SLAP Tear

People often ask which one is worse. Often it isn't one or the other.

SLAP lesions are hard to diagnose because they look very similar to shoulder instability and rotator cuff problems ^4,9. Over 40, wear-related SLAP tears become more common, and rotator cuff trouble is a common source of pain at that age too ¹. How serious yours is depends on the type of tear, what else is injured and what you need the shoulder to do.

No single test settles it either. An MR arthrogram (an MRI with contrast injected into the joint) is the usual scan. It's reported to pick up 82 to 100% of tears, but normal variations in the labrum can be mistaken for one ⁹. Ultrasound can give clues, but a diagnosis can't be made on ultrasound alone ². On examination, clinicians combine several tests. One positive out of three catches about 75% of real tears, but you need all three positive before the result is about 90% specific, meaning few false alarms ¹¹. That's a real limitation, and it's why a scan report alone shouldn't set your treatment plan.

Diagnosis starts with your story and a hands-on examination. We'll ask when the pain began, whether there was a specific injury, and which movements at work or in sport set it off ⁶. Then we check the shoulder's range of motion, strength and stability, and place your arm in different positions to see if that brings on your symptoms. We may examine your neck too, in case the pain is coming from a pinched nerve ⁶.

What we find decides whether you need imaging ⁶. An X-ray won't show the labrum, but it can rule out arthritis or a fracture ⁶. Relying on MRI alone over-diagnoses labral problems, so the examination carries the most weight in working out what's actually causing the pain ⁴.

For the vast majority of SLAP injuries, the first treatment isn't surgery ^1,3:

Be sceptical of confident numbers here. Reported success for conservative care runs from 22% to 85% ⁹, an enormous range that largely reflects your goals and the level you're returning to ⁹. A club cricketer and an elite professional thrower are asking different questions.

Anti-inflammatory medication. It's commonly used in early care ^1,6, and it can make the first weeks easier. Talk to your GP or pharmacist about it, because physiotherapists don't prescribe medication.

Cold packs. Also part of the documented early management, and useful for comfort ¹. Nothing suggests they change the tear itself.

Surgery: described here, not recommended. Well Motion doesn't perform surgery or decide who needs it, but you deserve to know what's involved. A SLAP repair is done by keyhole (arthroscopic) surgery through two to four small incisions of 5 to 7mm. It reattaches the labrum to the socket to reduce symptoms and restore stability ³. Type II tears are reattached or treated with a biceps procedure, and Type III bucket-handle fragments are usually removed ¹. Biceps tenodesis moves the biceps tendon's attachment point. It's increasingly used instead of repair, because SLAP repair has had high rates of revision and complications ⁵.

Read the surgical numbers carefully. Operative success is reported at 80 to 97%, but those studies varied widely and defined "successful" in different ways ⁹. For overhead athletes, getting back to their previous level ranges from 7 to 84% ⁹. After biceps tenodesis, 70% of overhead athletes returned to sport, and complication rates ran from 0% to 14% ⁵. Surgery is generally considered when non-operative treatment hasn't improved things ³. That decision belongs to you and an orthopaedic surgeon, after a proper trial of rehab.

Post-operative rehabilitation. If you've had surgery, this is where we have a real role. You wear a sling, including in bed, and shouldn't lie on the operated shoulder for the first six weeks ³. Functional movement usually returns by 8 to 10 weeks, and gains keep coming more slowly for up to a year. Most people return to sport and full activity by around six months ³.

Rehab for a SLAP tear follows The Well Motion Recovery Path™. You step up a phase on what the shoulder can do, not on a date.

• Reset: while the shoulder is irritable. Relative rest, a break from throwing ^1,3 and cold packs for comfort ¹. Expect to keep using the arm below shoulder height. We move you on once everyday reaching stops flaring it. After surgery, your surgeon sets the pace ³.
• Rebuild: the longest phase. Sports physiotherapy aimed at the posterior capsule and shoulder blade control ⁴, with manual therapy to help the capsule move. Expect slow gains: the stretching is described as a long, arduous process ⁴. We move you on when the shoulder stays settled through the range your sport or work asks of it.
• Return: throwing, overhead work or lifting, rebuilt in stages by retraining the movement itself ² and tested at the speed you need. You leave with a warm-up shoulder program and a daily stretch for the back of the shoulder, the closest tested guides for throwers ^7,8.

How long it usually takes. In one cohort of 63 people with an isolated type II tear, 71.4% had done well without surgery at an average of 21 months ¹². It had no comparison group. After a repair, functional movement usually returns by 8 to 10 weeks and most people are back to sport by around six months ³.

No trial has tested preventing SLAP tears on their own. What has been tested is preventing shoulder injuries in throwing athletes, and that's the closest guide:

• Put shoulder exercises in your warm-up. In a trial of 660 elite handball players, teams that did a shoulder programme three times a week in their warm-up had a 28% lower risk of shoulder problems over the season ⁷. The exercises worked on inward rotation, outward rotation strength and the muscles around the shoulder blade ⁷.
• Stretch the back of the shoulder every day. Among 92 high school baseball pitchers, 25% of those who stretched it daily had a shoulder or elbow injury, against 57% of those who did no programme ⁸. The pitchers chose their own groups, so read that as a hint.
• Build up gradually. A jump in activity can inflame the shoulder and weaken the rotator cuff (the small muscles that steady the joint), which leaves it less stable ⁴.
• Have your throwing checked. A qualified professional can assess your throwing mechanics and confirm the shoulder blade is held in a good position ⁴.