A SLAP tear can be a significant injury. What is a shoulder labral tear? If your labrum is torn, is surgery necessary? If so, what can you expect for the recovery? Arm yourself with information so you can make the best choices for you.
The shoulder is a ball and socket joint. The “ball” is comprised of the head of the humerus and the “socket” is the glenoid fossa located on the scapula or shoulder blade. In the shoulder this ball and socket formation is rather shallow with the ball being rather large compared to the socket.
Often the shoulder is described as a golf ball, sitting on a golf tee. This is unlike other ball and socket joints such as the hip where the socket is large. The labrum of the shoulder is a piece of cartilage attached to this glenoid fossa and functions to deepen the socket of the shoulder and thus add stability to the joint.
A SLAP tear in the shoulder is an acronym that stands for: Superior Labral, Anterior to Posterior tear and specifies the location of the labral tear. If you consider a typical clock, the SLAP tear is located between 9 o’clock and 3 o’clock positions and thus is in the upper or superior aspect of the labrum.
The severity of a SLAP tear can vary from simple fraying to a tear involving the biceps tendon. Because the long head of the biceps tendon attaches to the upper portion of the labrum, injury to the shoulder labrum can result in the biceps tendon attachment becoming disrupted.
A tear to the labrum can occur from repetitive stress or trauma. Small micro tears of the labrum can occur through repetitive activity such as overhead throwing or swimming. More significant tears generally occur through trauma such as a fall on an outstretched arm of in association with a shoulder dislocation.
How do you know if you have a SLAP tear? Shoulder labral tears can be difficult to distinguish from other shoulder injuries. Often symptoms include deep shoulder pain/ache, catching and/or locking, difficulty sleeping on the injured side, limited shoulder range of motion, and limited strength.
As with all soft tissue injuries, x-rays may be used to determine any fractures will not pick up injuries to the labrum. A physical exam can be helpful in finding any catching or locking. An MRI is generally necessary to determine if the labrum is involved. Often a contrast medium is injected into the shoulder joint prior to the MRI in order to get a clearer picture of the labrum. That being said, even with a contrast MRI, a labral tear may not be evident.
Because the labrum does not have a blood supply, when an injury to the labrum occurs it cannot heal on its own. The significance of the shoulder labral tear, however, will impact whether conservative treatments will be successful or if surgery will be necessary. Typical conservative treatment includes anti-inflammatory medication, ice, physical therapy, and cortisone injections.
Physical therapy is recommended as a means to both restore normal shoulder range of motion and restore strength. The muscles of the rotator cuff function to assist in keeping the head of the humerus in the socket. Rotator cuff weakness thus can allow for extra motion in the socket to occur and thus contribute to the pain associated with a shoulder labral tear. Restoring rotator cuff strength can be sufficient to all for a return to function and a reduction in pain.
If conservative treatment options are not successful, repair of the SLAP tear can be done arthroscopically. For a SLAP repair, anchors are used to reattach the labrum.
The severity and specific procedure utilized will impact the progression of activity after surgery. Often a period of 2-6 weeks of immobilization will be required. During this time range of motion exercises are often recommended in order to restore shoulder motion and minimize post operative stiffness. Once active motion is allowed to occur strengthening exercises will be gradually introduced. Each physician will have their own protocol for the rehabilitation process but most often a return to normal sports activity will occur between six and nine months.
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