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.
Brian Gunning
DR. Luks: I am a 70 year old male and had a posterior dislocation as a result of 100% of my 200 lbs falling directly on my left shoulder. It has been 10 months and many visits to my orthopd plus 30 PT secessions.
I have had little or no reduction in pain on any movement above my shoulder. My Doc knows its a labral tear but is hesitant to do surgery because it might not relieve my pain. He won’t tell me if waiting another year of pt will help.I haven’t been able to swing a golf club for the 10 months.
What is your opinion and explanation of no reduction of pain if I have the surgery ?n( The docs concern )
Thank you
Howard J. Luks, MD
Try to get another opinion … it is unlikely (but not impossible) that the labrum is the source of your pain. Without a good exam and discussion I can’t tell for sure.
Ruthie Casey
Dr. Luks
I am a 38 yr old active person. i lift weights 4-5 x a week. Recently my son and I went on a bke ride, and i had an accident and fell on my left arm and shoulder. Almost immediately I lost movement and now cannot even do ROM. My brain knows that i want to lift my arm and I try to tell it thats what we are going to do, but it just lays there. i have to use my right arm to pick it up and move it, and the pain is unbearable. MRI showed a slap tear but also showed a tear involving the inferior glenohumeral ligament. I see that surgery is not recommended for slap tears.. this is all french to me and I have no idea what i am looking at. this accident happened Thursday of last week and I still am unable to move it. It feels almost detached, as if it is just hanging and heavy. MRI also said i have moderate osteoarthrosis if the acromioclavicular joint with downward sloping of the acromion, and increased signal within the supraspinatus tendon near the insertion suggestive of tendinosis. Any thoughts or advice? Am I looking at possible surgery?
Howard J. Luks, MD
This is not unusual for rotator cuff strains… and what might have been a dislocation that spontaneously reduced. The shoulder takes a long time to recover. Physical therapy is generally the answer… and you need to alter your expectations… it can take weeks to months to recover from these injuries.
Karina
Hi. My name is Karina im 14 and I play volleyball. I plan on playing volleyball all through highschool and hopefully through collage. I am a front row hitter and hit all 3 positions. Last May I was diagnosed with a Slap tear. I have been given cortisone shots and they have helped for a few weeks but it has started to hurt non stop again. I am able to play with ice and pain meds but still very sore. I’m afraid that taking a season off from volleyball to get surgery will affect my chances of getting scholarships and will affect my chances of being able to play at my best potential. Should I risk getting the surgery or just wait until it gets to the point that I can’t play?
Howard J. Luks, MD
I’m sorry Karina… I can’t make that decision for you. It is not an easy decision. Good Luck !
Paul Pav
Hi Dr Luks.
I guess when you took the the Hippocratic Oath, you really believed in it. It’s so encouraging to see that there is still Doctors who care enough to answer hundreds of questions online.
I’m 19years old and have been lifting weights for the last 2 years. Recently I developed a lot of pain in my shoulder and went to see an orthopedic doctor who did an ultra sound test on my shoulder, and thinks I have some kind of a labrum problem . He recommended PT for 2 months and then I should see him again after that. Can PT make things worse with out knowing 100% what’s causing the pain and discomfort? What test would you recommend? Thank you so much in advance! PS Sorry for if my English is not that good.
Howard J. Luks, MD
there is very little chance that therapy will make something worse. Sound like you have a smart doc. Not all joint pains require an MRI.
Good Luck !
Chris McKinley
Hello Dr Luks,
Thank you for your article. I’m a 32/yr old male, die hard surfer. I had a SLAP repair two years ago. Somehow I re-tore and now have a SLAP tear in both shoulders. Is the success of surgery dependent upon how damaged the shoulder is? I’ve put off surgery this time around but don’t want to make my chances of recovery worse. I want to do whatever it takes to be able to continue paddling with full ROM (which I can do currently). I’ve seen 3 doctors, each recommending a different procedure (SLAP repair, biceps tenodesis, and biceps transfer). I would truly appreciate your input here, I don’t want to jeopardize my ability to surf in the future.
Howard J. Luks, MD
If you’re fine now why are you considering anything? For bothersome SLAP lesions most of the literature shows that a tenodesis is preferred over a repair… especially in the absence of instability