Labral Tears

A superior labrum anterior and posterior (SLAP) tear is an injury to the labrum of the shoulder, which is a ring of cartilage that surrounds the socket of the shoulder joint. The shoulder is a ball-and-socket joint, which means the ball of the upper arm fits into a shallow socket in your shoulder blade.

This socket is called the glenoid and is surrounded by a rim of strong, fibrous tissue called the labrum. The labrum stabilizes the shoulder joint and serves as an attachment point for many of the ligaments in the shoulder as well as one of the tendons from the biceps muscle in the arm. In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A labral tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury as well.  Labral tears can be caused by acute trauma or by repetitive shoulder motion, including: a car accident, a fall on an outstretched arm, forceful pulling on the arm, rapid or forceful movement of the arm when it is above the level of the shoulder and a shoulder dislocation.

Labral (SLAP) Tear Symptoms

• A sensation of locking, popping, catching or grinding
• Pain with movement of the shoulder or holding the shoulder in specific positions
• Pain with lifting objects, in particularly overhead
• Decrease in shoulder strength
• A feeling that the shoulder is going to “pop out of the joint”
• Decreased range of motion

There are several treatment options and the best option depends on the patient. Your physician will consider your age, activity level, general health and type of tear you have before deciding on the best treatment plan for you.

Conservative treatment options are often successful in managing labral tears. 

Nonsurgical options include:

• Non-steroidal anti-inflammatory medicine such as ibuprofen
• Physical therapy and range-of-motion exercises
• Rest from repeated and overhead motion of the shoulder

In some instances SLAP tears cause persistent pain and impact work, sport, or general daily activity.  If conservative options are exhausted with poor result; surgery may be necessary. Surgery is performed arthroscopically with small incisions. The labrum is evaluated arthroscopically to confirm the tear. The bone that the labrum attaches to is prepared to promote healing. Anchors, with high strength sutures in them, are then placed in to the top (superior) aspect of the glenoid (socket). The sutures are then passed underneath the torn labrum and knots are tied on the soft tissue side to secure the labrum to the bone.

Another option for surgery is a biceps tenodesis. The long head of the biceps tendon inserts onto the superior labrum and ‘pulls’ on it with overhead and rotational movements of the shoulder. The biceps tendon can be released from its insertion on the labrum and ‘tacked’ down (tenodesed) at a different location. This eliminates the ‘pull’ on the labrum and alleviates pain.