If you have deep shoulder pain that worsens with overhead activities, it could be a shoulder labral tear. These tears are classified by where in the shoulder the tear occurs, and one common type is a superior labrum anterior to posterior (SLAP) tear, which occurs at the top of the shoulder socket. Interventional Spine & Surgery Group features a multidisciplinary team that provides fast, patient-centered care and treatments for patients in central and northern New Jersey with SLAP tears. Here, we discuss the types of SLAP tears, the symptoms, and the treatment options available.
Key Takeaways
- A superior labrum anterior to posterior (SLAP) tear is an injury that occurs when the top of the labrum (glenoid), where the bicep tendon attaches, gets torn or damaged.
- There are four main types of SLAP tears, ranging from Type I to Type IV. They are categorized by the level of structural damage to the labrum and biceps tendon.
- The symptoms of a SLAP tear include deep, aching shoulder pain, popping or clicking sensations, shoulder instability, and weakness.
- To diagnose a SLAP tear, a combination of a physical exam, orthopedic tests like the O’Brien test, and imaging scans like a magnetic resonance arthrogram are used.
- SLAP tears can be treated with either non-surgical, conservative treatment methods like activity modification, physical therapy, and medication, or with surgery.
What Is a SLAP Tear?
A SLAP tear is an injury to the shoulder labrum. The shoulder labrum is a rubbery ring of cartilage that lines the rim of the shoulder socket, helping to secure the joint. When the cartilage gets damaged or frayed, it’s known as a labral tear. One of the most common types is called a SLAP tear, which occurs at the very top of the labrum (glenoid) where the bicep tendon attaches. It is often diagnosed in people who perform repetitive overhead motions, whether in sports or in job-related activities.
The Four Types of SLAP Tears
SLAP tears are typically classified further using the Snyder Classification, which features four types based on the structural damage of the superior glenoid labrum and biceps tendon anchor. These types include:
- Type I: This is when the superior labrum is fraying and degenerating, but the biceps tendon anchor is still securely attached to the bone.
- Type II: This is the most common type. It is when the superior labrum and the biceps tendon anchor are both completely detached from the top of the shoulder socket.
- Type III: This type is referred to as a “bucket-handle” tear, where the torn part flips into the joint. The biceps tendon anchor remains intact.
- Type IV: This type is also a “bucket-handle” tear, but it extends into and splits the biceps tendon itself.
The type of tear helps the medical team determine the best type of treatment, which may include conservative, non-surgical methods or surgery.
SLAP Type Comparison Table
| SLAP Type | Description | Surgery Required? |
|---|---|---|
| Type I | The superior labrum is fraying and degenerating, but the biceps tendon anchor is still attached to the bone | Rarely |
| Type II | The superior labrum and the biceps tendon anchor are completely detached from the top of the shoulder socket | Not typically; only if conservative treatments fail |
| Type III | A “bucket-handle” tear where the torn part flips into the joint and the biceps tendon anchor is intact | Not always, but frequently |
| Type IV | A “bucket-handle” tear that extends into and splits the biceps tendon | Yes, frequently |
What Are the Symptoms of a SLAP Tear?
When a person experiences a SLAP tear, it often causes noticeable symptoms. They include:
- Deep, aching shoulder pain
- A clicking, grinding, or popping sensation
- Shoulder instability and weakness
- Difficulty reaching overhead
Type I SLAP tears may only cause mild symptoms, while Type III and IV tears can cause severe symptoms.
What Are the Risk Factors and Causes of a SLAP Tear?
There are three main causes of most SLAP tears. They include:
- Sudden trauma: An acute injury, such as a direct blow to the shoulder, a fall onto an outstretched arm, or a forceful pull on the arm, is a major cause of SLAP tears.
- Repetitive overhead movements: People who participate in sports, such as volleyball, tennis, or weightlifting, or who work jobs with repetitive overhead movements experience chronic stress on their biceps and labrum tendons. This repetitive stress can weaken the tissue over time, resulting in SLAP tears.
- Aging: Aging causes the labrum to weaken over time, which makes it susceptible to wearing with minor stress.
There are certain risk factors that can increase a person’s vulnerability to a SLAP tear. These include being over age 40, participating in sports with repetitive overhead motions, and having joint instability.
How Is a SLAP Tear Diagnosed?
When a patient comes to Interventional Spine & Surgery Group with symptoms of a SLAP tear, they’ll need to undergo a thorough diagnostic process to confirm whether a tear is the cause of their symptoms. Here’s what you can expect:
- Physical exam: During the physical exam, the doctor will ask about your symptoms and medical history and examine your shoulder to check its mobility, stability, and strength. They will also look for any bruising or swelling.
- Diagnostic tests: To help determine whether the issue is a SLAP tear or another type of labral tear or shoulder condition, specialized orthopedic tests are often used. These include the O’Brien test, the crank test, and the biceps load test, which isolate the labrum and biceps attachment to see whether a SLAP tear is a likely diagnosis.
- Imaging scans: Imaging scans are the best way to confirm a SLAP tear. The gold standard is called a magnetic resonance arthrogram (MRA), which combines a standard magnetic resonance imaging (MRI) with contrast dye injected into the shoulder to highlight tears.
Through the information collected during the diagnostic process, the doctor can confirm or rule out a SLAP tear.
What Are the Treatment Options for SLAP Tears?
When it comes to treating a SLAP tear, both non-surgical and surgical methods can be used. Many SLAP tears are managed conservatively before considering surgery, although surgery is often necessary in severe tears. Treatment methods include:
Non-Surgical Treatments
The conservative, non-surgical treatments that doctors may prescribe for SLAP tears include:
- Rest and activity modification: To give the labrum and bicep tendon time to heal, the doctor will often suggest modifying or limiting activities that stress them. This may mean limiting overhead reaching and heavy lifting or taking a break from sports like tennis, weight-lifting, and swimming.
- Medications: A SLAP tear can cause pain and inflammation, so over-the-counter medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are often suggested to reduce swelling and pain during healing. They can help reduce discomfort so patients can participate in physical therapy.
- Physical therapy (PT): Physical therapy is a major part of SLAP tear treatment, helping the patient improve stability, rebuild strength, and restore their range of motion. Using targeted exercises, PT can help the patient strengthen their rotator cuff and scapular stabilizers to protect the healing tendon and prevent re-injury.
- Injections: The doctor may also recommend corticosteroid joint injections in the shoulder to provide targeted pain relief if other conservative methods don’t provide sufficient relief.
Surgical Treatments
In some cases, surgical treatment is recommended for SLAP tears. It is most often used when the tear is type III or IV and results in significant instability, or if conservative treatments haven’t worked within three to six months. There are three types of procedures that may be used for SLAP tears, which are all typically performed arthroscopically (using a tiny camera and specialized instruments inserted into small incisions). They include:
- Debridement: This is when the surgeon trims away the torn or frayed parts of the labrum to leave a smooth edge. It is generally reserved for older patients or minor tears where the biceps tendon is completely stable and uninvolved (type I).
- SLAP repair: This procedure involves reattaching the torn labrum to the shoulder socket using surgical anchors and sutures. It is often the approach for people who are younger, physically active, and want to maintain maximum shoulder strength and mobility.
- Biceps tenodesis: This is when the surgeon detaches the biceps tendon from the torn labrum and reattaches it to the upper arm bone (humerus). It relieves tension on the labrum and stops the biceps from pulling on the injured area. This procedure is most often used for severe tears or for older patients.
At Interventional Spine & Surgery Group, orthopedic procedures are performed by Dr. Deramo, a board-certified orthopedic surgeon who has experience with a variety of injuries involving the musculoskeletal system. He uses this experience to determine the best treatment method for each patient with a SLAP tear, whether it’s surgery or conservative care.
Explore Treatment for SLAP Tears Near You in New Jersey
Patients with SLAP tears can get fast treatment at Interventional Spine & Surgery Group. Whether the tear is type I or type IV or requires non-surgical or surgical treatment, our multidisciplinary team can provide patient-centered, high-quality care. We can see you now, we care, and we’ll help you get better. To learn more about SLAP tear treatment or to book an appointment near you in central or northern New Jersey, contact us today.
Frequently Asked Questions About SLAP Tears
What is a SLAP tear?
A superior labrum anterior to posterior (SLAP) tear is when the top of the labrum (glenoid), where the bicep tendon attaches, gets torn or damaged.
What are the symptoms of a SLAP tear?
The symptoms of a SLAP tear include:
- Deep, aching shoulder pain, especially during overhead movements
- Popping or clicking sensations during shoulder movements
- Shoulder instability
- Weakness
How is a SLAP tear diagnosed?
SLAP tears are diagnosed through a combination of a physical exam, orthopedic tests like the O’Brien test, and imaging scans, most commonly a magnetic resonance arthrogram.
Can a SLAP tear heal without surgery?
Yes, many SLAP tears can heal without surgery, especially Type I and II tears. They are treated with conservative treatment methods like activity modification, physical therapy, medication, and steroid injections.
What is the difference between a SLAP tear and a labral tear?
A SLAP tear is a type of labral tear. A general labral tear causes the ring of cartilage in the shoulder joint (labrum) to tear. A SLAP tear is a specific tear that occurs at the very top of the labrum where the biceps tendon attaches.
What are the types of SLAP tears?
There are four main types of SLAP tears, which are classified by the structural damage of the labrum and biceps tendon. They include:
- Type I, where the superior labrum is degenerating, but the biceps tendon anchor is still attached to the bone
- Type II, where the superior labrum and the biceps tendon anchor are completely detached from the top of the shoulder socket
- Type III, where the torn part flips into the joint, but the biceps tendon anchor stays intact
- Type IV, where the torn part of the labrum extends into and splits the biceps tendon
What type of SLAP tear needs surgery?
Type IV SLAP tears frequently require surgery, and type II and III tears also often require surgery.
How long is recovery after SLAP repair?
The recovery timeline after SLAP repair ranges from four to six months for daily activities and up to nine to 12 months for overhead sports.