Repair
SLAP Repair
Your shoulder is a ball-and-socket joint made up of three bones:
-
upper arm bone (humerus),
-
shoulder blade (scapula)
-
collarbone (clavicle).
The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Surrounding the outside edge of the glenoid is a rim of strong, fibrous tissue called the labrum.
The labrum helps to deepen the socket and stabilize the shoulder joint. It also serves as an attachment point for many of the shoulder's ligaments and one of the tendons from the biceps muscle in the arm.
What is SLAP tear?
The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.
Causes
Injuries to the superior labrum can be caused by acute trauma or by repetitive shoulder motion. An acute SLAP injury may result from:
-
A motor vehicle accident
-
A fall onto an outstretched arm
-
Forceful pulling on the arm, such as when trying to catch a heavy object
-
Rapid or forceful movement of the arm when it is above the level of the shoulder
-
Shoulder dislocation
-
People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears resulting from repeated shoulder motion.
However, many SLAP tears are the result of a wearing down of the labrum that occurs slowly over time. In patients over 30 to 40 years of age, tearing or fraying the superior labrum can be seen as a normal ageing process. This differs from an acute injury in a younger person.
Symptoms
The common symptoms of a SLAP tear are similar to many other shoulder problems. They include:
-
A sensation of locking, popping, catching, or grinding
-
Pain with movement of the shoulder or with holding the shoulder in specific positions
-
Pain with lifting objects, especially overhead
-
A decrease in shoulder strength
-
A feeling that the shoulder is going to "pop out of joint"
-
Decreased range of motion
-
Pitchers may notice a decrease in their throw velocity or the feeling of having a "dead arm" after pitching
Treatment
Non-surgical
In most cases, the initial treatment for a SLAP injury is nonsurgical—nonsteroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
-
Physical therapy. Specific exercises will restore movement and strengthen your shoulder. Flexibility and range-of-motion exercises will include stretching the shoulder capsule, which is the joint's strong connective tissue. Exercises to strengthen the muscles that support your shoulder can relieve pain and prevent further injury. This exercise program can be continued anywhere from 3 to 6 months, and usually involves working with a qualified physical therapist.
Surgical
Your doctor may recommend surgery if your pain does not improve with nonsurgical methods.
Arthroscopy. The surgical technique most commonly used for treating a SLAP injury is arthroscopy. During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a video monitor, and your surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
There are several different types of SLAP tears. Your surgeon will determine how best to treat your SLAP injury once he or she sees it fully during arthroscopic surgery. This may require simply removing the torn part of the labrum, or reattaching the torn part using sutures. Some SLAP injuries do not require repair with sutures; instead, the biceps tendon attachment is released to relieve painful symptoms.