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Slap Tears

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A SLAP tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint.

Anatomy

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Surrounding the outside edge of the glenoid is a rim of strong, fibrous tissue called the labrum. The labrum helps to deepen the socket and stabilize the shoulder joint. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.

 
shoulder labrum anatomy

The labrum deepens the socket of the shoulder joint, making it a stronger fit for the head of the humerus.

 

Description

The term SLAP stands for Superior Labrum Anterior and Posterior. In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.

 
SLAP tear

This cross-section view of the shoulder socket shows a typical SLAP tear.

Cause

Injuries to the superior labrum can be caused by acute trauma or by repetitive shoulder motion. An acute SLAP injury may result from:

  • A motor vehicle accident
  • A fall onto an outstretched arm
  • Forceful pulling on the arm, such as when trying to catch a heavy object
  • Rapid or forceful movement of the arm when it is above the level of the shoulder
  • Shoulder dislocation

People who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears as a result of repeated shoulder motion.

Many SLAP tears, however, are the result of a wearing down of the labrum that occurs slowly over time. In patients over 30 to 40 years of age, tearing or fraying of the superior labrum can be seen as a normal process of aging. This differs from an acute injury in a younger person.

Symptoms

The common symptoms of a SLAP tear are similar to many other shoulder problems. They include:

  • A sensation of locking, popping, catching, or grinding
  • Pain with movement of the shoulder or with holding the shoulder in specific positions
  • Pain with lifting objects, especially overhead
  • Decrease in shoulder strength
  • A feeling that the shoulder is going to “pop out of joint”
  • Decreased range of motion
  • Pitchers may notice a decrease in their throw velocity, or the feeling of having a “dead arm” after pitching

Doctor Examination

Medical History

Your doctor will talk with you about your symptoms and when they first began. If you can remember a specific injury or activity that caused your shoulder pain, it can help your doctor diagnose your shoulder problem — although many patients may not remember a specific event. Any work activities or sports that aggravate your shoulder are also important to mention, as well as the location of the pain, and what treatment, if any, you have had.

 

Physical Examination

During the physicial examination, your doctor will check the range of motion, strength, and stability of your shoulder.

He or she may perform specific tests by placing your arm in different positions to reproduce your symptoms. Your doctor may also examine your neck and head to make sure that your pain is not coming from a “pinched nerve.”

The results of these tests will help your doctor decide if additional testing or imaging of your shoulder is necessary.

 
testing shoulder range of motion
Your doctor will test your range of motion by having you move your arm in different directions.
Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

imaging Tests

X-rays. This imaging test provides clear pictures of dense structures, like bone. The labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures.

Magnetic resonance imaging (MRI) scans. This test can better show soft tissues like the labrum. To make a tear in the labrum show up more clearly on the MRI, a dye may be injected into your shoulder before the scan is taken.

 
MRI of SLAP tear

(Left) An MRI image of a healthy shoulder. (Right) This MRI image shows a tear in the labrum.

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