SLAP TEARS: Tears of the Superior
Labrum of the Shoulder Joint
The shoulder is a ball and socket joint. The socket is made deeper by having a rim of fibrocartilage than runs around its periphery- this is known as the labrum. The biceps muscle has a tendon, known as the long head of biceps tendon that takes its origin off the superior aspect of the labrum and glenoid.
Normally the labrum is attached securely to the socket. Sometimes the labrum becomes detached. When this occurs at the superior labrum, it tears anteriorly and posteriorly and is known as a SLAP (Superior Labrum Anterior Posterior) Lesion. The tear can be extensive, or it can be small. Sometimes the tear extends into the biceps tendon. The condition can sometimes be associated with an unstable shoulder.
Detachments of the superior labrum can be a “normal” finding, usually in an older patient. They can, however cause pain and loss of function in the overhead athlete (e.g. tennis player, baseball pitcher), or in somebody who has sustained a forceful injury to their shoulder. It is very common in people who lift weights in the gym.
All patients should initially be managed with non-operative measures which include modification of activities, analgesics, physiotherapy, and sometimes steroid injections. If these measures fail, then surgery may be considered.
Surgery in the younger population (under 35 years) involves repairing the labrum back to the bone. It is best performed arthroscopically (minimally invasive techniques) using a camera through 1 cm wounds. Anchors are put into the bone which have sutures which then secure the labrum to the bone. Sometimes the long head of biceps tendon is also treated by cutting it off the labrum (tenotomy) and then securing it to a different bone (tenodesis).
Surgery to the labrum in older patients, is often unsuccessful because of issues with a degenerate labrum healing and because it can lead to significant shoulder stiffness (for unknown reasons). If older patients require surgery we generally address the biceps tendon, which in older patients is often the main cause of pain, by doing a biceps tenodesis, and we debride the degenerate and torn labrum.
Surgery is followed by 4-6 weeks in a sling, followed by physiotherapy to regain motion and then strength in the shoulder. Recovery following surgery is approximately 6 months. Post operative stiffness can be a problem in all ages, and sometimes necessitates physical therapy for over 12 months.
Patients are advised, following surgery, to modify their activities in the gym, and other activities that involve heavy overhead lifting.