What is a Shoulder SLAP Tear?

A SLAP tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint.

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Dr. Jordan Leith, MD, MHSc, FRCSC, Sport Med Orthopeadic Surgeon, discusses what a shoulder SLAP tear is.

Nicole Fournier, BHKin, MSc (PT), CAFCI, Physiotherapist, discusses shoulder and neck injuries and pain.

Quiz: Do You Understand Shoulder Surgery?

Test your knowledge by answering the following questions:

Questions
True
False
1

The usual treatment for shoulder injuries is surgical options.

Explanation:
The usual treatment for shoulder injuries is non-surgical options such as medications, bracing and physiotherapy. Shoulder surgery is generally only explored if the non-operative options fail.
2

Arthroscopic shoulder surgery is often performed to repair soft tissue injuries.

Explanation:
Arthroscopic shoulder surgery (otherwise known as keyhole surgery) can be a good option for some patients. It is often performed to repair soft tissue injuries, and enables surgeons to introduce a fiber optic camera through a two- to three- millimeter incision.
3

For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery.

Explanation:
For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery. It is often done to repair rotator cuff tendons that have been damaged, often by arthritis.
4

Patients with recurrent shoulder dislocations may won't benefit from surgical reconstruction, only from non-surgical options.

Explanation:
Patients with recurrent shoulder dislocations may benefit from surgical reconstruction of the damaged tissues in the shoulder joint. This usually involves an arthroscopic day procedure, where the surgeon identifies the torn labrum or ligaments that have occurred with each shoulder dislocation.
5

Following shoulder surgery, most patients will benefit from physiotherapy.

Explanation:
Following shoulder surgery, most patients will benefit from physiotherapy to get their range of motion back, decrease pain and increase strength.
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What is a Shoulder SLAP Tear

LAP tears of the shoulder are tears to the labrum, which is a meniscus, or cartilage-like O-ring around the socket. And the SLAP basically stands for “superior labrum, anterior to posterior.”

So it’s located on the superior side of the glenoid, or the socket of the shoulder joint. And the biceps tendon enters the shoulder and attaches to that superior labrum.

SLAP tears usually occur in overhead athletes. So baseball pitchers, football players, volleyball players, people who play tennis. And it usually occurs from that overhead throwing motion, due to the torque from the biceps tendon, we think that you get a tear in the labrum, superiorly in the joint, and it can lead to symptoms of pain, sometimes catching sharp acute short-term pain in the shoulder joint.

Symptoms from SLAP tears usually consist of pain during a throwing motion or when the arm is in a position of elevation over the head. You may get the occasional sharp pain in the shoulder that lasts briefly and then settles when you stop that activity.

You can get a sense of instability sometimes in the shoulder, although rarely. It’s more often a deep-seated pain, deep in the shoulder joint, you can’t put your finger on it, and patients usually present with those symptoms occurring during their sporting activities.

The diagnosis of SLAP tears is a little more difficult than other shoulder disorders, because it’s a bit nefarious, you know, where the symptoms – they cross over a lot of different pathologies. But beginning with a thorough history and a physical exam of the patient can make you suspicious for a SLAP tear, but usually it’s either diagnosed with advanced imaging such as an MR arthrogram, or at the time of arthroscopy.

If non-surgical treatment of a SLAP tear fails to provide relief of your symptoms, then you’re ultimately going to require surgical intervention, which is done with arthroscopic day surgery. What happens at the time of surgery is sutures are placed in the superior labrum, and they are reattached back onto the socket, if it is a repairable labrum.

Sometimes it’s not, and if it’s a non-repairable labrum then what we do is we just debride or clean out the torn pieces of the labrum, and that usually settles the majority of the symptoms.

If you’re an overhead-throwing athlete or you participate in overhead sports, and you develop pain in that’s deep in your shoulder, you should seek the advice of an orthopedic surgeon to determine whether or not physiotherapy is all that you’re going to require, or surgical intervention to treat a SLAP tear if it gets diagnosed.

Presenter: Dr. Jordan Leith, Orthopaedic Surgeon, Burnaby, BC

Local Practitioners: Orthopaedic Surgeon

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