SLAP Tear

What is SLAP?

SLAP stands for superior labrum from anterior to posterior. It is part of the cartilaginous ring (labrum) attached to the periphery of the socket (glenoid) in the shoulder joint. It serves as an important stabilizer of the shoulder joint and provides an anchor point for various ligaments and the long head of the biceps tendon.

What Causes SLAP Tears?

SLAP tears can result from acute trauma, such as a fall on an outstretched hand, or more commonly, from repetitive overhead activities, especially among throwing athletes, weightlifters, racket players, or manual laborers.

SLAP tears can vary in severity from mild fraying of the labrum to complete detachment from the socket.

What Are the Symptoms of SLAP Tears?

Patients with SLAP tears may present with varying degrees of shoulder pain, especially with overhead movement, sometimes accompanied by a popping, clicking, or grinding sensation. Some may experience deep vague aches, easy fatigue, or a decrease in performance in sporting activities.

How Are SLAP Tears Diagnosed?

SLAP tears can be diagnosed by your doctor after assessing your symptoms, performing a shoulder examination, and conducting MRI imaging.

What Are the Treatments for SLAP Tears?

The available treatments include pain control, rest, physiotherapy, and surgery.

​The treatment algorithm is often individualized depending on the patient's demographics, activity demands, and the severity of the condition. In most cases, non-operative treatments are carried out first. Physiotherapy with a focus on rotator cuff strengthening and correcting any muscle imbalances (scapulothoracic dyskinesia) is particularly beneficial.

When symptoms persist despite non-operative measures, surgery may be needed.

What Are the Surgical Procedures for SLAP Tears?

Depending on your age, activity level, types, and severity of the SLAP tears, your doctor may recommend one of the following operations suitable for you.

1. SLAP Repair

SLAP repair involves the meticulous reattachment of the torn labrum to its original position using arthroscopic techniques. This minimally invasive approach not only reduces surgical trauma but also facilitates quicker recovery and better outcomes for patients. Typically performed as day surgery, SLAP repair offers a promising solution for individuals seeking relief from shoulder instability and pain.

During the arthroscopic SLAP repair procedure, small incisions are made around the shoulder joint, allowing the surgeon to access the damaged labrum with specialized instruments and a tiny camera (arthroscope). The torn labrum is then meticulously reattached to its anatomical footprint using sutures or anchors, restoring stability and function to the shoulder joint. Following the procedure, patients are usually advised to wear an arm sling for 3-6 weeks to support the healing process.

2. Biceps Surgery - Tenodesis vs Tenotomy

The long head of the biceps runs along the bicipital groove, enters the shoulder joint, and attaches to the superior labrum. In SLAP tears, the biceps tendon can be involved in varying degrees, ranging from mild fraying and inflammation to detachment along with the labrum. The portion of the biceps tendon running along the bicipital groove can also be inflamed, frayed, or damaged in isolation (without SLAP tear) and become a source of shoulder pain.

Biceps tenotomy and tenodesis are surgical procedures aimed at addressing issues with the biceps tendon, particularly in cases of SLAP tears or isolated damage. Each procedure offers unique benefits and considerations, depending on the patient's age, activity level, and the extent of tendon involvement.

Biceps Tenotomy:

Biceps tenotomy involves the surgical release of the biceps tendon from its attachment to the superior labrum. This procedure effectively relieves tension on the tendon and alleviates associated pain. By detaching the tendon from the labrum, biceps tenotomy eliminates the source of discomfort without the need for reattachment.

Biceps Tenodesis:

In contrast, biceps tenodesis involves the reattachment of the biceps tendon after its release from the superior labrum. However, instead of reattaching the tendon at its original site, it is secured lower down on the humerus (arm bone). This technique aims to maintain the functional integrity of the biceps muscle while addressing underlying pathology.

Considerations and Recovery:

Following either procedure, patients can expect a period of postoperative rehabilitation aimed at restoring shoulder function and strength. Physical therapy plays a crucial role in this process, guiding patients through exercises to promote healing and improve range of motion. While recovery times may vary, both biceps tenotomy and tenodesis offer promising outcomes for relieving pain and enhancing shoulder function.