A SLAP lesion or tear is a term often used in injury assessments to describe an injury to the surface of the shoulder where the arm connects to the appendicular skelton (the trunk). We have talked a lot about the complexity of the shoulder joint and in this injury we are concerned mainly with the ‘glenohumeral’ joint. This joint is the ‘ball and socket’ joint of the shoulder, which in this case is more like a billiard ball on a teaspoon.
SLAP stands for Superior Labral Tear from the Anterior to the Posterior.
Labral tears can also occur in the hip joint but these are not referred to as SLAP tears.
The labrum is the articular surface (the area where the ball of the arm bone or humerus connects to the actual joint surface or glenoid cavity *the socket of the shoulder). Its like looking at the Universal Joint on a car crankshaft. The surface on the inside of the socket is where the labrum forms a secure ‘cuff’ for the bony humerus to insert into. Like a ring of fibre that makes the articulation more secure, it helps to create a deeper rim. Like the rubber ring on a preserving jar.
Technically the Glenoidal lLabrum is made up of the extensions of the long head of the Biceps Brachii that inserts in the front and then the long head of the Triceps muscle at the back aspect of the articulation come together to form this ring that can also referred to as the glenoid ligament
When this ‘labrum’ has a tear or a section that peels away like a lemon peel, this can cause a great deal of irritation within the joint capsule that creates a constant inflammation and pain in the joint that can be associated with ANY movement. If you can imagine, a wedge underneath the head of the bone inserting into the capsule much like a peel in a mortar and pestle and how much this would create a problem for smooth operating joint.
The real symptoms of this nature are often very generic shoulder pain. A deep aching pain is often a precursor in assessing a SLAP lesion but that can also be said of MOST shoulder injuries. In this way, SLAP lesions are often not the first assessment arrived at by medical practitioners. As these symptoms can be so generic in nature, then it is difficult to be certain that a SLAP lesion has occurred. Even the great doyen of scans the MRI, can sometimes miss a SLAP lesion. In this way sometimes arthroscopic surgery can be the only definitive way to ascertain a lesion of this nature. Literally ‘going in and having a look’.
Any injury here has huge implications for people who are involved in throwing or overhead actions like a tennis serve, the ‘catching’ sensation within the shoulder and also a weakness or downgrading of the throw ability. It is more of a dull throb in terms of constant pain and generic movement won’t necessarily illicit the catching sensation.
There are different types of SLAP Tears or Lesions and they pertain to whether the Biceps Tendon or ANCHOR is intact, fraying or whether there is a detachment of the securing biceps tendon or indeed a ‘bucket tear’ where both the anterior and posterior aspects are not intact.
Whilst there is some support for non surgical techniques that reinforce the shoulder joint via strengthening the supportive structures such as the rotator cuff to re=establish stability, the surgical procedures (arthroscopic) have increased in efficiency to have a 65-90% success rate.
Surgical procedures have developed to indicate arthroscopic incisions to reduce swelling and inflammation of the shoulder generically. This aids in much speedier recovery. Repairing of the tear can take two forms of reinforcing the tear or sometimes, taking the biceps tendon and reattaching it somewhere else to prevent the wear on the labrum. This is particularly indicated when the patient is over 40 as this type of tear is common in those who have wear and tear on the shoulder.
With any shoulder recovery after surgery, the issue is always about regaining Range of motion efficiently and then stabilising the growing movement of the shoulder in incremental stages. Stabilising each interval where increased range of motion is achieved. In this way we look at Scapular Stability, Increasing range of motion particularly overhead and ensuring that in each new stage of motion, you have stability and strength to hold the shoulder securely.
Recovering from Arthroscopic surgery on the shoulder can take 4-6 months and it is most important for patients to NOT move the shoulder too much immediately after surgery. So you exercise athletes who want to get back into training in the belief of stimulating growth or strength, you need to be wary here. This is not the case with shoulder surgery.
Small incremental stages must be introduced and only toward the latter stages of the recovery will you be putting any load through the shoulder or indeed the biceps tendon or even the triceps. It’s a waiting game. But in the end it is worth it to alleviate the deep aching pain that comes from a SLAP tear.
