Labral SLAP Tears

Impact of SLAP Tears On Anatomy and Health

SLAP tears can impact your anatomy and health in several ways:

• Shoulder Stability: The labrum helps to stabilise the shoulder joint. A SLAP tear can lead to a feeling of shoulder instability.
• Range of Motion: SLAP tears can limit your shoulder range of motion, particularly in activities that involve overhead movements or rotating the arm.
• Strength and Function: SLAP tears can cause weakness in the shoulder, making it difficult to perform certain movements or tasks that require strength and stability, such as lifting heavy objects or participating in sports activities.
• Pain and Discomfort: SLAP tears often result in persistent shoulder pain, especially when performing certain movements or during specific activities. The pain may be located deep within the shoulder joint and accompanied by a catching or popping sensation.
• Impaired Performance: Athletes or individuals who engage in repetitive overhead motions, such as baseball pitchers or weightlifters, may experience a decline in their performance due to the limitations and pain associated with a SLAP tear.

Who is Most at Risk for SLAP Tears?

Regarding the risk factors for SLAP tears, certain groups of people may be more susceptible to these injuries:

• Athletes: Overhead athletes involved in sports like baseball, tennis, swimming, or volleyball, which require repetitive shoulder motions, are at higher risk due to the strain placed on the shoulder joint.
• Weightlifters: Individuals who frequently perform weightlifting exercises, particularly those involving overhead presses or heavy loads, are prone to developing SLAP tears.
  
• Age: SLAP tears can also occur due to age-related degeneration and wear and tear on the shoulder joint, making older individuals more susceptible.

What are the Causes of SLAP Tears?

Some common causes include

• Repetitive Overhead Motions: Activities or sports that involve repetitive overhead movements, such as throwing, swimming, or serving a tennis ball, can gradually wear down the labrum and lead to a SLAP tear.
• Trauma or Injury: Sudden trauma or injury to the shoulder joint, such as a fall onto an outstretched arm or a direct blow to the shoulder, can cause a SLAP tear.
• Degenerative Changes: The natural ageing process can lead to degeneration of the shoulder joint, including the labrum, making it more susceptible to tears, even with minor trauma or regular activities.

What are the symptoms of SLAP tears?

Common symptoms include:

• Shoulder Pain: Persistent pain in the shoulder joint, often deep within or at the front of the shoulder, especially during specific movements or activities.
• Catching or Popping Sensation: Some individuals may experience a catching or popping sensation in the shoulder joint during certain movements.
• Weakness or Instability: A feeling of weakness in the shoulder, difficulty performing certain movements, or a sense of the shoulder "giving way".
• Decreased Range of Motion: Limited range of motion in the shoulder, particularly during activities that involve overhead motions or rotating the arm.
• Clicking or Grinding Sounds: Some individuals may hear clicking, grinding, or popping sounds when moving the shoulder.

Types of SLAP Tears

• Type I SLAP Tears involve fraying or degeneration of the superior labrum but no true tear. The labrum may show signs of wear and tear, but it remains intact.
• Type II SLAP Tears are the most common and well-known type. They involve a tear that extends from the superior labrum to the biceps tendon attachment. This type typically occurs when the biceps tendon is pulled or yanked forcefully.
• Type III SLAP Tears involve a bucket-handle tear of the labrum without involving the biceps tendon. In this type, a portion of the labrum is detached and flips into the joint, creating a "bucket-handle" appearance.
• Type IV SLAP Tears are a combination of a SLAP tear and a tear of the biceps tendon. The tear extends through the labrum and involves the biceps tendon as well.

How are SLAP tears diagnosed?

An orthopaedic surgeon typically performs a comprehensive evaluation to diagnose a SLAP tear. The diagnostic process may include:

• Medical History: The surgeon will ask about your symptoms, previous shoulder injuries, and activity level.
• Physical Examination: The surgeon will examine your shoulder, checking for signs of tenderness, instability, range of motion limitations, and specific tests to reproduce or assess the symptoms associated with SLAP tears.
• Imaging Tests: Various imaging tests may be used to visualise the shoulder joint and confirm the diagnosis. These may include:
• X-rays: X-rays will be taken to rule out other shoulder conditions or detect any associated bony abnormalities.
• Magnetic Resonance Imaging (MRI): An MRI scan can provide detailed images of the soft tissues, including the labrum, allowing the doctor to assess the location and severity of the tear.
• Magnetic Resonance Arthrography (MRA): This MRI scan involves injecting a contrast dye into the shoulder joint before imaging. It enhances the labrum's visibility and can help accurately identify SLAP tears.
• Computed Tomography (CT) Scan: CT scans can provide detailed images of the bony structures of the shoulder joint and may be used to assess any associated bony abnormalities.
  

Treatment Options for SLAP Tears

The treatment approach for SLAP tears may include the following:

• Conservative Treatment: In cases where the SLAP tear is small or not causing significant symptoms, conservative measures may be recommended. These include rest, activity modification, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation, and exercises to strengthen the surrounding muscles and improve shoulder stability.
• Arthroscopic Repair: Surgical intervention may be necessary for more severe or symptomatic SLAP tears. Arthroscopic surgery is a minimally invasive procedure using small incisions and specialised instruments. The surgeon repairs or reattaches the torn labrum during the surgery using suture anchors.
• Biceps Tenodesis: In some cases, if the biceps tendon is significantly involved or the tear is complex, the surgeon may perform a biceps tenodesis. This involves detaching the biceps tendon from its attachment to the labrum and attaching it to another location, typically on the humerus bone.
• Rehabilitation: A rehabilitation program is crucial for a successful recovery following surgery. Physical therapy will focus on restoring the range of motion, strengthening the shoulder muscles, and gradually returning to normal activities or sports.

What if SLAP Tears are Untreated?

If left untreated, SLAP tears can lead to persistent pain, weakness, and instability in the shoulder joint. It may affect daily activities, sports performance, and overall quality of life. Additionally, untreated SLAP tears can increase the risk of further damage, such as worsening of the tear, which may necessitate more extensive treatment or surgery.

It is important to consult with an orthopaedic surgeon for an accurate diagnosis and to discuss the appropriate treatment options for your condition. They can guide the best action to manage the SLAP tear effectively and promote optimal recovery.