SLAP Tears

SLAP is an acronym for Superior (top) Labrum (the bumper around the glenoid) Anterior (front) to Posterior (back).

The long head of biceps tendon attaches to the top of the glenoid bone (and labrum).  As we age, degeneration in this area becomes more common causing inflammation.  This inflammation causes pain.  Pain from a SLAP lesion is almost always related to the biceps tendon, rather than from the SLAP tear itself.

SLAP tears are common in athletes who throw with their arm overhead, such as baseball, javelin and tennis players and, in these people, surgery to repair the tear may be required.

Despite being commonly reported on MRI scans, they almost never need treatment in older people.

Treatment options vary from conservative to surgical.  Physiotherapy may be considered as an option for lower demand shoulders.  Physiotherapy cannot repair a slap tear, but through better shoulder strength, activity modification and education, for many people this can provide a satisfactory result.  If the inflammation is less with the above strategies, then your pain will be less, and as long as the lifestyle modifications are satisfactory to you, then all is good 🙂

For those with high shoulder demand lifestyle, then surgery may be become an option.

Treatment without surgery works in about 50% of patients.  In older patients, cutting the biceps tendon (tenotomy), or moving it to a new location outside of the shoulder (biceps tenodesis), fixes the symptoms.

While a SLAP tear often involves damage to the labrum, it is somewhat different to anterior shoulder instability, where the shoulder actually dislocates.  There is usually no sensation of the shoulder dislocating, just pain when using the arm overhead or when loading the biceps tendon.

Post-operative care.  Generally speaking, a sling needs to be worn for 4-6 weeks after a SLAP repair. Active range of motion exercises are performed for the next 4 -6 weeks and then a strengthening program commenced.  Full recovery is usually 6 months.

Fitness is best maintained on a stationary exercise bike or jogging (being very careful not to fall).

None of these operations give you a super strong / bulletproof shoulder and just as you injured your shoulder the first time, you may injure it again with violent sporting activity.