Your Handy Guide to SLAP Tear Treatment

SLAP tears are a specific kind of shoulder injury that affects the cartilage inside the shoulder joint. They’re commonly seen in people who do a lot of overhead activity, whether in sport or manual work. The pain and limited movement they cause can interfere with everyday tasks and long-term shoulder health.

If you're someone dealing with unexplained shoulder pain, understanding the nature, treatment, and prevention of a SLAP tear is crucial for long-term shoulder health. For many years, less invasive treatments have been widely available for SLAP tears, including physiotherapy shoulder pain techniques. However, recognising when professional assessment is needed can make all the difference in preventing further damage. Let's learn more about these below.

What Is the SLAP?

SLAP stands for Superior Labral Anterior Posterior. This refers to an injury affecting the superior labrum, which is the cartilage rim attached to the shoulder socket (glenoid). The term “anterior posterior” indicates that the tear runs from the front (superior labrum anterior) to the back (posterior) of this labrum area. This spot also happens to be the attachment point for the biceps tendon, which plays a key role in stabilising the shoulder joint.

SLAP Tear Definition

A SLAP tear, also called a SLAP lesion, is a tear of the cartilage surrounding the upper arm bone part of the shoulder socket. It typically occurs where the biceps tendon connects to the glenoid labrum, the ring of cartilage that deepens the socket for the ball and socket joint of the shoulder. A SLAP injury may involve the labrum alone or also the biceps tendon and surrounding soft tissue.

Also known as labrum tears, this condition represents up to 8% of shoulder injuries. It’s especially common in athletes who engage in repetitive overhead movements, such as swimming, tennis, or basketball. However, SLAP tears can also affect non-athletes, particularly those who perform heavy lifting or have experienced a sudden fall or forceful movement.

Types of SLAP Tear

SLAP tears come in several forms, but the most common ones are classified into four main types based on the extent and location of the tear within the superior labrum anterior and posterior area of the shoulder joint. Below is a more detailed breakdown of each type:

1. Type I: Fraying or degeneration of the superior labrum, but the labrum remains attached to the underlying bone. This type is often degenerative and more common in older adults.
2. Type II: The labrum and the biceps tendon are torn from the shoulder socket. This is the most common type of SLAP tear and often occurs due to a shoulder dislocation or injury.
3. Type III: A bucket-handle tear of the labrum, where a portion of the labrum is detached and can become trapped within the shoulder joint. This type can cause symptoms like clicking, popping, or locking in the shoulder.
4. Type IV: A bucket-handle tear that extends into the long head of the biceps tendon. This tear is often associated with shoulder instability and may require surgical repair.

What Causes a SLAP Tear?

A SLAP tear can result from either an acute injury or repetitive overhead movements. Common causes include:

• Falling on an outstretched arm
• Lifting objects with force or jerking motions
• Throwing athletes using repetitive shoulder motion
• Overhead athletes like swimmers, tennis players, or weightlifters
• Sudden shoulder dislocation

Older patients may also experience SLAP tears due to general wear and degeneration.

Symptoms of a SLAP Tear

SLAP tear symptoms can vary widely depending on the severity and location of the tear, as well as individual factors. They can be subtle or even absent in some cases. While some people experience distinct symptoms like pain, clicking, or popping during shoulder movements, others may have minimal or no noticeable symptoms, especially with smaller or less severe tears.

However, common symptoms that can suggest a SLAP tear include:

• Deep, aching shoulder pain
• Reduced range of motion and external rotation
• Popping, clicking, or grinding in the shoulder joint
• Pain during overhead activities or lifting weights
• Chronic shoulder pain that doesn’t respond to rest
• Weakness or instability in the shoulder muscles

The symptoms of a SLAP tear can sometimes be similar to those of other shoulder conditions, such as rotator cuff tears or tendonitis, which can make diagnosis more challenging.

Diagnosing a SLAP Tear

Due to the variability of symptoms, a physical exam and imaging tests, like MRI or arthroscopy, are often necessary to confirm a SLAP tear diagnosis. The process typically involves a combination of patient history, where a doctor may perform specific movement tests to detect pain or weakness in the affected shoulder. Imaging, particularly magnetic resonance imaging (MRI), often with contrast dye, helps confirm if there is a torn labrum or damage to the biceps tendon.

SLAP tear diagnosed in athletes or individuals with shoulder problems is often confirmed after ruling out similar conditions like rotator cuff tears or biceps tendonitis.

Treatment for a SLAP Tear

Treatment depends on the severity of the tear, the patient’s age, activity level, and whether the tear is from an injury or overuse. Options range from nonsurgical treatments to surgical treatment in more complex cases.

Medications and Injections

For many, initial management includes:

• Nonsteroidal anti-inflammatory medications (NSAIDs) to relieve pain
• Corticosteroid injections for reducing inflammation and improving movement

These treatments help manage tear symptoms and support healing in minor or stable tears.

Physiotherapy

Physical therapy is a cornerstone for recovery, especially in mild to moderate tears. Experienced physical therapists at Phoenix Rehab provide personalised treatment and targeted exercises that focus on:

• Strengthening the shoulder muscles
• Improving range of motion
• Reducing strain on the biceps muscle and glenoid labrum
• Enhancing shoulder stability through targeted exercises

It is especially effective for a shoulder labral tear caused by repetitive motion or age-related degeneration.

Arthroscopic Surgery

If conservative care fails or the tear is severe, slap tear surgery may be needed. Surgeons use miniature surgical instruments in an arthroscopic procedure to:

• Trim or remove the torn tissue
• Perform a SLAP repair by reattaching the labrum and biceps tendon
• Sometimes, perform a biceps tenodesis (reattaching the biceps outside the labrum)

Surgery is more common in young, active individuals or when the tear results in persistent chronic pain or shoulder instability.

Recovery Time for a SLAP Tear

Recovery time depends on treatment type and tear severity. It can take several months, with a full return to pre-injury activity typically requiring 6-12 months. Initial recovery, including wearing a sling and limited movement, can take 4-6 weeks. Gradual strengthening and increased activity can begin after that, with full recovery and return to sports-specific activities generally taking 3-6 months.

The rehabilitation process involves:

• Gradual return of motion
• Progressive strengthening
• Delayed return to sports or overhead work

Following through with therapy is key to regaining shoulder strength and function.

Preventing SLAP Tears

While not all SLAP tears are preventable, these steps reduce your risk:

• Warm up properly before repetitive overhead activities
• Avoid sudden, jerking movements with the shoulder
• Strengthen the rotator cuff and scapular stabilisers around the shoulder blade
• Maintain a good range of motion in the shoulder joint
• Use proper form during sports or when lifting weights

Overuse remains a significant risk, particularly for athletes who throw or manual workers. Early intervention in minor shoulder injuries can prevent further damage.

Conclusion

A SLAP tear, or superior labral anterior posterior injury, can be a significant source of shoulder pain and dysfunction, especially if left untreated. Early diagnosis, the right treatment, whether conservative or surgical, and a focused recovery plan are essential to getting back full shoulder strength and avoiding long-term shoulder problems. You can manage a SLAP lesion effectively and return to your normal routine with confidence as long as you stay informed and proactive.