Shoulder – SLAP Lesion Repair

Labral tear

The shoulder is comprised of three bones called the scapula (Shoulder blade), the clavicle (collarbone), and the humerus (upper arm bone). The glenoid is in the shallow socket of the shoulder blade where the head of the upper arm bone rests. The humeral head, or ball, of the shoulder joint is much larger than the glenoid socket, but the socket is surrounded by a ring of strong, fibrous tissue called the labrum.  The labrum deepens the socket, serves as a bumper to provide additional stability, and serves as the attachment site to important ligaments.  The biceps tendon also attaches to the top of the labrum, also called the SLAP region.

A SLAP tear occurs in the top (superior),  the front (anterior) and back (posterior) of the point where the biceps tendon attaches to the labrum. The term SLAP is an acronym for Superior Labrum Anterior and Posterior.

CAUSES

A SLAP tear can occur either from trauma or from overuse.  Motor vehicle accidents, falling on an outstretched arm, or forceful pulling on the arm can all result in a labrum tear.  Shoulder dislocations can also cause a tear, often to the front (anterior) or back (posterior) of this structure.  Repetitive overhead activities can also lead to tears of the top of the labrum.  Chronic degenerative fraying of the labrum can be seen in patients over the age of 40 years.  These chronic tears are not uncommon and are often seen in association with other problems including rotator cuff tears, and should be distinguished from acute traumatic tears in young people, or SLAP tears in overhead athletes.

SYMPTOMS

Some of the most common symptoms include:

  • A feeling of catching, locking, popping, or grinding in the shoulder.
  • Pain associated with overhead activities.
  • Loss of strength, pain with lifting heavy objects.
  • Loss of velocity or control in throwers, “dead arm” feeling.
  • Feeling of instability, or true dislocation of the joint, particularly with anterior or posterior tears

TREATMENT

For most SLAP tears, conservative management is often effective in alleviating symptoms and improving function. Anti-inflammatory medication and periodic icing may be used to help alleviate some of the symptoms. Following diagnosis, rehabilitation exercises may also be administered to help strengthen the rotator cuff and correct shoulder blade mechanics.

If patients continue to experience symptoms despite conservative management, surgery may be recommended.  Surgical treatment of labrum tears would include debridement, repair, or biceps tenodesis.  For anterior and posterior labrum tears associated with instability or dislocation, repair is typically performed arthroscopically.   For SLAP tears which involve the top portion of the labrum where the biceps tendon attaches, repair is typically reserved for young patients with tears due to trauma or participation in overhead sports.  For most other patients, SLAP tears can be effectively treated by releasing the biceps tendon from the torn labrum, and reattaching the biceps tendon lower down on the humerus bone.  This individualized approach to the treatment of labrum tears leads to decreased pain and improved function in the long term for the majority of patients.

A SLAP Lesion Repair is a minimally invasive arthroscopic procedure which uses a tiny camera and miniature surgical instruments to repair the damaged area.

The video below demonstrates the procedure.