occasionally patients will have pain into the proximal (upper portion) of the biceps. These symptoms usually occur with activities overhead and activities away or across your chest.
Diagnosis can be determined by a thorough history and physical examination by a trained sports medicine and orthopedic shoulder specialist. Once the initial diagnosis has been made through special anatomical testing, an MRI arthrogram (3 dimensional picture with contrast injection) may be ordered to confirm the diagnosis and assist in determining the severity of the tissue injury. Occasionally, X-rays of the shoulder complex will be ordered to determine if any bony conditions exist prior to your MRI arthrogram.
Treatments can include conservative versus surgical management. A specific individualized treatment program will be created from your thorough history, physical examination, and radiological testing. Conservative management can consist of anti-inflammatory medications, a cortisone injection, orthobiologics, physical therapy and/or rest. Surgical management may be recommend pending the severity of the damage of the labrum. Labral tears are surgically repaired through arthroscopy.
Shoulder arthroscopy occurs when a small camera is placed into the shoulder joint to visualize the labral damage. During this visualization, ligaments, bones, and muscles of the shoulder complex is further assessed by the orthopedic surgeon. Once the assessment has been completed the surgeon uses a variety of instrumentation to repair the fibrous complex and ligaments to re-stabilize the shoulder. In additional to the SLAP tear, a patient’s biceps tendon may have been effected by the injury. If damage is visualized during arthroscopy the tendons anchor will be tenotomized (cut) from the shoulder and reattached outside the shoulder complex. This additional step of the procedure will remove the damaged portion of the tendon to provide additional pain relief. The repaired tissue is reattached with either bio-composite or knotless suture anchors.
Rehabilitation post-operatively will begin immediately. Patients will be placed into a sling for 4 weeks. A home exercise program will begin immediately following surgery. These exercises will be performed until formal rehabilitation can begin one to two weeks post-surgical repair pending its severity. A physical therapist or athletic trainer will begin your formal rehabilitation through a planned rehabilitation protocol. Initial outpatient sessions will consist of obtaining pain-free passive range of motion. Strengthening of the shoulder complex will begin around the 8-10 week post-operative phase once range of motion has been achieved. Total recovery from SLAP repair can range from 3-4 months.