Athletes who are involved in repetitive throwing or lifting activities (baseball players, football players, dancers, weightlifters) are particularly prone to shoulder SLAP tears.
The shoulder joint is composed of three bones (the scapula, clavicle and humerus). The head of the humerus (upper arm) fits into a small depression in the shoulder blade called the glenoid. The labrum, composed of tough fibrous tissue, serves as the attachment point for the ligaments of the shoulder and also the bicep tendon. The labrum is located on the outside edge of the glenoid and helps to stabilize the shoulder.
SLAP (superior labrum anterior and posterior) injuries can be caused by both an acute injury and wear and tear. Forceful pulling on the arm (i.e. catching a heavy object) and forceful or rapid movement of the arm when it is above the level of the shoulder (i.e. throwing a ball) may cause a traumatic SLAP tear. Repetitive sports that involve lifting or throwing may result in the wearing down of the labrum. Aging also causes the labrum to wear down, making it more prone to injury.
SLAP tears may cause pain (especially when lying on the shoulder or trying to maintain a specific arm position), crepitus (grinding, popping or cracking with movement of the shoulder), decrease in shoulder strength, loss of range of motion and a sensation that the shoulder/arm is going to “give out”.
Diagnosis is based on history, physical examination of the shoulder during specific types of movement, x-ray (to rule out bony abnormalities) and sometimes MRI to better visualize the labrum. Treatment is aimed at relieving pain using anti-inflammatory drugs, rest and physical therapy to restore movement and strength.
When non-surgical means fail, arthroscopic surgery to determine the extent of the damage and repair the damaged labrum may be recommended. Following surgery, the shoulder is immobilized for two to four weeks, then physical therapy is done to improve range of motion and flexibility and decrease shoulder stiffness.