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slap tear

Arthroscopic image of a SLAP tear vewing from the posterior portal of a left shoulder with the patient lying on their right side. The superior labrum and biceps tendon are detached from the superior glenoid (socket) and the underlying tissue is red and frayed.

What is a SLAP tear?

A SLAP - or Superior Labrum Anterior-to-Posterior – tear is an injury to the fibrocartilage labrum that surrounds the glenoid (socket) in the shoulder. SLAP tears occur at the upper part of the labrum, where the biceps tendon attaches (see figure to right). As a result, both the labrum and biceps tendon are often involved in the injury.

What causes a SLAP tear?

SLAP tears can be caused by either a traumatic injury or by repetitive overhead activity. Traumatic SLAP tears are thought to result from either a traction mechanism, such as a sudden pull on the arm, or a compression mechanism, such as a fall onto the outstretched arm.

What are the symptoms of a SLAP tear?

Pain is the most common symptom. However, the location of the pain is variable and may be located in the back, top, or front of the shoulder. The pain is typically made worse by overhead activity and roughly 50% of people with SLAP tears admit to experiencing mechanical symptoms such as catching or grinding.

A second set of symptoms is seen in people participating in repetitive overhead activities – classically the overhead or throwing athlete. These athletes experience a decline in performance associated with activity related shoulder pain. Throwers may experience “dead arm syndrome”, which is characterized by pain with attempted throwing as well as a decline in throwing velocity.

What is the treatment for SLAP tear?

Treatment begins with activity modification to avoid aggravating activities, anti-inflammatory medication to reduce shoulder inflammation, and sometimes physical therapy to improve shoulder mechanics. In overhead athletes, rest from throwing combined with physical therapy aimed at improving throwing mechanics, muscle balance, and internal rotation range of motion often leads to symptomatic relief. When non-surgical treatments fail to provide adequate relief, arthroscopic SLAP repair or biceps tenodesis may be indicated.