Shoulders

What are SLAP Tears?

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Published on Saturday, 26 June 2010 10:04

Written by Robert G. Klitzman, M.D.

Article written by Robert Klitzman, MD, Norman OK

SLAP tears are relatively common shoulder injuries that are commonly not understood well. First, SLAP stands for Superior Labrum Anterior/Posterior. To understand what this means, you have understand the anatomy involved.

The Anatomy

As most people know, the shoulder is a “ball and socket” joint. In reality, the socket part of this joint is very flat and the “ball” sits on it like a golf ball sits on a tee. The socket, or glenoid, does not provide much stability to the ball (humeral head). An added bit of stability is provided by the labrum.

The labrum is a rubbery ring made of cartilage and acts as a gasket to “deepen” the socket and give the joint more stability. The last piece of the anatomy is the long head of the biceps tendon. The biceps muscle gets it name (bi) from the fact that it has two attachments in the shoulder area. One is outside the joint, the short head. The long head attaches to the labrum at the 12:00 position (comparing the socket to the face of the clock). A SLAP tear is a tear of the attachment of the labrum in front of the labrum (anterior) to behind the labrum (posterior).

Causes, symptoms and treatments for SLAP lesions

Okay, now that we have the anatomy down, what about the causes, symptoms, and treatments for SLAP lesions. SLAP tears are quite common and not all SLAP tears cause symptoms. The symptomatic ones are what this discussion is about. As with other problems in the shoulder (such as rotator cuff tears), SLAP lesions can be the result of a gradual process with a “wear and tear” component or they can happen suddenly from an injury. Common mechanisms of injury include a fall on an outstretched hand, partial dislocation of a shoulder, lifting a heavy object, or repetitive overhead activities such as throwing or working with arms overhead.

Symptoms that can be associated with SLAP lesions include: catching or popping in the shoulder with the arm overhead or reaching out or a deep achy pain in the shoulder. The symptoms aren’t very specific. After a clinical exam by a shoulder specialist, the next step in diagnosis is usually a MRI. An MRI with contrast injected in the shoulder is best for identifying SLAP lesions.

Once the diagnosis has been made, how do we treat these injuries? As with most shoulder pathology, conservative therapy is the first treatment. We usually start with physical therapy and anti-inflammatory medications. If these fail to provide relief, the next step is an arthroscopic shoulder surgery.

I will discuss the surgical treatments in an upcoming article.