Treatment of Superior Labral Tears (SLAP tears)

In the shoulder, the superior labral complex consists of the biceps tendon and the meniscus-like tissue called the labrum.  Together these components help stabilize the shoulder joint during overhead activities.  In the mid-1980's, the labral complex was identified as a possible source of shoulder pain and dysfunction in throwing athletes.  Since then, numerous reports have furthered our understanding of this complicated structure and helped orthopaedic surgeons properly treat these so-called 'SLAP' tears.

Damage to the superior labrum typically results from a fall onto an outstretched arm, repetitive throwing or traumatic dislocations of the shoulder.  The damaging force, whether all at once or over time, causes this stable anchoring complex to become loose and painful.  Injured athletes often report deep-seated pain, catching, popping or soreness within the shoulder joint that is very hard to pin point.  Diagnosing the problem relies on maintaining a high level of suspicion based on a thorough history and physical examination.  The use of MRI scans greatly increases the accurate diagnosis of a superior labrum injury.

Once diagnosed, non-operative treatment such as Physical therapy or activity modification may help decrease pain and discomfort.  Oral anti-inflammatory medication or cortisone injections may temporarily decrease soreness, but do not cure the mechanical problems created by the SLAP tear.  Shoulder rehabilitation to maintain full range of motion and to strengthen the surrounding rotator cuff and scapular muscles may occasionally improve symptoms.  Activity modification to decrease the stress on the shoulder may also allow the individual to remain relatively symptom free with routine daily activities.

When non-operative management fails to control painful symptoms, arthroscopic surgical techniques are the mainstay of treatment.  Arthroscopy of the shoulder allows visual examineation of all the shoulder structures and helps rule out any co-existing injuries.  Once the labral tear is identified, any degenerative tissue is removed and the underlying bone from where the labrum tore free is prepared to allow for reattachment of the labral structures.  Many advanced arthroscopic skills are needed to properly place the anchors and pass the stitches that are used to tie the tissue back down onto the bone.

Once properly secured, the shouder is placed in a protective sling to safeguard against disruption of the repair.  A formal physical therapy program is initiated to gradually work on proper strengthening and stretching.  A throwing program is then started and progressed as tolerated to return an athlete to full competition.

 

Author
Luis M. Espinoza MD Dr. Espinoza served as the AAA Team Doctor for the the New Orleans Zephyrs/BabyCakes since joining the Orthopedic Center for Sports Medicine in 2003. He is double board certified in General Orthopedic Surgery and Sports Medicine.

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