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As an orthopedic surgeon and sports medicine specialist at Town Center Orthopaedics, Dr. Jeffrey Berg has previously discussed labrum tears of the shoulder, a frequent cause of shoulder pain. In this article, Dr. Berg discusses a particular type of labral tear called a SLAP tear. SLAP tears cause 4%-8% of shoulder injuries, and although they happen more frequently to people who play sports, they can also happen as people age.
SLAP stands for “Superior Labrum from Anterior to Posterior.” Let’s break down exactly what that means.
The labrum is a cartilage ring that surrounds your shoulder socket (or glenoid cavity). The labrum in the shoulder acts as a cushion for your upper arm bone and, at the bottom of the socket, serves as an attachment point for ligaments that connect the upper arm (humerus) to the socket. It also deepens the socket so the shoulder joint stays in place. Both of these functions help stabilize the shoulder. The labrum at the top of the glenoid, the superior labrum, is the attachment point for one arm of your biceps tendon. It also maintains continuity for the remaining labrum and assists indirectly in stabilizing your shoulder.
When the superior (top) part of the labrum is torn within its substance or from its attachment at the top of the shoulder socket, a SLAP tear occurs. This tear may extend from the front (anterior) to the back (posterior) part of the labrum. This torn labrum may also be more localized.
The vast majority of shoulder labrum tear symptoms include these common complaints:
A SLAP tear labrum tear may occur from an acute injury, a traumatic event, or recurrent micro-trauma. The traumatic tears are caused by acute trauma that occurs when the arm is forcibly stretched overhead or when the arm is pulled forward, away from the body, such as while holding a steering wheel of an auto that abruptly stops during an accident. In both of these cases, the biceps tendon attached to the superior labrum essentially “pulls” the labrum off the top of the glenoid.
A somewhat similar mechanism also causes SLAP tears resulting from recurring overuse micro-trauma. These tears most commonly occur from repetitive overhead activities or overhead motion sports such as baseball pitching, playing volleyball or tennis, or rock climbing. During these activities, the biceps tendon also pulls on the superior labrum however with less force but repeatedly. This is the so-called “peel back” mechanism. Much like when a paper clip bends back and forth until it breaks, the labrum’s attachment is slowly disrupted until a SLAP tear happens.
Superior (SLAP) Labral Tear
There is tremendous variability in how a healthy superior labrum appears. Sometimes, the labrum is firmly fixed to the superior glenoid. Frequently it is not. Sometimes, the labral tissue in the shoulder area is thick, and sometimes it’s rather thin. All of this variability makes differentiating between a person’s “normal” anatomy and a SLAP-type tear very difficult.
Initially, when SLAP tears were first described, surgery was common due to overdiagnosis, by calling rare forms of normal anatomy of the superior labrum a tear. Fortunately, shoulder surgeons’ understanding of the labrum region has grown. We can now better determine when a labrum SLAP tear exists and when one doesn’t. As a result, the diagnosis of patients with SLAP tears is less common, SLAP tear surgery is less frequent, and more conservative treatments are pursued first.
Pain and damage can worsen if a SLAP tear isn’t treated. But, if you’re suffering from shoulder labrum tear symptoms, it’s important to see a health-care provider and have a physical examination.
Visit our shoulder specialists at one of our convenient Town Center Orthopaedics locations in Ashburn, Centreville, Fairfax, and Reston, Virginia. To schedule an appointment, call us at any time at (571) 250-5660 or request an appointment online.
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