SLAP lesions are a unique type of labral tear in the shoulder. SLAP lesions occur in overhead athletes due to chronic repetitive stress. But many SLAP lesions are simply due to aging. How should your SLAP lesion be treated? MRI machines have become more powerful and radiologists have become better at interpreting the findings. Perhaps that is why shoulder surgeons have noticed a significant increase in the number of SLAP lesions being diagnosed across all age groups. It is important to bear in the mind the research of DePalma performed over 70 years ago. During his autopsy studies, he found that more than 75% of people over 60 had labral tears in the shoulder. Simply stated that means that the majority of these tears are not bothersome, do not hurt you and thus do not, in and of themselves require surgery. Again, as hard as it is to hear, sometimes our parts simply wear out. So it is important that we listen to you describe your symptoms, correlate that with a proper physical exam and then determine if a SLAP lesion is the cause of your pain.
What is a SLAP lesion or SLAP tear?
The two terms are synonymous. They mean the same thing. As the picture above shows, a SLAP lesion involves the tear of the glenoid labrum from the top of the socket of the shoulder.
The superior labrum serves as the attachment for our biceps tendon inside the shoulder. The labrum plays a role in the stability of the shoulder. It helps keep the shoulder well seated within the socket during aggressive overhead activities such as pitching, swimming and playing volleyball. The superior labrum does not come into play from a functional perspective during our normal daily activities of dressing, feeding, cleaning, weeding, gardening, running, cycling, etc.
Why do SLAP lesions hurt?
SLAP lesions can lead to a unique form of instability (where the shoulder is “loose”), and as previously mentioned, primarily occurs in overhead athletes. When the shoulder is loose because of a SLAP tear, and the player puts their arm up in the throwing position they may feel pain in the back of the shoulder. We call this “internal impingement”. This occurs because the SLAP tear has led to a very subtle loosening (not enough for the shoulder to dislocate) which will hurt when the superior labrum (where the tear is) is stressed.
Does a SLAP Lesion require surgery?
A troubling study was just released …
A study in May 2012 issue of The American Journal of Sports Medicine reflects this trend (towards operating on too many SLAP tear). Alan L. Zhang et al looked at insurance data collected for over 11 million patients from 2004 to 2009. They found a remarkable 105% increase in SLAP repairs performed across the United States between 2004 and 2009.
The 20-29 year and 40-49 year age groups had the highest incidence of SLAP repairs. Males comprised approximately 75% of those surgical patients. Interestingly, SLAP repairs were performed more often in the West and the South compared to the Midwest and Northeast.
The majority of SLAP lesions or tears encountered in a typical orthopedists office do not need to be repaired and are usually not the source of pain. Even if the surgeon believes that the tear might be the source of pain, the results of repairing SLAP lesions has been relatively poor in patients over 35-40, so many researchers suggest that the tear not be fixed and that a biceps tenodesis be performed ( anchoring the biceps on the humerus and taking the stress off of the superior labrum.
SLAP lesions found in young pitchers, volleyball players, tennis players and swimmers can be fixed if the tear is leading to significant pain and the inability of the athlete to perform at their usual performance level. They do, however, have the option of changing positions, etc and not having surgery. But bear in mind, just because a SLAP lesion is fixed, does not mean you will return to pitching.
The results of SLAP lesion repairs and return to sports is also mixed. Some reports show that athletes can return to their prior performance levels, yet some recent literature shows that that might not be the case. The jury is still out on this.
Bottom line:
SLAP lesions are very common. Just because you have one, does not mean you need surgery. If you are an overhead athlete and have internal impingement due to a SLAP tear you may choose to have surgery – but you may not be able to return to your prior level of functional performance. Tough decision.
Scarlett
Hi i am 15 and I fell on my shoulder at cheerleading last night it hurt heaps at first but now it is sore but not unbearably sore. When I lift my arm it seems to pop out and pop in when I put it down. What do you recommend I do?
Howard J. Luks, MD
You should see an Orthopedist.
mark paterson
Hi , two and a half years ago i underwent rotator cuff surgery , the ultrasound indicated i had a 15mm x 13mm full thickness tear to the supraspinatus , shortly after surgery i was told they also repaired a full thickness tear to my subscapularis at the same time.
I am 49 years old now and very active and always have been re work and at the gym , ten months ago i had an mri scan because of weakness and mild to moderate aching pain in my effected shoulder , some of the findings on the mri report are – moderate ACJ arthropathy evidence of previous surgery with marked tendinopathy/scarring of the subscapularis tendon attachment .
poorly defined proximal biceps tendon without definite retraction.
There is an impression of a superior labral tear.
Extensive partial thickness tearing of the supraspinatus tendon attachment both on the articular and the bursal side , with an intrinsic cyst extending along the musculotendinous juction but no significant retraction or associated rotator cuff muscle atrophy.
I feel i am 50% weaker since surgery and still cannot sleep on my right side , but my severe pain i had before surgery has vastly improved which i am grafeful for .
My concerns are is this/these tears , do they need surgical repair , my job entails my arms being over my head alot throughout the day and my dominant arm my right side is now 50% weaker than prior which really is also effecting my gym training as well as my work .
Howard J. Luks, MD
Your weakness is more than likely related to your rotator cuff. If physio is not successful at restoring your strength, perhaps a regenerative solution such as Rotation Medical patch might be useful.
howard luks
Jennifer Clinard
Dr. Luks,
I’m a 39 year old female, avid golfer, professional graphic designer. I started having severe shoulder pain about a year ago. Without imaging, I was diagnosed with a strained trapezius. I underwent physical therapy for about two months to no avail. No improvement, just discouragement. Approximately two months ago I began experiencing numbness in my outer two fingers, in addition to the already existing pain. I had an MRI which revealed the following:
1. Tear of the superior and posterosuperior portions of the labrum with a 14x6x8 mm posterosuperior paralabral cyst which extends into the spinoglenoid notch.
2. Mild lateral down sloping and mild thickening of the coracoacromial ligament of the acromion which could be associated with shoulder impingement.
I meet with a specialist on Friday but in the meantime, could you please explain what all of this means? I’m confused and really need relief from this pain.
Thank you.
Howard J. Luks, MD
Hi Jenn … THe labrum is a soft cartilage disc that sits on and surrounds the socket or glenoid of the shoulder. If there is a tear in the upper back of the labrum (posterior-superior), then fluid can leak out of your shoulder joint, under the tear and cause a cyst. The issues with cysts in that area and that they can press on a nerve to that region and that can lead to pain. Without examining you I can not tell you if that is the cause of your pain… but a good shoulder doctor should be able to confirm that. https://www.shoulderdoc.co.uk/article/1496 Here’s a good discussion which will show you what I’m talking about :-)) He has a better graphic artist than me :-)))
‘Good Luck
Victor
Dr. Luk,
I am glad I found this page and hope you can help me out or at least help me come to a decision. I just turned 24 years old and have shoulder pain. I have fully range of motion, but the shooting pain comes and goes at different instances, sometimes its there in certain positions. It started back in the beginning of January which I believed occurred from lifting two very heavy boxes on my left shoulder at work. Something that I dont normally do especially that weight. I felt my shoulder sore and went to the employer’s doctor who said it was bicep tendinitis, and therefore said to put ice on it. It didn’t work! After 4 weeks, I went to my doctor who sent me to physical therapy for a month, but even after that I still had shooting pain on my shoulder. I had an MRI done which showed a small tear and was sent to an orthopedic who had me do another MRI with contrast which resulted in his opinion that I did have a labral tear and needed surgery to fix it. According to the radiology report it says under, Impression: “redemonstration of subtle tiny glenoid labral articular disruption; question sprain of the superior glenohumeral ligaments or coracohumeral ligament; Mild tendinosis of the supraspinaturs, infraspinaturs, and subscapularis tendons. Small partial thickness undersurface TEAR of the supraspinatus tendon.” I booked the surgery with him for July 16, 2015 to secure the booking. I went to a second opinion to a doctor who is said to be of the best orthopedics in my city (and is one of the orthopedics for my city’s baseball and basketball team) but what confused me is that he said that I do not need surgery! I asked him that how long would it take then to heal if it wasn’t a tear as the other doctor had mentioned, and he said to just give it time, for which I asked him how much more time since it’s already been more than 5 months and it does bother me still. He didn’t say specifics, just said to give it more time. So now I am here, confused, nervous, and I have to admit I am scared to making a wrong decision about having the surgery done or not. I do not know why one doctor says I do need surgery and the other doesn’t. Please help, any advice or comments would help me in making a final decision. (If it helps to know my current activities, they are: studying most of the day at a desk, work one day a week, and in the near future office work which might involve driving to different locations.). Please help. Thank you for your time.
Howard J. Luks, MD
I agree with your second opinion … physio therapy and time are your best options right now.
Victor
Thank you for your quick response. So even though it is a tear, it can still heal with time? Or you dont think its a tear, based on the second doctor’s opinion? Im worried that if I dont do the surgery and it is a tear even if its small that it could get bigger, that is why I dont do things that can make it bigger if thats the case. Would you say that I can exercise, lift, etc. ? Is there a certain amount of time on your part that you believe would do it and heal? If its not a tear, I dont understand then why I have pain for so long…