Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Surrounding the outside edge of the glenoid is a rim of strong, fibrous tissue called the labrum. The labrum helps to deepen the socket and stabilize the shoulder joint. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.
The labrum deepens the socket of the shoulder joint, making it a stronger fit for the head of the humerus.
The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP injury, the top (superior) part of the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint, is injured. A SLAP tear is when this superior labrum in the shoulder is torn. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.
This cross-section view of the shoulder socket shows a typical SLAP tear.
Injuries to the superior labrum can be caused by acute trauma or by repetitive shoulder motion. An acute SLAP injury may result from:
People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience SLAP tears as a result of repeated shoulder motion.
Many SLAP tears, however, are the result of wear and tear of the labrum that occurs slowly over time. In patients over 40 years of age, tearing or fraying of the superior labrum can be seen as a normal process of aging. This differs from an acute injury in a person under the age of 40.
Your doctor will take a detailed history of the mechanism of injury and medical history. Any work activities or sports that aggravate your shoulder are also important to mention, as well as the location of the pain, and what treatment, if any, you have had.
During the physical examination, your doctor will check the range of motion, strength, and stability of your shoulder.
He may perform specific tests by placing your arm in different positions to reproduce your symptoms. Your doctor may also examine your neck and head to make sure that your pain is not coming from a "pinched nerve". The results of these tests will help your doctor decide if additional testing or imaging of your shoulder is necessary.
The following tests will help in diagnosing a SLAP tear:
In many cases, the initial treatment for a SLAP injury is nonsurgical. Treatment options may include:
• Arthroscopic SLAP repair animation - http://www.youtube.com/watch?v=gfnkm0j9iQo
Arthroscopic shoulder surgery is recommended if your pain caused by a SLAP tear does not improve with nonsurgical methods. The surgical technique most used for repairing a SLAP injury is arthroscopy. During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments. Because the arthroscope and surgical instruments are thin, your orthopaedic surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.
There are several different types of SLAP tears. Dr van den Berg will determine how best to repair your SLAP injury once he or she sees it fully during arthroscopic surgery. This may require simply removing the torn part of the labrum, or reattaching the torn part using stitches. Some SLAP injuries and tears require cutting the biceps tendon attachment. Your surgeon will decide the best repair option based upon the type of tear you have, as well as your age, activity level, and the presence of any other injuries seen during the surgery.
Complications from shoulder arthroscopy are very rare. As with any surgery, however, there are some risks. These are usually minor and treatable. Potential problems with arthroscopy include infection, excessive bleeding, blood clots, shoulder stiffness, and damage to blood vessels or nerves. Dr van den Berg will discuss the possible complications with you before your operation.
At first, the repair needs to be protected while the Superior Labrum Anterior and Posterior heals. To keep your arm from moving, you will most likely use a sling for 4-6 weeks after surgery. How long you require a sling depends upon the severity of your injury.
Once the initial pain and swelling has settled down, your doctor will start you on a physiotherapy program that is tailored specifically to you and your injury. The therapy program focuses first on flexibility. Gentle stretches will improve your range of motion and prevent stiffness in your shoulder. As healing progresses, exercises to strengthen the shoulder muscles and the rotator cuff will gradually be added to your program. This typically occurs 4 to 6 weeks after surgery.
Your orthopaedic surgeon will discuss with you when it is safe to return to sports activity. In general, throwing athletes can return to early interval throwing 3 to 4 months after surgery.
Most patients report improved shoulder strength and less pain after surgery for a SLAP tear. Because patients have varied health conditions, complete recovery time is different for everyone.
In cases of complicated injuries and repairs, full recovery may take several months. Although it can be a slow process, following your surgeon's guidelines and rehabilitation plan is vital to a successful outcome.