Labral and SLAP Tears

Shoulder Labral Tear

The shoulder joint is a "ball and socket" joint that enables the smooth gliding and thereby the movements of arms. However it is inherently unstable because of the shallow socket. A soft rim of cartilage, the labrum lines the socket and deepens it so that it accommodates the head of the upper arm bone better.

Causes

Traumatic injury to the shoulder or overuse of shoulder (throwing, weightlifting) may cause labral tear. In addition ageing may weaken the labrum leading to injury.

Symptoms

Shoulder labral tear injury may cause symptoms such as pain, catching or locking sensation, decreased range of motion and joint instability.

Diagnosis

Shoulder labral tear is often diagnosed with symptoms, history, physical examination and radiological techniques. Magnetic resonance arthroscopy may be more appropriate for diagnosing shoulder labral tear.

Conservative Treatment Options

Your doctor may start with conservative approaches such as prescribing anti-inflammatory medications and advice rest to relieve symptoms until diagnostic scans are done. Rehabilitation exercises may be recommended to strengthen rotator cuff muscles.

Surgery

If the symptoms do not resolve with these conservative measures, your doctor may recommend arthroscopic surgery. During arthroscopic surgery, your surgeon examines the labrum and the biceps tendon. If the damage is confined to the labrum without involving the tendon, then the torn flap of the labrum will be removed. In cases where the tendon is also involved or if there is detachment of the tendon, absorbable wires or sutures will be used to repair and reattach the tendon. After the surgery, you will be given a shoulder sling to wear for 3-4 weeks. You will be advised motion and flexibility exercises after the sling is removed. These exercises increase the range of motion and flexibility of shoulder joint.

SLAP Tear

The shoulder joint is a ball and socket joint. A ‘ball’ at the top of the upper arm bone (the humerus) fits neatly into a ‘socket’, called the glenoid, which is part of the shoulder blade (scapula). The term SLAP (superior –labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder. The labrum is a ring of fibrous cartilage surrounding the glenoid for stabilization of the shoulder joint. The biceps tendon attaches inside the shoulder joint at the superior labrum of the shoulder joint. The biceps tendon is a long cord-like structure which attaches the biceps muscle to the shoulder and helps to stabilize the joint.

Causes

The most common causes include falling on an outstretched arm, repetitive overhead actions such as throwing, and lifting a heavy object. Overhead and contact sports may put you at a greater risk of developing SLAP tears.

Symptoms

The most common symptom is pain at the top of the shoulder joint. In addition, catching sensation and pain most often with activities such as throwing may also occur.

Diagnosis

Diagnosis is made based on the symptoms and physical examination. A regular MRI scan may not show up a SLAP tear and therefore an MRI with a contrast dye injected into the shoulder, is ordered. The contrast dye helps to highlight SLAP tears.

Treatment

Your doctor may recommend anti-inflammatory medications to control pain. In athletes who want to continue their sports, arthroscopic surgery of the shoulder may be recommended. Depending on the severity of the lesion, SLAP tears may simply require debridement or some may need to be repaired. A SLAP repair can be done using arthroscopic techniques that require only two or three small incisions.

Regular exercises that make the shoulder muscles strong should be done. Adequate warm-up exercises before activities and avoiding high contact sports can help prevent injuries that cause instability.