Over the past few years, we’ve seen a sudden increase in baseball and softball participation around the country. In fact, according to the MLB, more than 25 million Americans participated in baseball and softball in 2017. Unfortunately, due to the nature of pitching, the shoulder is often injured during throwing sports, and a SLAP tear is a particularly common pitching injury seen in sports medicine. In addition to overuse, a slap tear may also be the result of direct trauma, such as a hard fall or a car accident. What’s the underlying cause of your shoulder pain? In this article, we’ve gathered all the information you most need to know about labrum/SLAP tears. Let’s take a look.
First and foremost, it’s helpful to remember that the “SLAP” in “SLAP tear” is actually an acronym, meaning Superior Labral Tear from Anterior to Posterior. “Labral” refers an anatomical feature called a labrum. What is the labrum in the shoulder? The shoulder labrum is a protective ring of cartilage and connective tissues surrounding the shoulder joint and is the insertion point of the shoulder ligaments in the shoulder “socket”, or glenoid. With a SLAP tear specifically, the top portion of the labrum (where the labrum attaches to the bicep tendon) is injured.
There are many classic symptoms associated with a SLAP tear injury. Understanding your symptoms and explaining these aches and pains to your doctor will allow the two of you to pinpoint the underlying shoulder injury. SLAP tear symptoms include pain during certain shoulder movements (especially overhead motions such as pitching and throwing). Shoulder pain when lifting objects above the shoulder is another SLAP tear symptom, although this can also be the result of another injury. Shoulder instability and diminished shoulder range of motion are both commonly reported with severe SLAP tears.
Many patients report shoulder clicking and the shoulder catching during certain activities. This locking and catching may be caused by labrum bucket handle tears. Shoulder grinding may also occur as a result of diminished cartilage and direct contact between bones. Throwing athletes may notice a significant decrease in velocity. Dead arm symptoms and shoulder pain when throwing a baseball are typically associated with type 2 SLAP tears. (We will discuss the various SLAP tears types in greater detail later in this article.)
A shoulder labrum injury can occur in many ways. Repetitive, above-the-shoulder motions may injure the labrum over time, making a SLAP tear a common pitching injury. Baseball players and softball players may suffer labrum injuries as a result of overuse or poor mechanics. SLAP tears are also common in other sports and athletics such as volleyball, golf, and weightlifting. However, while a labrum tear is a common sports-related injury, labrum injuries are by no means limited to athletes. In fact, many occupational activities involving repetitive shoulder movements may cause labrum injuries.
Although the majority of SLAP tears are the result of repetition and athletic activity, there are other common causes. Direct, sudden, traumatic events such as motor vehicle accidents, slips, and falls may also result in a labral tear, damage, or a dislocated shoulder. As is the case with other joints and cartilages, fraying and general wear are to be expected over time, and for this reason, individuals over 40 years of age may experience shoulder pain as a result of shoulder osteoarthritis. There are also many structural and genetic risk factors to note. For example, scapular dyskinesia (abnormal movement or positioning of the shoulder blade) and rotator cuff defects may also increase the likelihood of a SLAP tear or labrum injury.
There are four main types of SLAP tears. A type 1 SLAP tear involves general fraying of the labrum. With a type 1 SLAP tear, the labrum is still attached to the glenoid rim. A type 1 of SLAP tear is commonly associated with the aging process. A type 2 SLAP tear involves the complete detachment of both the labrum and bicep tendon from the glenoid. Type 2 SLAP tears are by far the most common, representing more than 40 percent of all cases. A type 3 SLAP tear involves a bucket handle tear, with the bicep tendon remaining attached. Type 4 SLAP tears are essentially a type 2 SLAP tear and a type 3 SLAP tear combined. Type 4 SLAP tears also involve bucket handle tears, with these tears extending into the bicep tendon.
A SLAP tear is notoriously difficult to diagnose, but there are many tests your doctor may use to correctly diagnose your shoulder injury. Prior to diagnostic imaging, your doctor will use a series of circumduction tests to pinpoint the underlying cause of your shoulder injury and rule out other possible causes of your shoulder pain. The most common shoulder injury tests include the posterior stress test, the load and shift test, the Kim test, the jerk test, and the O’Brien’s test. The O’Brien’s test is commonly referred to as the “SLAP Test,” although it is not the only technique for diagnosing a slap tear. This test helps demonstrate and identify shoulder weakness and shoulder instability.
We hear this question regularly from patients who have suffered a labrum tear, and the answer is exceptionally multifaceted and complicated. It’s important to understand all your options, so let’s take a look at the data and the ramifications. While SLAP tear treatment without surgery may effectively decrease shoulder pain symptoms and restore strength and shoulder joint mobilization, the labral tear may be further aggravated by participating in athletics and certain activities. SLAP tear surgery is typically the most effective treatment option to minimize shoulder pain and prevent further injuring the labrum.
It’s an unfortunate fact that a SLAP tear will not heal itself naturally. Without surgery, individuals should expect to hit a functional and athletic plateau. Based on your shoulder injury and lifestyle, your doctor will determine a set of “return to play” guidelines, to determine how aggressively and how often you should participate in shoulder movement activities. Younger athletes in particular should certainly consider arthroscopic SLAP tear surgery to prevent shoulder instability and further injury down the road.
While SLAP tear surgery is often used to treat a labrum tear, there are nonsurgical options to consider. Depending on your activity level and lifestyle, non-surgical SLAP tear treatment may be the right option for your labrum tear. SLAP tear physical therapy is a common rehabilitation pathway for many patients. Once your shoulder injury has been diagnosed, your doctor will design a SLAP tear rehab program for you. Typically, these SLAP tear exercises will first focus on increasing flexibility and range of motion. SLAP lesion exercises will then progress to incorporate training and weight-resistance, to strengthen the surrounding muscles and help stabilize the joint.
It’s important to follow the exact SLAP tear physical therapy regimen established by your doctor. This is because different SLAP tears types will require different labrum tear exercises. For example, individuals with compression-related SLAP tear injuries should avoid certain weight-training exercises to prevent further injury. Similarly, certain types of SLAP tear lesions may be further damaged by excessive bicep exercises.
Arthroscopic SLAP tear surgery is the most common procedure used to correct labrum tears. As mentioned previously, there are many different types of SLAP tears, and as a result, there are numerous SLAP tear surgeries. For less complex slap tears, the procedure may simply involve debriding or removing frayed or loose tissues. Depending on the severity of the SLAP tear, your procedure may also involve removing or reattaching connective tissues.
Both nonsurgical and surgical SLAP tear treatment strategies will involve labrum tear physical therapy exercises. After SLAP tear surgery, your doctor will first immobilize the shoulder, elbow, and arm to allow the labrum to heal and prevent further injury. To accomplish this, you will wear a sling for a few weeks. This immobilization time may be longer or shorter depending on your specific SLAP tear. Once your doctor has assessed your SLAP tear recovery, he or she will then prescribe labrum tear physical therapy exercises to aid the healing process. SLAP tear physical therapy is designed to increase the overall range of motion and mobility of the shoulder joint, and then strengthen the surrounding muscles to prevent injury down the road. It may take four to six months for the injury to fully heal after shoulder surgery.
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