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.
Jimmy
I had surgery in December 2014 to repair a SLAP tear, 12:30-6:30 with 5 anchors on my right shoulder. Around the same time I was having pain in my left shoulder. I rehabbed my right shoulder and now 6 months out am fairly happy with the result. My left shoulder has gotten progressively worse in that time, I’ve had two cortisone shots, multiple rounds of physical therapy and the MRI shows labrum tear and cyst. I don’t have dislocations or major instability. I dislocated my shoulder in 1997 and assume I tore my labrum then. The pain in my left shoulder is worse than it ever was in my right and nothing seems to help. I’m hesitant to have SLAP surgery again but will if I have to. What is your experience with just biceps tenodesis? I’ll be 40 in 1 month I’m not sure if I’m mentally up to the rehab of a full slap repair again.
Howard J. Luks, MD
Hi Jimmy ! I would love to help you with your questions. You can find me on Curely where I can answer questions by text or email … Join me there. http://www.curely.co/
Howard Luks MD
Seth
Separated shoulder, fell on shoulder
1. Findings consistent with grade 2 acromioclavicular sprain with acromioclavicular ligament and
capsular rupture and moderate to large joint effusion. There is bony edema involving the distal
clavicle and acromion without fracture. There is sprain of the coracoclavicular ligament without
coracoclavicular interval widening.
2. Findings consistent with SLAP type superior labral tear with extension of labral tearing through the
anterior glenoid labrum. There is a paralabral cyst adjacent to the anterior labrum.
3. Suspect very small chronic impaction fracture along the posterolateral humeral head. There is no
bony Bankart fracture. No anterior-inferior inferior glenoid labral tear seen. There is normal
alignment of the glenohumeral joint on this exam.
4. Intact rotator cuff tendons and biceps tendon.
Your thoughts? Been over two months and pain is not getting any better. Surgery?
Howard J. Luks, MD
Hi Seth ! You can find me on Curely where I can answer questions by text or email … Join me there. http://www.curely.co/
Barbara
I understand that a SLAP repair is not as successfull in persons over 40 and these are usually degenerative lesions. But what about a tear from a trauma? Would those be different?
Howard J. Luks, MD
Good question … we might approach those differently if the pain persists after time, PT, etc… But a biceps tenodesis might still be the best procedure. It’s a judgement call at the time of surgery…. if surgery is needed.
Glenn Jones
Hi Doctor Luks,thanks for your reply in Janurary about my slap tear in my left shoulder.I took your advice thank God. My chiro gave me exercises to do,I changed my swimming technique and now I have full movement back in my left shoulder with no pain.Also I’am swimming the same times with less effort.A neighbour had the same problem as me.His shoulder was operated on last October,he is still in a lot of pain and does not have full movement yet. Thanks heaps,that could have been me.
Cheers Glenn Jones Melbourne Australia
Howard J. Luks, MD
So great to hear that Glenn !!! :-) Feel free to drop us a note, video or recommendation :-) https://www.facebook.com/Howard.Luks.MD
Again… great news!!
Cheers
Linda
Husband and sons say slap tear labrum surgery is the best for 15yr old boys. I say there is nothing surgery Can’t make worse and its the course of last resort. They think surgery fixes I say it may just repair. Thoughts on surgery for 15yr old rugby playing wrestler driven by seasons and not his future body health.
Howard J. Luks, MD
You are correct … the only surgery without risk is the surgery that didn’t take place. Only a small percentage of SLAP lesions need to be fixed.