SLAP Tears

A SLAP tear, which stands for Superior Labrum Anterior and Posterior tear, is a specific type of labrum injury occurring at the upper (superior) part of the labrum, where the biceps tendon attaches. In a SLAP tear, the labrum is torn at the top, extending from the front (anterior) to the back (posterior) of the shoulder socket. These tears can range from mild fraying to severe detachments, potentially causing pain, instability, and loss of function in the shoulder.

SLAP tears can occur due to a variety of mechanisms, including acute traumatic injuries and repetitive stress injuries. Athletes who participate in sports that involve repetitive overhead movements, such as baseball, tennis, swimming, and weightlifting, are at an increased risk because constant strain on the shoulder joint. Common causes include:

• Acute trauma: A sudden impact or force can cause a SLAP tear. This often happens when falling onto an outstretched arm, experiencing a direct blow to the shoulder, or undergoing a sudden and forceful pulling motion, such as trying to lift a heavy object.
• Repetitive overhead motions: Over time, activities that require frequent overhead arm movements such as throwing, serving in tennis, or swimming cause wear and tear of the labrum, eventually resulting in a SLAP tear.
• Heavy lifting: Lifting heavy objects, particularly in an improper manner, can place excessive stress on the shoulder joint and lead to labral damage.
• Degenerative changes: As people age, the labrum becomes more prone to fraying and tearing. This degenerative process can make older individuals more susceptible to SLAP tears, even with minimal trauma.
• Shoulder dislocation: If the shoulder dislocates or subluxates (partially dislocates), the labrum can tear, leading to a SLAP injury.

SLAP tears can present with a variety of symptoms, depending on the severity and extent of the tear. Common symptoms include:

• Deep shoulder pain, particularly during overhead movements
• A sensation of clicking, popping, or grinding within the shoulder
• Weakness in the shoulder
• Reduced range of motion, especially with lifting or rotating the arm
• A feeling of instability or the shoulder “giving way”
• Pain that worsens with certain movements, such as throwing, lifting, or reaching behind the back
• Discomfort when lying on the affected shoulder

Because these symptoms can overlap with other shoulder conditions, such as rotator cuff injuries, bursitis, or arthritis, it is essential to seek medical evaluation for an accurate diagnosis.

Diagnosing a SLAP tear requires a thorough medical history, physical examination, and imaging studies to confirm the presence and severity of the injury. Dr. David Gazzaniga, a renowned orthopedic surgeon and sports medicine specialist at the Newport Orthopedic Institute in Orange County, California, follows a systematic approach to diagnosing and treating SLAP tears. The diagnostic process includes:

• Physical examination: Dr. Gazzaniga assesses shoulder movement, strength, and stability through various specialized tests.
• Patient history: Understanding the mechanism of injury, whether from an acute incident, repetitive overhead activity, or degenerative wear, helps guide the diagnostic process.
• X-rays: Although X-rays cannot directly visualize soft tissue injuries like a SLAP tear, they help rule out fractures, bone abnormalities, or degenerative changes in the shoulder joint.
• MRI with contrast (MR arthrogram): This is the most effective imaging study for diagnosing a SLAP tear. A contrast dye is injected into the joint, highlighting the labrum and allowing the doctor to detect tears, fraying, or detachment of the tissue.
• Diagnostic arthroscopy: If imaging studies are inconclusive, an arthroscopic evaluation may be performed. This minimally invasive procedure uses a small camera inserted into the shoulder joint to provide a direct view of the labrum and confirm the extent of the injury.

SLAP tears can significantly impact shoulder function, particularly for athletes and individuals who perform repetitive overhead movements. If left untreated, these tears can worsen over time, leading to chronic pain, instability, and potential damage to other shoulder structures, such as the rotator cuff.