1. SLAP Tear Is a Newer Diagnosis
The shoulder is like a ball (humeral head) on a plate (glenoid portion of shoulder blade). Because of this, the shoulder is inherently an unstable joint. Additional stability is imparted by the labrum, an O-ring of tougher cartilage surrounding the glenoid. This gives the glenoid some more depth and curvature, which helps prevent dislocations. The long head of the biceps tendon attaches to the top of the glenoid. This helps push the humeral head down and is a stabilizer of the joint. Subtle tears in the superior (upper) portion of the labrum began to be noticed with the advent of shoulder arthroscopy. In 1984, Andrews described labral tears in overhead athletes. In 1990, Snyder described a pattern of injury involving the superior labrum, and he coined the term SLAP tear.
2. SLAP Stands For "Superior Labrum, Anterior and Posterior"
The biceps attaches to the superior labrum. If the glenoid were a clock face, the biceps attaches at the 12 o'clock position. SLAP tears involve the superior labrum, both anterior and posterior to the biceps anchor. That would be 10 o'clock to 2 o'clock. They usually occur in overhead athletes and weightlifters with repetitive use. They also can occur with acute trauma, such as falling on an outstretched hand, lifting heavy objects overhead, reaching out to grab something to keep from falling and banging into the side of the shoulder.
3. At Least Seven Types of SLAP Tears Exist
Snyder originally described four types of SLAP tears. Now there are at least seven different types of SLAP tears described, involving more of the labrum and biceps tendon.
4. The Diagnosis Is Difficult to Make
A SLAP tear diagnosis is based on physical examination and imaging, including CT or MRI, with or without an injection of contrast. This being said, the diagnosis is still difficult to make. The doctor may move your arm into certain positions to see if he can elicit pain. The doctor may choose to obtain further studies, sometimes with an injection of contrast dye into the shoulder joint itself. Despite this, it is difficult to tell for certain if there is a SLAP tear, even on MRI. The reason for this is that there is quite a bit of variation in that particular area. What looks like a tear, may be an normal anatomic variation and vice versa. The final diagnosis of a SLAP tear occurs during surgery.
5. Some SLAP Tears Improve With Rest and Physical Therapy; Others Require Surgery
Rest and a trial of anti-inflammatory medications can calm down the symptoms. Physical therapy can strengthen the muscles around the shoulder. If these fail, then arthroscopic surgery may be needed. Through the scope, the surgeon can confirm the diagnosis and repair the SLAP lesion. Sometimes, smaller tears can be debrided or cleaned up. Larger, unstable tears may need to be repaired through the use of anchors into the glenoid bone. Usually, you will be in a sling for about four weeks. It takes about four to six months before the shoulder is fully healed.
