What is a SLAP Tear?

Figure 1 – The flap of tissue in the middle of the picture is a SLAP tear. The normal smooth labrum (to the right) has been torn causing a split of the labrum. There are four different types of SLAP lesions, this is a Type III. Watch Dr. Stetson perform a SLAP Lesion of the Shoulder. Watch Video>>

The term SLAP tear refers to a tear of the superior labrum of the shoulder. The labrum is a piece of fibrous tissue made of cartilage, called fibrocartilage, which surrounds the glenoid or the socket of the shoulder. It forms a rim like structure which aids in stabilizing the shoulder joint and provides an attachment for the ligaments of the shoulder. The biceps tendon attaches inside the shoulder joint at the superior labrum or at the top of the shoulder joint. Tears of the superior labrum are called SLAP Tears and can cause shoulder pain mimicking other shoulder problems. These are often difficult to diagnose and can often times be only seen at the time of arthroscopic surgery. The term SLAP was coined by Dr. Steven Snyder of the Southern California Orthopedic Institute where Dr. Stetson did his fellowship. See figure 1 for an example of a SLAP tear.

What causes a SLAP tear?

A SLAP tear can be caused by many different ways. The most common cause is a fall or some other sort of injury to the shoulder. Some patients fall landing directly on their shoulder or others fall on their outstretched hand. Another cause of SLAP tears is repetitive overhead activities seen in tennis players, baseball players, volleyball players or other overhead athletes. Some patients can recall a specific injury while others cannot.

What is the most common complaint?

The most common complaint is pain. In addition, over half the patients with SLAP tears will also complain of painful clicking and popping. SLAP tears are often seen with in combination with other shoulder problems which makes it difficult to diagnose..

How is a SLAP tear diagnosed?

With any shoulder problem, the first step in diagnosing a SLAP tear is to get a complete history and physical examination from a qualified shoulder surgeon. X-rays are also taken and if the symptoms warrant, an MRI is also done. A regular MRI may not show a SLAP tear and so often times an MRI with a dye injected into the shoulder, a so called MR arthrogram, is ordered. This is able to detect a SLAP tear better than just a normal MRI.

How is a SLAP tear treated?

SLAP tears are difficult to diagnose and are often seen with other shoulder problems such as bursitis and rotator cuff tears. Although bursitis and even rotator cuff tendonitis often responds to physical therapy and a cortisone injection, SLAP tears do not. They typically need to be repaired with surgery. This can be done using advanced arthroscopic techniques requiring only two or three small incisions, each less than a half inch in size. It is done as an out-patient surgery, meaning you go home the same day. It does require physical therapy for about six weeks after the surgery and most patients are able to return to their activities about three months following the surgery.

Watch Dr. Stetson perform a SLAP Lesion of the Shoulder. Watch Video>>

William B. Stetson, MD
Associate Clinical Professor
University of Southern California Keck School of Medicine
Department of Orthopaedic Surgery

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