Anatomy:

The head of your upper arm bone (humerus) fits into a rounded socket (glenoid) in your shoulder blade (scapula). 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 ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.

The term SLAP stands for Superior Labrum Anterior-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.

Cause:

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 or lift 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 as a result of repeated shoulder motion.

Many SLAP tears, however, are the result of a wearing down of the labrum that occurs slowly over time. In patients over 30 years of age, tearing or fraying of the superior labrum can be seen as a normal process of aging. This differs from an acute injury in a person under the age of 30.

Imaging:

X-rays will be taken at your office visit to ensure there are no bony abnormalities, arthritis, or fractures. The labrum of the shoulder is made of soft tissue, so it will not show up on an x-ray. To have a clearer picture of the labrum, an MRI can better show soft tissues. To make a tear in the labrum show up more clearly on the MRI, a dye may be injected into your shoulder before the scan is taken, called an “MRI arthrogram.”

Treatment:

Nonsurgical Treatment
The initial treatment for a SLAP injury is usually nonsurgical. Treatment options may include:

• Resting your shoulder to avoid aggravating activities.
• NSAIDs like Ibuprofen, Tylenol, or Aleve to reduce pain and swelling.
• Physical therapy to restore movement and strengthen your shoulder.
• Steroid injections, usually cortisone, to relieve painful symptoms and calm down inflammation in the shoulder joint.

Surgical Treatment

Your doctor may recommend surgery if your pain does not improve with nonsurgical treatment. This is usually performed arthroscopically. During the arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. This is a minimally invasive procedure using very small incisions (cuts), rather than the larger incision needed for standard, open surgery.

• Depending on the extent of the SLAP tear and patient age, the labrum and/or biceps tendon may need to be repaired.
• Arthroscopic surgery is usually an outpatient day surgery that allows you to go home the same day. You will wear a sling for 4-6 weeks to avoid any shoulder range of motion. During this time, it is still okay to shower, and you’re allowed to move your elbow, wrist, and fingers.
• You will participate in physical therapy after you’ve completed wearing the sling to restore range of motion and eventually strengthen your shoulder.