Shoulder pain- what is a SLAP tear?

• Do you have shoulder pain thats not improving?
• Is your pain worse with overhead activities or throwing sports?
• Do you have catching or clicking in the shoulder joint?

You might have a slap tear, also known as a labral tear! Let’s explore what a labral tear is an what you need to do about it.

What is a SLAP tear or a labral tear in the shoulder?

The labrum is a circular ring of flexible, fibrous connective tissue, that surrounds the shoulder joint around the edge of the socket. This labrum increases the stability of the shoulder by making the socket just a little bit deeper, while still allowing for the required flexibility of one of the bodies’ most sophisticated joints. One well-known muscle of the arm, the biceps, has an attachment directly into the labrum and is a common site of injury.

A tear of the labrum can occur in many locations, however the most common is at the point where the biceps tendon attaches to the labrum. Usually, this tear follows a typical pattern and is referred to as a superior labrum tear, anterior to posterior (SLAP tear). If there is a tear in the labrum, it can result in reduced stability of the ball in the socket.

What causes it?

SLAP tears can be caused by trauma such as a fall onto an outstretched hand or a dislocated shoulder. Tears can also develop over time with repeated throwing actions or overhead activities as the labrum is weakened and eventually injured. Traumatic tears are more likely to be symptomatic or painful than the tears that develop slowly over time.

What are the symptoms?

As mentioned, SLAP tears can occur suddenly, through trauma such as a fall or dislocation, or develop slowly through repeated stress. Often if the injury develops over time, patients can be unaware they have sustained a tear and the injury doesn’t have a significant impact on their pain or function. These slowly developing SLAP tears can however, place more tension on the long head of biceps tendon causing biceps related pain. When the tear occurs through a sudden action or trauma (such as dislocation), symptoms can be more marked. Sufferers often notice pain deep in the shoulder joint with overhead shoulder movements, a feeling of weakness, loss of power and/or accuracy with throwing activities. Some people may notice a popping or clicking sensation and occasionally the shoulder may give way. In severe tears, the shoulder might feel unstable and even be at increased risk of dislocation.

How can physiotherapy help?

Your physiotherapist is able to help diagnose a suspected SLAP tear and send you for further imaging if needed. SLAP tears are often graded by severity from I to IV as a way to guide treatment. Physiotherapy is usually recommended as a trial for all tears before considering surgical repair and in many cases can effectively help patients return to their previous activities, symptom-free. Treatment includes a tailored strengthening program to improve the shoulder joint stability.

If physiotherapy is unsuccessful, surgical repair with a full rehabilitation program can be recommended. Surgery will usually either repair the tear or reattach the biceps tendon to the humerus (tenodesis). Following surgery, a period of rest in a sling is required before physiotherapy rehabilitation can begin.

Remember there can be many reasons for pain and its essential to get an accurate diagnosis from your physiotherapist!

Want to learn more about shoulder pain and impingement? Read more here

Together our team work in a thorough manner to provide a complete biomechanical assessment of your problem as well as a thorough step-by-step explanation and treatment plan to help you move forward to a healthier, happier you. Learn more about our physiotherapy team here!

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