SLAP Tear

A SLAP tear is a tear of tissue that is located on top of the shoulder. SLAP stands for Superior Labrum Anterior Posterior.

The shoulder is a ball and socket joint

The shoulder is a ball and socket joint, similar to a golf ball on a tee. A rim of tissue called the labrum surrounds the socket like a bumper on a pool table.

The labrum surrounds the socket

Several muscles in the shoulder and arm insert on the ball and socket. For example, the biceps muscle in the arm is anchored on top of the labrum.

The biceps muscle inserts on the top of the labrum

A SLAP tear is a detachment of the biceps muscle where it is anchored to the top of the labrum. It is similar to a tree being uprooted from its soil.

Normal labrum surrounding the shoulder socket

A SLAP tear is torn tissue on top of the labrum

To evaluate for a SLAP tear, a doctor will perform an examination after a history is taken. X-rays are performed to image the shoulder. To further evaluate the shoulder, an MRI may be ordered. The MRI will show muscles, tendons, and ligaments around the shoulder that are not visible on the x-ray.

Sometimes a SLAP tear can be present with other shoulder injuries, such as an instability injury (Bankart tear) that can occur after a dislocation.

An isolated SLAP tear occurs from 9:00 to 3:00 on a clock face

A SLAP tear combined with an instability tear occurs from 9:00 to 6:00 on a clock face

SLAP tears are often painful and can cause clicking in the shoulder. They often occur as a result of a jarring motion of the arm. Unfortunately, SLAP tears do not heal on their own and usually require surgery to allow them to heal properly.

Surgery

If surgery is recommended it is performed arthroscopically. Arthroscopic surgery uses small incisions and small tools, about the size of a pencil, to perform the procedure. All work is visualized with a small camera, the arthroscope. The surgeon sees inside the shoulder with the arthroscope and its images are projected on a video screen.

Arthroscopic camera and tools in the shoulder

The torn tissue is stitched back to the bone. By stitching the torn tissue back to the bone, the SLAP tear can heal in its proper location. The stitches are held in the bone with metal or plastic anchors that are drilled into the bone.

SLAP tear before repair

SLAP tear repaired back to its normal location with stitches

Examples of metal anchors with attached sutures (stitches) used to reattach torn tissue to bone

X-ray after SLAP repair with an anchor

As mentioned earlier, SLAP tears can occur at the same time as instability tears. If the two are present, then they are both repaired during the same procedure.

A combined SLAP tear and instability tear

Repair of a combined SLAP tear and instability tear

What to expect after SLAP repair surgery

Your doctor may prescribe a sling after surgery. If so, you will probably wake up from surgery with the sling on.

A typical post-operative sling

Recovery after SLAP repair surgery is gradual. Patients usually take one to two weeks off from work. Physical therapy will be required for a proper recovery, usually for several months. Activity restrictions will apply after surgery until appropriate rehabilitation goals have been achieved.

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