What are the other Names for this Condition? (Also known as/Synonyms)

• Shoulder Labrum Tear
• SLAP Lesion
• Superior Labrum Anterior and Posterior Tear 

What are SLAP Tears? (Definition/Background Information)

• The shoulder joint is made up of three different bones: The shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus)
• The humerus fits into a socket within the shoulder blade, called the glenoid
• SLAP Tears is an injury to the top part of the shoulder joint called the labrum. The word ‘SLAP’ denotes “Superior Labrum Anterior and Posterior”. SLAP Tears occur in both the front (anterior) and back (posterior) of the labrum
• SLAP Tears are very painful injuries and may be the result of any sudden or violent physical activity, or due to overuse of the shoulder. This may include normal daily activities that require repetitive use of the shoulder muscles, or participation in any athletic sports
• In many cases, SLAP Tears can be treated non-surgically. However, surgery is recommended if an individual does not respond to conservative treatment methods
• The prognosis of SLAP Tears is usually excellent with appropriate treatment 

Depending on the severity of the injury, physicians usually classify SLAP Tears into four different types. These types include: 

• SLAP Tears Type I: Type I is the partial tear and degeneration of the top part of the labrum
• SLAP Tears Type II: The most common type of SLAP Tear, it involves the top part of the labrum that is completely torn-off the glenoid. This mainly occurs as the result of an injury, such as a dislocated shoulder. Additionally, SLAP Tears Type II can also be subdivided into anterior, posterior, and combined anterior-posterior tears
• SLAP Tears Type III: It is characterized as a bucket-handle tear of the labrum without the bicep attachment. The treatment usually involves an arthroscopic surgery
• SLAP Tears Type IV: Also characterized as a bucket-handle tear of the labrum that extends into the biceps tendon. Arthroscopic surgery can treat this type of SLAP Tear by reattaching the labrum, repairing a biceps tear, or a biceps tenodesis 

Who gets SLAP Tears? (Age and Sex Distribution)

• SLAP Tears may occur in individuals of all age, race, ethnic groups, or gender
• Individuals performing certain occupations, such as construction workers, athletes participating in overhead sports, such as baseball and cricket, all involving repetitive motions, are at an increased risk of this shoulder injury type
• In individuals over the age of 40 years, a superior labrum tear is believed to be the normal result of aging. This condition is different from an acute traumatic injury that takes place in individuals under 40 years old 

What are the Risk Factors for SLAP Tears? (Predisposing Factors)

Common risk factors of SLAP Tears include: 

• Individuals who participate in sports that require a lot of repetitive shoulder movements, such as baseball, tennis, weightlifting, golf, cricket, etc. have a higher risk of sustaining a SLAP Tear
• Occupations that involve a lot of physical activities (heavy lifting, handling of machines/equipment), such as construction and industrial work 

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of SLAP Tears? (Etiology)

SLAP Tears may occur due to a sudden violent physical activity, or due to the gradual wear and tear of the muscles and cartilage, caused by overuse. A few causal factors include: 

• Individuals participating in certain sports activities that require a set of repetitive movements for prolonged periods, such as baseball or tennis
• Direct trauma to the shoulder associated with an automobile accident
• Sudden lifting or pulling: Use of a sudden force to pull or grab an overhead object can cause a SLAP Tear, by putting a tremendous amount of stress on the tissues surrounding the shoulder joint
• A shoulder dislocation
• A direct fall onto the shoulder, or falling with an outstretched arm, are some of the other causes of SLAP Tears 

What are the Signs and Symptoms of SLAP Tears?

The symptoms of SLAP Tears are usually mild at the beginning and do not warrant immediate medical attention. There could be a noticeable pain associated with activities that involve lifting the arms above one’s head/shoulder. 

The signs and symptoms of SLAP Tears include: 

• Feeling of ‘looseness’ in the shoulder
• Limited range of motion in the shoulder
• A popping, locking, grinding, or catching sensation in the shoulder
• Reduced strength in the shoulder
• Weakness, loss of shoulder strength
• In baseball pitchers (or cricket bowlers), there may be a noticeable decrease in throwing velocity, or dead arm feeling after pitching (or bowling) 

How are SLAP Tears Diagnosed?

Some of the tests a physician may use to help diagnose SLAP Tears include:

• Physical examination: During the physical examination, the physician will examine an individual’s range of motion, strength, and stability of the shoulder. The physician may also check the head and neck to rule out pain associated with a “pinched nerve”. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
•  X-ray of the shoulder: SLAP Tears are soft tissue injuries and hence, they do not show up on X-rays. However, a physician may order an x-ray to rule out other possible causes of shoulder discomfort, such as fracture or arthritis
• Magnetic resonance imaging (MRI) of the shoulder: An MRI is a more detailed scan that uses radio waves and strong magnetic fields to produce clearer images of the labrum. Before the scan is taken, a dye may be injected into the shoulder, which allows the physician to obtain a clearer image of a labrum tear 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of SLAP Tears?

Some of the complications associated with SLAP Tears include:

• Degenerative joint disease (osteoarthritis)
• Prolonged and chronic pain
• Shoulder instability or shoulder dislocation
• Frozen shoulder (adhesive capsulitis), if left untreated
• Recurrence of injury
• Severely limited range of motion in the shoulder 

How are SLAP Tears Treated?

In many cases, SLAP Tears can be treated using non-surgical conservative measures. However, surgery is recommended, if an individual does not respond to non-surgical treatments.

Nonsurgical treatments for SLAP Tears include: 

• Any activity that further aggravates the shoulder condition should be avoided. The physician usually recommends refraining from all such activities, until the symptoms get better
• Applying ice to the shoulder/arm can help reduce pain and swelling
• Certain medications, such as ibuprofen and naproxen, can help reduce mild to moderate pain, within the shoulder
• After the signs and symptoms have decreased, it is important to begin some light motion exercises. Physical therapy may help restore strength, as well as improve flexibility, in the muscles
• If conservative measures (rest, medications, and physical therapy) do not relieve pain, a localized anesthetic or cortisone injection can help reduce inflammation and relieve pain 

Surgical treatments for SLAP Tears include: 

• Shoulder arthroscopy: Arthroscopic surgery is a minimally invasive surgical procedure that is used to visualize, diagnose, and repair the shoulder joint using small instruments. During this procedure, a surgeon inserts a thin tube attached to a camera (a fibro-optic camera) into the joint via a small incision on the skin of the joint. Visualizing the joint via a camera helps the physician view the inside of the shoulder and to determine the treatment and also repair the labrum

Many orthopedic surgeons prefer to treat SLAP Tears with arthroscopy instead of an open surgery, due to shorter recovery times and the involvement of less pain.

How can SLAP Tears be Prevented?

In individuals with a history of SLAP Tears, a daily stretching exercise program may help reduce the chances of its recurrence. It is also important to incorporate exercises into one’s activities to help strengthen the shoulder and shoulder muscles. 

A few prevention techniques for SLAP Tears may include: 

• Avoid any repetitive lifting or pulling of objects (especially overhead) that are heavy
• In sports, learn the correct techniques and avoid poor (overhead) throwing practices 

What is the Prognosis of SLAP Tears? (Outcomes/Resolutions)

• Individuals with SLAP Tears, usually make a full recovery, if correct physical therapy is administered
• However, those with more severe conditions may experience recurrence of the symptoms, even after physical therapy has been completed. The duration for a complete recovery may be prolonged in such cases
• After surgery, individuals can expect to wear a sling for 2 to 4 weeks. However, many sportspersons or athletes require 6-12 months to recover fully from a SLAP Tear 

Additional and Relevant Useful Information for SLAP Tears:

The biceps tendon is attached to the top part of the shoulder joint (the labrum). A SLAP Tear may also cause the biceps tendon to be injured.