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SLAP Tear Shoulder Pain Physiotherapy

A SLAP tear happens when there is damage to the ring of cartilage on the socket of the shoulder joint (medically termed as the labrum or "labral"). 

Shoulder SLAP tears and injuries mostly happen from

• falls or
• from repetitive over-head movements such as swimming, throwing sports/activities or racquet sports like tennis
  

Typical symptoms of a shoulder SLAP tear lesion includes

• shoulder pain
• shoulder weakness
• shoulder instability and possibly
  
• a "catching/locking" sensation in the shoulder
  

Treatment usually involves medication and shoulder pain physical therapy, but in some cases, your shoulder surgeon may recommend corrective shoulder surgery.

first of all, What Is A SLAP Tear?

A  SLAP tear occurs in our glenohumeral joint (shoulder joint, between the glenoid process and humerus).

Anatomically, this is where the top part of the arm bone (which is the head of humerus), which is shaped like a ball, fits into a socket on the front-side of the shoulder blade (which is the glenoid fossa). 

Our shoulder socket is very shallow, to free up the shoulder to allow for lots of movement. To compensate for this and to improve the stability of the shoulder, there is a special ring of cartilage (medically known as the glenoid labrum), which helps to deepen the socket without restricting movement.

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The glenoid labrum is reinforced by the tendons of various muscles of the shoulder. 

With a SLAP tear, the top part of the glenoid labrum, which is reinforced by one of the biceps tendons, is torn.   This top part of the labrum tears from away from the glenoid socket from front to back (anterior to posterior), often damaging the biceps tendon as well.

Common Causes of slap shoulder pain and injuries

SLAP tears can develop suddenly through a one-off event, known as an acute injury, or gradually from repetitive movements, known as a chronic injury. 

Acute SLAP Shoulder Injuries

Acute injuries tend to affect younger people, under the age of 40. They are typically caused by:

• A Fall: most commonly onto an outstretch hand
• RTA: especially if you have pushed through your outstretched arms to brace yourself from the impact
• Shoulder Dislocation: when the head of humerus pops out of the glenoid socket
• Lifting: picking up a heavy object
• Sports Injury: such as a tackle, especially when your arm is above your head, or pulling down through the arm

Chronic SLAP Shoulder Injuries

Chronic tears tend to occur in people over the age of 40, and degeneration of the glenoid labrum is often seen as part of the normal aging process.  They are usually caused by:

1. Repetitive Movements: especially with the arm above the head such as throwing actions, racket sports or swimming
2. Repetitive Heavy Lifting: which pulls down on the arm e.g. weight lifting

Symptoms of SLAP shoulder pain and Lesions

The common symptoms of a SLAP tear include:

• Pain: with shoulder movements or when lifting things above the head.  It tends to be a dull ache, rather than a sharp pain
• Weakness: decreased strength in the upper arm
• Instability: it may feel as if the shoulder is going to “pop-out”.  Often affects sleep as it can be difficult to get into a comfortable position as the shoulder drops slightly when lying on it due to the instability
• Difficulty Throwing: athletes may complain of a loss of strength and velocity (speed) when throwing
• Decreased Movement: range of motion at the shoulder may be reduced
• Catching Sensation: or a feeling of impingement (blocked movement) when moving the arm

Your doctor should be able to diagnose a SLAP tear from talking to you and examining your shoulder.  He may also want to get x-rays or an MRI, often with contrast dye to get a clearer picture.

Treatment Options

Treatment will depend on the type of SLAP lesion and the associated symptoms.  Generally, conservative (i.e. non-surgical) treatment is tried first and if this fails, surgery will be considered.

Non-Surgical Treatment

Conservative treatment for a SLAP lesion will likely include:

1)  Medication: pain-relief and anti-inflammatories such as naproxen and ibuprofen
2)  Rest: from aggravating activities
3)  Physical Therapy: exercises to regain the strength, stability and movement of the shoulder, some of the shoulder physiotherapy that you may receive with our senior physiotherapists include:

• cold therapy
• heat therapy
• moist heat paraffin wax therapy
• radio-frequency Indiba physiotherapy to accelerate soft tissue healing
• joint mobilization
• stretching exercises
• strengthening exercises
• scar management
• hands on manipulation and mobilization (manual therapy)
• soft tissue management
• heat therapy and heat treatment and heat pack to relief tight muscles and joints
• ultrasound therapy to accelerate soft tissue healing
• exercise therapy
• acupuncture and/or dry needling
• deep tissue release
• and more

Surgery

If you are still having problems after three to six months of rehab, SLAP repair surgery may be advised.  This is usually done arthroscopically (keyhole surgery).  A small camera (arthroscope) is inserted into the shoulder joint so the surgeon can see exactly what damage has been done. 

Surgical technique will depend on the type of tear.  The surgeon will debride (clean up) any frayed edges, and then either remove or reattach and torn parts of the glenoid labrum.  When reattaching torn segments, anchors are inserted into the bone of the shoulder socket and the torn glenoid labrum is sewn back together and held in the correct place with sutures attached to the anchors. 

Following surgery, you will need to wear a sling initially for a few weeks (including in bed) to allow the shoulder to heal.  You will work with a physical therapist on a progressive rehab programme to regain the movement, strength and stability of your shoulder.

It usually takes 4-6 months to return fully to sports. 

SLAP tear surgery is successful at reducing pain and instability and restoring function in most cases and complications are rare.

Reference Sources

• https://www.shoulder-pain-explained.com/SLAP-tear.html