Shoulder Anatomy

The shoulder joint is a ball and socket joint. It is made of the ball is the head- of the upper arm bone (the humerus), which fits into the socket of the shoulder blade (the scapula). However, the head of the upper arm bone is four times larger than the socket which is shallow. The socket is surrounded by a rim of cartilage called the labrum, which doubles the depth of the socket for joint stability. The labrum also functions like a gasket sealing the joint and a bumper to keep the head of the upper arm bone in the socket, and an anchor for the biceps’ tendon.

The top of the shoulder labrum is a common site for injury and degeneration, which can cause pain and disability. The superior labrum plays an important role in shoulder stability.

What is a SLAP tear?

Superior Labrum Anterior to Posterior (SLAP) is injury to the top of the labrum where the biceps tendon attaches to the labrum, causing a tear or detachment of the labrum. The biceps tendon may also be injured.

A SLAP lesion is a common shoulder injury especially in overhead athletes. However, superior labral tears are often asymptomatic in overhead throwers and Major League Baseball team physicians consider superior labral tears to be adaptive changes! Still SLAP tears can cause instability in overhead athletes. In addition, a high incidence of SLAP lesions develops in the 30 – 40-year-old population due to normal aging.

The two most common types of SLAP tears are:

• Type I is fraying at the top of the rim due to the normal aging process
• Type II is the most common and involves injury to the labrum and biceps tendon.

What causes a labral tear?

• High energy injury from an auto accident
• Shoulder dislocation
• A fall on an outstretched arm
• Forceful movement of the arm when it is above the shoulder
• Repetitive use over time from throwing and overhead sports (throwing sports and weightlifting)
• Normal aging can cause the labrum to wear out fray or tear

What are the symptoms of a labral tear?

Deep shoulder pain is commonly felt at the back of the shoulder. In a type II tear where the biceps tendon is detached the pain may be felt at the front of the shoulder

• Deep shoulder pain
• Pain with certain movements such as lifting overhead, throwing a ball, or hitting a ball
• A sensation of catching, locking, and grinding in the joint
• Impaired sports performance
• Loss of strength
• Reduced range of motion makes it a challenge to reach or throw or engage in any overhead activity
• Lifting and throwing movements aggravate the symptoms

How is a SLAP tear diagnosed?

An orthopedic surgeon will conduct a physical exam, and imaging studies to diagnose the tear.

What are the treatment options for a SLAP tear?

The goal of treatment is to relieve shoulder pain associated with inflammation and tendon wear due to injury, overuse, or aging. Initial treatment is conservative, nonsurgical management that involves the use of over-the-counter anti-inflammatory pain medications to treat pain and swelling, rest, activity modification, eliminating pain from throwing activities, and physical therapy. Physical therapy is designed to help retore function and strength. In many cases, conservative treatment is successful in treating symptoms and restoring function.

When conservative measures are not successful at resolving symptoms, labral repair and biceps surgery are routine arthroscopic operations for SLAP lesions. Labral repair is arthroscopic surgery to remove the torn part of the labrum or reattaching it with sutures.

Physical therapy after labral repair is performed in stages.

• Stage one begins seven days after surgery and lasts 4-6 weeks. The goal is protection of the shoulder repair with a sling, activation of the shoulder’s stabilizing muscles; and control of pain and swelling.
• Stage two begins at six weeks and lasts for twelve weeks after surgery. Discontinue sling support. The goal is to restore full active and passive range of motion, rehabilitate rotator cuff strength, strengthen shoulder blade muscles, and begin to use the arm for daily activities.
• Stage three begins at ten weeks after surgery. The goals are restoration of full range of motion and rotator cuff strength.
• Stage four is focused on strength, mobility, and stability. In addition to therapeutic exercises, sports-related activities like a throwing program, overhead racquet program and or return to swimming may be recommended.
• Stage five is to begin active return to activity.

Physical therapy is vital to recovery. Complete healing and recovery can take six months.

At CAO sports performance we offer athlete rehabilitation, performance enhancement, and injury prevention-based and evidence-based therapy, individualized to your needs and goals. Contact us to schedule an appointment to discover how physical therapy can relieve your pain, improver your movement and recover after surgery. We have offices in Leonardtown, Waldorf and California, Maryland for your convenience.