SLAP tears of the shoulder

The "socket" of the shoulder joint is surrounded by a ring of flexible connective tissue, known as a labrum. This labrum increases the stability of the shoulder while allowing the joint to stay flexible. The long head of the biceps tendon has an attachment directly into the labrum, which is often a point where injuries occur. A tear of the labrum can occur in many locations, however the most common is at the point where the biceps tendon attaches. Usually, this tear follows a typical pattern and is referred to as a superior labrum tear, anterior to posterior (SLAP tear). 

How do they happen?

SLAP tears can be caused by trauma such as a fall onto an outstretched hand or can develop over time through repeated stress. Repetitive overhead activities such as throwing or painting can also gradually weaken the labrum over time and lead to a tear.

What are the symptoms?

Often if a SLAP tear develops over time, patients can be unaware they have sustained an injury at all and there is no significant impact on their pain or function. Pre-existing SLAP tears can however place more tension on the long head of the biceps tendon, leading to overuse disorders of that tendon as a secondary complication.  
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When the tear occurs through a sudden action or trauma, symptoms can be more noticeable. Patients often notice pain deep in the shoulder joint with overhead shoulder movements, a feeling of weakness or a loss of power or accuracy with throwing activities. Some people may feel a popping or clicking sensation and occasionally the shoulder feels like it "gives way". In severe tears, the shoulder might feel unstable and be at increased risk of dislocation. 

How can physiotherapy help?

Your physiotherapist can help diagnose a SLAP tear and send you for scans if needed. SLAP tears are graded by severity from 1 to 4 as a way to guide treatment. Physiotherapy is usually recommended as a trial for all tears before considering surgical repair and in many cases can effectively help patients return to their previous activities, symptom free.  

If physiotherapy is unsuccessful, surgical repair with a full rehabilitation program is then recommended. Surgery will either repair the tear or reattach the biceps tendon to the humerus (tenodesis). Following surgery, a period of rest in a sling is required before rehabilitation can begin.