The labrum is a fibrocartilaginous tissue that circles the peripheral rim of the glenoid (socket of the shoulder). It serves as the attachment site for the shoulder capsule and ligaments that run between the humeral head (ball) and glenoid (socket) to provide stability. The long head of the biceps tendon also attaches to the superior (upper) bony glenoid through the superior labrum.
Injury to the superior labrum is called a SLAP lesion (tear), which stands for Superior Labrum, Anterior to Posterior (front to back). A SLAP tear may involve degenerative (wear and tear) fraying, a split in the labrum, or complete separation of the labrum from the bony glenoid, with or without damage to the biceps tendon attachment. Superior labral separations may also cause some shoulder instability.
Superior labral tears can be difficult to see on MRI and are sometimes only found during arthroscopic surgery.
What Is SLAP Tear Repair?
SLAP tear repair is performed arthroscopically using a camera through very small incisions, or portals.
Surgery may involve debriding, or cleaning and removing, torn labral pieces and torn fragments that are not detached from the bone, or repairing the separated labrum back to the glenoid (socket).
Repair of the labrum is performed by placing absorbable suture anchors in the superior (upper) bony glenoid. Sutures connected to the anchors are passed through the torn portion of the labrum and tied to secure the labral tissue back against the bone.
Superior labral tears often affect the attachment of the proximal long head of the biceps tendon. Repairing the biceps further down along its course just below the shoulder, called a biceps tenodesis, may also be required.
Causes and Risk Factors
Causes of a SLAP tear include:
- Repetitive throwing or overhead hitting motion
- Falling onto an outstretched arm
- Pulling the arm backward when overhead
- Sudden force applied to the biceps while contracted
- A direct blow to the shoulder with the arm in a throwing position
Risk factors include:
- Contact sports, such as wrestling and football
- Overhead sports, such as baseball, tennis, and volleyball
- History of shoulder dislocation, subluxation, or injury
- Increasing age
- Poor physical conditioning, including strength and flexibility
- Inadequate warm-up before practice or play
Symptoms
Frequent signs and symptoms include:
- Shoulder pain that is worse with overhead activities, especially with the arm in the late cocking phase of throwing
- Usually no pain at rest
- Intermittent mechanical symptoms such as locking, clicking, or snapping associated with pain
- Loss of velocity and accuracy when throwing in pitchers
Treatment
Following an acute shoulder injury with a history and physical findings consistent with a SLAP lesion, conservative treatment with physical therapy is often needed to help determine whether symptoms are caused by a milder sprain or strain or an actual SLAP tear.
After four to six weeks of proper shoulder therapy, most milder sprains or strains that do not require surgery will improve, while actual SLAP tears may continue to cause symptoms and pain with specific physical examination tests.
Arthroscopic surgery is recommended if symptoms persist despite non-operative treatment. Surgery may involve debriding torn labral tissue or repairing the separated labrum back to the glenoid.
Repair is performed using absorbable suture anchors placed in the superior bony glenoid. Sutures attached to the anchors are passed through the torn labrum and tied to secure it back against the bone.
If the superior labral tear affects the attachment of the proximal long head of the biceps tendon, a biceps tenodesis may also be required.
Recovery and Outcomes
If the labrum is repaired, immobilization in a sling is required for six weeks to allow it to heal back to the glenoid. After surgery and immobilization, physical therapy is recommended to regain shoulder motion, strength, and function.
Labral tears do not heal by themselves because of their limited blood supply and continued motion of the torn portion. Following surgical treatment, the lesion often heals and symptoms improve dramatically.
Potential complications include:
- Recurrence of symptoms, especially if activity is resumed too soon
- Failure of the SLAP repair to heal
- Infection
- Bleeding
- Injury to nerves
- Shoulder stiffness
- Shoulder and elbow weakness
- Inability to repair the labral tear
- Re-tearing of the repaired labrum
- Post-traumatic arthritis
- Prolonged recovery for overhead athletes, especially throwers
- Persistent symptoms
When to See Dr. Chudik
If shoulder symptoms persist despite non-operative treatment, schedule an evaluation with Dr. Chudik.