What Is a Labrum SLAP Tear?
A labrum SLAP tear is a tear in the cartilage that is part of your shoulder joint.
A labrum is a rim of cartilage that goes around the socket part of a ball-and-socket joint. In your shoulder, this is called the glenoid labrum. You also have a labrum in each hip joint.
Your shoulder has three bones: the scapula (shoulder blade), humerus (upper arm bone), and clavicle (collarbone). They work together in a ball-and-socket joint where your arm connects to your trunk.
Your labrum is soft tissue that connects the socket part of the scapula (called the glenoid) with the head of the humerus. A tear in the labrum results in insufficient cushioning between those bones.
What Does SLAP Stand For?
SLAP stands for Superior Labrum Anterior and Posterior. In this acronym, “superior” means top, so the top of your labrum is torn in this injury. “Anterior" means the front, and "posterior” means the back, so the tear extends from the front of the labrum (closer to your chest) to the back. This part of the labrum is also attached to your biceps tendon, which connects your biceps muscle to your shoulder.
There are different kinds of labrum tears. A SLAP tear occurs in the top part of your labrum, but a Bankart tear is in a different area of the labrum and usually happens after a shoulder dislocation.
What Causes Labrum SLAP Tears?
There are three ways your labrum can tear:
Overuse. Anyone who moves their shoulder the same way over and over can tear their labrum. You might repeat an overhead motion at work or during sports or exercise. Athletes who repeat this overhead motion, such as baseball and volleyball players, may be prone to SLAP tears.
Injury. When you slip, it's normal to stretch out your arm to break the fall. The impact on your extended arm can cause a labrum SLAP tear. You can also tear your labrum in a car wreck, by dislocating your shoulder, or while doing something that pulls hard on your arm.
Wear and tear. Car tires get worn down when you put a lot of miles on them, and so does your labrum. Day in and day out, your labrum does a lot of work. If you're 40 or older, it’s a common issue.
Labrum SLAP Tear Symptoms
The pain from a SLAP tear may be either a dull ache or a sharp pain that you feel deep in your shoulder. A labrum SLAP tear may not hurt all the time.
Symptoms of a SLAP tear include:
- Pain when you reach your arm up or make an overhead motion
- Pain when you lift something
- A feeling like your shoulder might pop out of its socket
- A catching, locking, or grinding feeling
- An unstable feeling in your shoulder
- Loss of shoulder strength
- Reduced range of motion in your shoulder
If your biceps tendon is also injured, you might feel pain in the front of your shoulder.
SLAP Tear Classifications
SLAP tears are labeled or classified by type. The first four types are the ones that were documented originally, and the others were added later. The types of labrum SLAP tears are:
- Type 1. The labrum is fraying or torn, but the biceps tendon is intact.
- Type 2. The labrum is torn and the biceps tendon is injured. This is the most common type. (Type 2 includes multiple subtypes.)
- Type 3. This is called a "bucket handle" tear because part of the torn labrum hangs down into the joint. The biceps tendon is intact.
- Type 4. It's a bucket-handle tear, with the tear extending to the biceps tendon.
- Type 5. A type 2 tear plus a Bankart tear.
- Type 6. A type 2 tear plus a flap of torn tissue.
- Type 7. A type 2 tear plus along with an injury to a ligament called the middle glenohumeral ligament.
- Type 8. A type 2 tear that extends toward the back.
- Type 9. A tear that extends to the front and back of the labrum.
- Type 10. A tear that extends to the rotator interval — a part of the shoulder.
Labrum SLAP Tear Diagnosis
A labrum tear can have many causes, and your labrum can tear in different places. A labrum SLAP tear is just one type of labrum tear. Also, SLAP tears often involve injuries to other tissues in and around your shoulder, so they can be hard to diagnose.
To diagnose your injury, your doctor will ask questions about your symptoms, pain level, and where it hurts. If there's a specific injury or event that changed the way your shoulder feels, tell your doctor.
During a physical exam, your doctor will move your arm and shoulder into different positions and check your range of motion and strength. They may also examine your head and neck to see if your pain is caused by a pinched nerve rather than a labrum tear.
Your doctor may order one of these tests:
Labrum SLAP Tear Treatment
Usually, surgery is not the first treatment option. Doctors often start by prescribing anti-inflammatory drugs for pain and swelling. They may also give you a corticosteroid shot into your shoulder joint to ease the pain.
Your doctor may suggest working with a physical therapist or show you specific exercises to build up the muscles around your shoulder joint.
If medication and exercise don't help enough, surgery may be your next step. The kind of operation depends on your injury, your age, and how active you are.
Surgeons often repair labrum SLAP tears with arthroscopy, in which the doctor makes and works through small cuts in your shoulder. They place a tiny camera in your shoulder joint. This sends images to a bigger screen in the operating room. Using small tools, your surgeon can trim the torn part of your labrum and then repair or reattach it.
Biceps tenodesis is another common surgery for SLAP tears. It moves your biceps tendon down and reattaches it to your upper arm bone (humerus).
Recovery After Surgery
If you have surgery, expect to be in a sling for a month or so to keep your arm still. After the swelling has gone down, you can move it again with guidance from a physical therapist.
A physical therapy, or rehabilitation, program will help improve your shoulder’s range of motion and flexibility. Physical therapy exercises also will strengthen the muscles around your shoulder and help prevent future injury.
Depending on your age and the extent of your tear, it could take two months for your labrum to heal and another two months to build up the same strength you felt before the tear.
Post-Surgery Complications
After surgery, the most common complications are pain and stiffness. Some other complications of surgery include:
- Infection
- Excessive bleeding
- Blood clots
- Damage to blood vessels or nerves
Most patients recover fully from surgery to repair a labrum SLAP tear. They typically have less pain and better shoulder strength afterward.
Some types of surgery are better suited to people of different ages and activity levels. If you’re under age 40, arthroscopic labrum repair surgery may be more successful, and if you’re older, biceps tenodesis may be more successful. However the treatment you need depends on several factors, including your age, type of injury, and activity level.
How to Prevent SLAP Tears of Superior Labrum
Preventing a SLAP tear can be difficult, especially if the cause is a fall or another sudden injury that you don’t expect. But if you notice pain or stiffness in your shoulder, talk to your health care provider before it becomes serious. It may help avoid a SLAP tear of the superior labrum.
If your activity includes overhead motions, such as throwing a baseball or softball, here are some ways to prevent a tear in your superior labrum:
- Warm up your shoulder before activity.
- Stretch your shoulder muscles regularly.
- Perform strengthening exercises regularly, such as lifting weights.
- Use proper technique in your sport or activity.
Takeaways
A SLAP tear is a tear in part of your labrum, which is a rim of cartilage in your shoulder joint. This type of injury can happen if you fall down and put your arm out to break your fall, or in sports that require repeated overhead motions. The treatment you need for a labrum SLAP tear depends on how severe the tear is, among other factors. In some cases, you may need surgery, and in others, anti-inflammatory drugs and physical therapy may be enough to help the injury heal.
Labrum SLAP Tear FAQs
Can a SLAP tear heal on its own?
Sometimes, a labrum SLAP tear may heal on its own, or with rest and physical therapy. But this depends on how severe the tear is. Some tears require surgery or other treatment.
What happens if a SLAP tear goes untreated?
If you have a labrum SLAP tear and don’t get it treated, it can get worse and cause chronic pain. It can also limit how much you can use your shoulder.
Is a SLAP tear worse than a rotator cuff tear?
A SLAP tear isn’t necessarily better or worse than a rotator cuff tear, because these are injuries to separate areas of your shoulder. A SLAP tear is a tear in the cartilage called the labrum, while a rotator cuff tear is a tear in a rotator cuff tendon or tendons. Both injuries can vary in pain level and severity.
How to heal a labrum tear without surgery
If you have a labrum or SLAP tear, the treatment you need will depend on several factors. Treatment options other than surgery include anti-inflammatory drugs, corticosteroid shots, and physical therapy.
What is the difference between a SLAP tear and a labral tear?
A labral tear is a tear in your labrum, and a SLAP tear is one type of labral tear. SLAP stands for Superior Labrum Anterior and Posterior.
