Slap Lesion Labral tear
Labral tear- SLAP lesion

 

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.

Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

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About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

125 comments on “SLAP Lesion Treatment : Video discussion: Surgery vs No Surgery

  • Dear dr Howard Luks,

    I’m 22 year old female with diagnosed SLAP type IV tear. I consulted two doctors and they reccomend me the surgery. I’m a sport climber and I cannot imagine my life without this activity. But I also cannot imagine a life with disabled arm (I want to have kids and function normally).
    So the question is: should I do the surgery? Will it be worse if I don’t do it or if I do it? One doctor suggested tenodesis but this is madness, I’m too young for such a surgery, so I didn’t agree for it.
    The injury is quite old (about 5 months), but it bothers me in normal life and every-day activities. I do physiotherapy and it helped a bit (with pain and range of movement), but still I cannot do any overhead activity (even just hanging on a horizontal bar). I do realise it is impossible to make an orthopedic consult over the internet, but maybe you could tell me if there are ANY alternative methods of SLAP treatment than surgery?

    best regards,

    Paula Augustyniak

    • Paula… you are correct.. it’s tough to make a diagnosis and suggest a treatment regimen using the comment section :*). Whether or not a SLAP repair is necessary is based on a thorough exam to be sure that your complaints and findings are consistent with a SLAP lesion. As you know, a type IV SLAP lesions involves the biceps tendon itself. Although rare, there are occassions when a biceps tenodesis is necessary if the tear within the biceps extends up into the part (of the biceps) that exits from the shoulder to head down the arm towards the muscle. I hope this makes sense!
      Howard Luks

  • Dear Sir,

    Thank you for the answer! I’m a little bit calmer now (when thinking about the surgery). My surgery is scheduled for December 5th, so it’s soon. My surgeon uses normally Johnson&Johnson Mitek Lupon or Gryphon suture anchors. I’m afraid that I’ll have an allergy reaction. I have really strong allergy to almost everything. I read that the products of decompose of bioabsorbable suture anchors cause an immune response quite often. Are there any tests I could do? Or I should go for titanium anchors? Or maybe it’s so rare I should not worry?

    best regards,

    Paula Augustyniak

    • I’m a fan of metal hardware and anchors for many reasons. Especially since many bio anchors leave a cyst when they absorb. That being said, there are circumstances when bio anchors are a good choice too :-) . But the choice of anchor will not affect the results of the surgery. Most anchors hold within the bone just fine. Talk to your doctor to express your reservations.
      Good Luck

  • Dear Dr. Howard Luks,

    Thank you for this article. I have gone through a series of different diagnosis on my shoulder. First was irritated Rotator Cuff which sent me to therapy for 6 weeks. The pain I was experiencing did not go away. I was then treated for Bursitis and given an injection. Most recently I had an MR Arthogram and was diagnosed with a SLAP Type II Tear of the Labrum. I coach multiple sports and have noticed a distinct weakness and pain when both throwing a baseball or shooting a basketball. Reading your article makes me wonder what you thought my options would be if I did not opt to have surgery.

    • Eric … I think you have a pretty good idea about what your life is like without surgery. As you know, surgery is not necessary for many people with labral tears. In addition, keep in mind — for people over 35-40 the recommended treatment for a SLAP lesion is usually a biceps tenodesis… and not simply a labral repair.

      I hope this doesn’t confuse you further and provides you with something to discuss with your surgeon.
      Good Luck
      Howard Luks

  • Hi there… thank you so much for this article. Iam a 50 year old very active female .. as a child I had a few dislocations to my left shoulder.. and have been lifting weights now too for at least 30 years.. regularly… until this year, I had basic pain… then I heard a pop and it all started. Fast forward.. Dr. thought on initial consult it was a bicep tendon strain so gave me an injection and asked me to rest.. I did .. not much changed.. so I went back to the gym.. and left out the overhead lifts… started to get tingling and loss of strength in my arm and hand.. so went back to Dr.. still thought it was Bicep tendon.. ( only an X-ray at this point) .. so I had two injections this time.. 6 weeks later with complete rest.. only getting worse. I called and asked for an MRI.. MRI ( I had one without contrast ) .. MRI proved to show SLAP tear with paralabral cyst.. took the MRI findings to a new Dr. ( Ortho that did a very successful complete shoulder replacement on my 75 year old mom last year) .. he informed that I have a lot of wear and old injury to include osteoarthritis.. and feels.. that not only do I need the tear repair.. but also possibly will need cadaver cartilage replacement.. as he feels what I have is worn out. I can honestly say.. I am in constant pain, my daily lifestyle is not the same.. and that is without working out even.. I mean just doing nothing hurts.. :( Im terrified.. ! Dr. suggested that if I do not choose this surgery now.. he thinks I will be in the office at a later time.. with a worse condition. ? Im a healthy woman.. very active and I take care of myself.. I just hope this does not take away my lifestyle..? Iam okay with modifying when I need to .. thoughts?

  • I had a MRI and Impression showed I have a Superior Labral Tear. I am 45 and not an athlete but do have a lot of ache pain and with sudden movements it does bring me to my knees with pain (almost spasm feeling). Dr is recommending surgery. If I was to do physical therapy first could it relieve this pain or should I just do the surgery?

    • SLAP repairs in 40 and 50 somethings has a very poor track record. If the surgeon believes that the SLAP is the source of your pain — and it is frequently not the source — then there are other ways to deal with this that have a far better track record.

      Rotator cuff tendinosis, partial tears etc are the most common source of pain in your age group.

      Good Luck!

  • Dear Dr. Howard Luks,
    I understand a proper diagnosis or opinian is impossible to give over the internet but I would still greatly appreciate your opinion on my case. I’m 25, and a professional circus artit specializing in handbalancing. Back in november I was diagnosed with bursitis and a small SLAP on my left shoulder. I had two months of my normal activity pause with intense physiotherapy, which finally worked fine (my shoulder got back to his usual shape and I haven’t had problems since). However, after getting back into training I was scared and heavily compensated on my right shoulder, which after hard training for an upcoming show resulted in what my doctor diagnosed as type II SLAP injury, with the labrum being affected “from 10 to 2”, though no damage had been done to the rotator cuff or bicep tendon.
    Again, I stopped activity for 6 weeks, did physiotherapy, then slowly went back to training. My doctor, who at the same time was operating another friend from SLAP, told me he didn’t consider operation for me at this point, and suggested to keep my life as usual and see how the shoulder felt.
    It’s been 3 months since and overall I can train back at my normal intensity, but sometimes and often for “silly” reasons (like throwing something) I can get very intense pain that travels through the shoulder, normally for 2-3 days to one week, then goes away. This has happened around 4 times.
    A new doctor saw me a couple of weeks ago, because the pain was lasting longer than normally, but after making me do pushing tests in different shoulder positions he still unadviced operation, even though given the damage originally done to my shoulder it’s still possible that I’ll have to have it somewhere in the future.

    I know the operation results are mixed, mostly at my level of activity, and it worries me that if I ever got the operation I wouldn’t be able to come back to my level, after losing a year of work.
    I would also like to know what is your opinion on nutritionnal complements or creams, as organic silicium.

    Thank you very much

    • It’s a difficult decision making process. You are correct. With certain athletes the return to pre-activity levels in not predictable. But on the flip side, if non-surgical management doesn’t allow you to return to your chosen activities then you need to make a decision whether or not the risks of the procedure proposed by your surgeon is outweighed by the potential benefits.

      Good Luck … and get as many opinions as you need until you’re comfortable.

  • Dear dr Howard Luks,

    I fell on a stretched arm three years ago. I’ve been having a lot of subluxations ever since, during overhead activities or even when someone pulled my arm during soccer. I have a teared labrum and a dent in the bone according to the mri I had last week.

    However, at the gym I can still do pullups or pushups for example. I’m extremely careful with overhead presses, because I know my shoulder can fail just like that. Is this thanks to strong rotator cuffs that I am still able to do these things? I mean, for a while my shoulder was way weaker than it is today.

    I am thinking of surgery, because I am afraid the tear might get worse somehow if untreated. Does this make sense? Surgery would take place in 2015, as I need to continue working now.
    Is it unwise to continue doing fitness and occasionally some friendly boxing until that time? I don’t want to make things worse.

    Thank you in advance and kind regards from the Netherlands!

    Tony

    • Hi Tony…
      Most active people who had a dislocation and now have a labral tear, Hill-Sachs lesion (dent) and recurrent instability — will choose to have the shoulder repaired to minimize the risk of dislocating or subluxating again.

  • Dr Luks,

    Im a 34 y/o surgical resident who recently had a SLAP repair of my dominant arm (June 2013). I originally injured the shoulder trying to get back in shape after intern year and was doing a lot of pushups, pullups, etc. i had a hx of grade 3 separation in that shoulder at 20 which i never had repaired and essentially functioned normally until the SLAP tear. i saw an ortho surg, spent over a yr doing conservative management /PT, but still had pain, so i underwent surgery, had 3 anchors 9-12 o’clock, no bicep tendon involvement. It has been over 15 months now and i still have pain in addition to some stiffness compared to opposite arm, painful clicks/pops with certain movements especially overhead and a “jump” on internal rotation when my arm is down at my side. This has worsened recently as Ive been increasing my level of activity. I plan on returning to my surgeon but i would like some advice as well. I realize I may have re-tore, but any thoughts on what else could be causing the symptoms? What are the success rates on re-treats? I’ve oftened wondered if im any better off having done the sx vs not, what’s the success rate on conservative management for persistent pain after single sx? Thank you!

    • Derek …
      SLAP lesions are a difficult problem. The overall success rate is not as high as we like, and the risk of stiffness and persistent pain is fairly high as well. Perhaps a second opinion to determine if the SLAP is the source of your pain to begin with. Once you identify the pain generator, then you can determine the proper treatment plan. A biceps tenodesis is preferred to a revision … and is also preferred as the primary procedure in many circles.

      Good Luck
      Howard Luks

  • We are working on ATHLETES of Gymnastics and Wrestling from INDIAN ARMED FORCES and have found similarities in what Dr Howard Luks says.
    In fact, we are lucky to have 15 years plus follow up of 15 genuine sports men, and have found that most SLAP repairs fail (with or without patients being aware of it). Still most sport men continue to do well as they learn to manage the tear.. We have found that in follow up Xrays 10 out of 15 athletes had their anchors out of glenoid but they were a symptomatic.
    We also believe that SLAP tears like ACL in knees will be causing instability and not pain! In case the pain is associated with evidence of SLAP, open minded clinical assessment is required to rule out other structures/functions which may be the cause.
    Though one may find 15 cases too small a number but 15 years follow up is good enough with extremely active athletes from armed forces of INDIA.
    We are pleased to find this site which talks of facts!
    best wishes
    VIPUL CHAVDA

  • Dr. Luks,

    I had a SLAP repair 5 months ago, 3 anchors but bicep tendon was intact. I have developed a winged scalpula shortly after the surgery. My ROM is worse then before surgery and my shoulder is very weak and pain is pretty constant. My surgeon has me doing scalpular stabilization exercises. They only seem to aggrivate it more….. Is it possible to have nerve damage from this procedure? I have told my surgeon about my symtoms but he just says its due to bad posture? Im a 42yr old male who before surgery was very active and enjoyed wieght lifting and exercising. My therapist says its definately not posture related. Injury was due to direct trauma to shoulder. Any advice would be greatly appreciated!

    Thank You

    • It is time for a second opinion. Without examining you and doing further (nerve) testing I can not tell you why your scapula is winging right now. Sorry.
      Good Luck

  • I am 32 yrs old female and was in a car accident about a month ago.. I had a mri on oct 1 which revealed a flap tear in superior labrum as well as type 3 hook shaped acromion with secondary indentation upon supraspinatus tendon as well as subacromial bursitis.. We tried cortizone shot but it doesnt feel as though it helped much as a matter of fact I am having much worse pain especially while trying to fasten by bra or hold my arms up above my head to put my hair in a ponytail.. They are saying maybe surgery if the shots dont work.. I am a mom and work cutting/ hauling trees, not sure about this surgery or the down time from such a surgery.. Is there any advice that you can share with my family and I about these findings and this procedure?? Thanks :)

    • Hi Shannan…
      Most orthopedic surgeons would try physical therapy after an injury like this. Ignore the type 3 acromion and indented muscle — those have been proven (long ago) not to actually be a source of shoulder pain. A labral repair would be a big deal given your job description. It would be nice if surgery could be avoided.

  • Hi Doc,

    I had a type 2 SLAP repair, biceps tenodesis and a mumford procedure. I had the surgery almost three months ago. Long story short I had another MRI and I was told it was another SLAP tear and edema. How is this possible?

    • This is a very complicated subject. Unfortunately, many SLAP repairs do not work.. and sometimes an MRI will show persistent changes (signal) after surgery, but the tear has actually healed. That can make it difficult to determine whether or not a new tear occurred or the old one didn’t heal. BUT… the more important issue is to determine whether or not the SLAP lesion is the source of your pain. Many many people have SLAP lesions that do not bother them. That means that something else in the shoulder is the source of your pain. Have you considered a second opinion?

      Good Luck

  • Hi Doc,
    Just a “little” background info: I am an 18 year old freshman in college who is playing Division 1 softball. In April I had a labral debridement, MRI had a false-positive for a SLAP tear from I believe from 10-2. Biceps was very red when my surgeon went in but thought PT after the surgery would clear it. Fast forward 7 months and two more rounds of PT later and my bicep tendon pain is increasing as the days go on. This is the worst pain I have ever felt. Surgeon decided he wants to perform a capsulorraphy because he believes my naturally loose shoulders are causing my pain. I asked why not do a bicep tenodesis and they (mainly his physicians assistant) said I was a little too young for them to want to perform that. Just curious what the best thing would be? I don’t understand why you wouldn’t do a procedure that seems to have the best chance of eliminating this pain? I do not want to be going back under for a third surgery because the second one didn’t work out.

    • Great question Alex … The treatment should be geared towards the issue causing you pain. If your biceps is proven to be the source of your pain (u can inject anesthesia using ultrasound to numb the biceps) then a biceps tenodesis can be considered. If your shoulder has subtle anterior instability due to a SLAP lesion, or anterior laxity then a shift or SLAP repair might be the way to go. It’s a call that I can NOT make sitting here. It requires a very thorough exam. You can have a subtle “peel-back” SLAP lesion which can produce instability and is a common finding in overhead throwers. Those can easily be missed by an inexperienced arthroscopist. So… all that was just for your education and was NOT a treatment recommendation [nor “medical advice”]. You need to be examined by a solid shoulder doc. The exam is the key here.. not the MRI findings.
      Good Luck

  • I fell on an arm outstretched to the side which then went behind me. I was wearing a rucksack so had extra weight. X-ray and MRI (without contrast due to allergy) show nothing (no there tears or inflammation) but nearly all the SLAP tear tests Kuhn’s O’Briens etc give me slight pain during the test and more pain after. I have a winged scapula on that side and am doing exercises to try and strengthen the shoulder and sort out posture. It is 8 months since the accident and although I now have much less pain I believe it is because I have worked out new ways of doing things. I am 49 and teach Archery and climbing (though I do not need to participate it helps to be able to demonstrate and I have lost a lot of power especially when my arm is above or behind me. Just holding a telephone to my ear for any length of time gives me pain and my bicep feels sore/tight. My surgeon wants to go in arthroscopically and deal with any problems he encounters including slap repair and tenodesis. My family who are all medical think I should put up with it as I’m ‘managing’ and an op could make things worse!!!?

    • Susie..
      The winged scapula is possibly your biggest issue. Unless the scapula is well positioned and the supporting muscles are functioning normally then the rotator cuff muscles will not work well… and they will tend to be very “cranky”. Unless the winging is corrected, you should not expect your shoulder pain to go away. IF you have a true winging scapula then it is unlikely that a SLAP/tenodesis would help you. For painful biceps tendons we have had fairly good success with ultrasound guided injections into the sheath around the biceps.

      Good Luck!!
      Howard Luks

  • Dr. Luks
    In March of 2013 I underwent surgery for a labrum tear(10-5oclock). The surgery included biceps tenodesis, SAD, DCE, AC and labral debridement. I am a 52 year old male. I have had continuing pain in the top and rear of the shoulder ac joint and spasm in the upper trapezius. The pain gets worse when overhead (145 degrees) and even more so when there is weight in the hand. The pain also happens when I am making a movement like tightening my belt. There is also weakness as well. I have been going to PT and received 2 cortisone shots since the surgery for this ongoing problem. A recent MRI shows a small tear in the supraspinatus. My Dr. Doesn’t seem to feel it is something to be addressed as he says it is tiny tear. I would like to know if a small supraspinatus tear could be causing this pain and weakness or if it suggests something else. Thanks in advance for any info or guidance you may be able to offer

  • Dr. Lux,
    Please help. I need some advice. I was diagnosed with a SLAP tear and and a Rotator cuff tear and was told after an exam that physical therapy won’t help only arthroscopic surgery.
    Some of the MRI findings were:
    1. Small incomplete posterior-superior lab real tear,
    2. Mild marrow edema in anterior humeral head could represent a small subtle reverse Hill-Sachs lesion. Mild glenoid retroversion.
    3. Mild supraspinatus tendinodis.
    4. Mild patial tearing of the distal sub capilaris tendon.
    I have pain when extending my arm. This got worse over the summer while recovering from abdominal surgery. I would have thought the rest would have made it better but it made it worse possibly from inactivity and non use.
    I only want to do the surgery if really needed and other methods won’t make the shoulder feel better.
    Thanks, Jim

    • You actually do not have a true SLAP lesion with that reading, and do not have a full thickness rotator cuff tear. Most sports docs would suggest PT before the suggest surgery for these findings. Did you read our latest blog post on rotator cuff tears? Time for another opinion to come up with a treatment plan you are comfortable with

      Howard Luks

  • Dr. Luke,
    First I apologize for misspelling your name in the original email.
    Thank you so much for your analysis of my MRI reading.
    I will get another opinion and will read your blog.

    Again Thanks for your help.

    Best regards,
    Jim

  • Hi Dr. Luks,

    Good day! I’m also diagnosed with SLAP lesion based on the results of MRI. And before the MRI, the Orthopedic Doctor did several physical test on me. He eventually asked me to take the MRI and the result of the MRI shows that there’s a small triangle in my shoulder, which the doctor said is the sign of the SLAP lesion. I asked how to treat it like take pain medication. But the doctor told me that the only way to treat my injury is to have surgery. I’m not really sure how severe the tear is but when I rotate my arm, the popping sound is really loud. You can hear the popping sound 15 feet from me. I also feel discomfort with my shoulder even if I’m not doing any activities that requires a lot of work from my shoulder. Even if i’m just lying on my bed, i feel a little pain and discomfort which also extends to my trapezius muscle. With this, can you advise me if i already need to have the surgery and is it also normal that i feel discomfort in my traps because of the SLAP lesion?

    Thank you and more power,

    Rudolf

    • Sorry Rudolf … without examining you and speaking with you I can not comment. I can say that most surgeons feel that SLAP lesions are over-diagnosed, and over-treated. A SLAP lesion would not be expected to bother your trapezius.

      best of luck

      Howard Luks

  • Dear Dr Luks,
    Just back from the hospital in the Netherlands where I was diagnosed with a SLAP tear, clearly visible on the MRI as the characteristic white triangle. The injury is likely caused by being dragged to shore after material damage while kite-surfing. I am 54 years of age and my doctor now wants to start surgery asap. I get worried and confused while reading your comments here. Reason for my doubt is that pain only started some 1 month after the kite surfing incident and gradually increased to continuous high painlevels today which is 3 months now. My shoulder doesn’t pop or crack and is also not instable. Should I opt for a corticosteorid injection first to rule out other causes of my pain like bursitis and then ask for the alternative of tenodesis surgery instead? Are there other alternatives you can suggest to try first? Two weeks continuous high doses of paracetamol/ibuprofen did not help me at all.
    Peter

    • Peter … I like the way you are thinking. As you can tell from your reading, labral tears are very common. You may have had the tear before the incident. Many of us 50 somethings have SLAP lesions on MRIs performed to assess our rotator cuff. By far, the more common causes of pain in our age group is the rotator cuff, bursa, AC Joint and biceps. I would pursue methods to determine what the pain generator is — ultrasound guided injections are very useful. Then you can determine the proper treatment course. A labral tear is never an emergency. Even though the pain may cause us to make a hasty decision – sticking with tried and true treatments like injections and therapy are never a bad place to start.
      Good Luck

  • Dear Dr. Luks,

    I am 71 years old. I am a tennis player, skier, X-country skier (both diagonal and skate). I ski every day in the winter, and play tennis every other day in the rest of the year, I am right handed. I have had rotator surgery twice on my right arm (and once on my left). I also have a fused right wrist (STS fusion, and probably the cause of all further surgeries) I have no intention of stopping my activities, I am however inconsiderable pain after the activities and often awaken in pain. The pain is is the shoulder, and in the muscles of my arm (biceps and biceps tendon) and shoulder. I have been doing PT for over a year. It helps but not enough. Can surgery work on someone my age?

    Best,

    Michael

    • Hi Michael… too many variables to tell you whether or not the answer is yes. We need to know the pain generator – Rotator cuff ? AC Joint? Biceps? etc. Then we need to know quality of the the cuff- retraction? atrophy, etc. Revision surgeries never have the same success rate as a primary surgery. Sometimes we need to use grafts which MIGHT improve upon the results of cuff repairs. Difficult problem, be sure to see someone comfortable with complex revision shoulder surgery.

  • Hello Dr. Luks:
    I am scheduled for SLAP tear repair on January 15th, and having doubts. It’s left shoulder, pain level about 2-3 scale. I have full range of motion with mild pain. MRI showed the possibility of a SLAP tear. I have had 2 rounds of cortisone injection with reasonable pain relief.
    My should problem began from climbing up into trucks by using steering wheel as the leverage. I have some mild “popping” but with out pain. MY right shoulder has similar pain, but doesn’t “pop”
    I am 65 year old male, working at a fire department, and very active. I don’t play sports, run, jog or lift weights. I am in very good health, but have had a number of elbow, knee and foot orthopedic repairs in my past. The shoulder pain does not prohibit me from working or any other activity.
    I feel I should cancel the surgery because the research I have been doing indicates my situation doesn’t require it, and the pain can be managed with NSAIDS. The surgery looks quite invasive, and obviously painful, with a long term recovery period attached to it. The surgeon was ambivalent to a certain degree when I asked if I should have it or not. He said that at my age normally it isn’t done because it probably is more from wear and tear/repetitive motion type, but because I still work a full time job at a busy fire department, I probably should have it done.
    I need to make a definite decision very soon so I can get this either done or cancelled.
    I would appreciate you thoughts. I am also going to confer with some other medical professionals to get their opinion as well.
    Thank you

    • Kudos for doing your research. Fixing SLAP lesions in 65 year olds is not recommended … and rarely necessary. In addition, the pain typically does not respond to injections. At your age the most likely source of pain — and I obviously can not confirm this without examining you — is your rotator cuff. Rotator cuff tendinosis, and partial tears can cause mild, moderate or severe pain in various individuals. Even if someone were convinced that your SLAP lesion was the source of pain, the decision to have surgery is purely based on its effect on your your quality of life — which doesn’t seem terrible by your description.

      I can not make treatment recommendations to patients via a blog — but it does seem like your thinking and hesitancy is accurate.
      Good luck with your second opinions.

      Howard Luks

  • hey Dr howard i had a biscep surgery back in may slap tear and i was just wounding what r the chanes ofa slap tear retearing as ive been geting little popings on where its anchord what im trying to ask you is did i redamge it i went to my doctor he said the poping is normal

    • Some popping may be normal after surgery … this is best left to your doctor to determine in this situation.

  • had surgery back in may i asked him about it agian hes saying its normal becuase im active workingout and runing mainly what i was trying to ask becuase i dont wanna go bug him is there any way i prolly poped it out or thats prolly not gonna happen sorry if my spell gammer isit good

  • Hi Dr. Luks,

    I had an accident 12 years ago that resulted in a shoulder dislocation and SLAP tear. In the intervening years, the shoulder has dislocated again three times. I reduced these dislocation within seconds each time. Afterwards, I experience pain and instability for a few weeks. After 6-8 weeks, I resumed strength exercises on my shoulder and it becomes stable again. When my arm is overhead and forced back, the shoulder is still prone to dislocation, so I have be careful. Otherwise, I experience no pain and can do pull ups, play tennis, etc. Two months ago I dislocated it again kiteboarding, my new favorite sport. I think the instability in my shoulder is going to be a constant problem in kiteboarding, so I’m considering having surgery on it now after all these years. I’m 44. Do you think I should consider surgery?

    Thank you.

    • If your exam and MRI are consistent with your story and you want to maintain an active lifestyle then it might be the right choice for you. Time to have a long sit down with a good shoulder doc.

      Good Luck

      Howard Luks

  • Thank you very much for sharing such important information.

    I am an amatuer bodybuilder and was recently diagnosed with a slap tear, I’m not under extreme pain however i would like to understand if i can carry on working out without risking aggravating my injury. I’ve had the injury for over 6months now,

    Thanks,

    Viktor

    • We treat many SLAP lesions with “benign neglect” or observation.
      Good Luck
      Howard Luks

  • Hi Dr Luks, 3 years ago i had a non displaced tear of the anterior labrum at the 3 o’clock position, better demonstrated in the ABER position. Small associated paramenisceal cyst. Had no pain during the injury, my shoulder just felt “loose”.

    Recently, I just had an accident, my shoulder now hurts when i do simple overhead activities and there is locking and popping of the ball and socket joint. I can feel my bone shifting around whenever i rotate my arm.

    • Your orthopedist should be able to tell you whether or not your examination is consistent with a diagnosis of instability … where the shoulder slides forward too much. If they can’t … try a doc who specializes in shoulders.

  • Hi Dr. Luks. I just found your youtube video and web site, and thought I would ask for your opinion. I recently had an MRI that showed anterior and superior labral tears along with possible subacromial impingement and bursitis, but no rotator cuff tears. My chief complaints are pain crossing my arm in front, pain attempting a throwing position (but I have never thrown anything), pain putting weight on my shoulder, and the inability to lift my arm in front, when straight and palm up. This has been going on for a few months now, I suspect from too much weight lifting (which I have of course stopped). OTC anti-inflammatories and stretching didn’t help. I am scheduled for labrum surgery (plus whatever else the doc finds), but the catch is that I am almost 50. Do you think that would be of any value? (The rehab looks rather intimidating.) If not, I am not sure what would be worth trying next – maybe cortisone or more aggressive PT? I want to remain active and stay healthy!

    Thank you for the informative resources you have provided!

    • HI Doug … Labral repairs at our age are controversial. Unless you have instability then most tears do not need to be fixed. If your MRI shows evidence of rotator cuff tendinosis, partial tears and/or bursitis, then that is the likely cause of your pain. Selective injections performed by ultrasound guidance can usually tell you which space your pain is coming from … and can be very useful in guiding treatment plans.

      Good Luck

  • Hi Dr Luks,

    I’m a 35 year old very active male. I lift weights, swim, ski, ride bikes, run… You name it, I’m game. I dislocated my left shoulder (skiing) in 2006, and haven’t had any issues until September 2014 when my latest injury occurred. I was setting dumbbells down after a lift, and bend over to set them down reaching up over my head (sort of).

    I had an MRI with contrast done and was diagnosed with a Type IV SLAP tear. I also have a lot of AC joint pain. Most of my pain in fact, I think, comes from the AC joint. Not the SLAP tear. 2 surgeons have recommended I repair the SLAP tear, and both indicated the biceps tenodesis was a possibility (but unlikely). However, their opinions differ regarding the AC joint. The first surgeon recommended an acromioplasty, but the second said there is a risk for increased stiffness, and that at my age and level of activity, he wouldn’t do it. He said if I were 55, it would be a different story.

    My pain and discomfort during activity is definitely coming from the AC joint area. I can do military press without pain, but cannot bench without pain. It aches at night. I’m a side sleeper. It seems reasonable that’s coming from the SLAP tear. I don’t know for sure though, and doctors have told me the pain can come from different places. I was also told by a third surgeon (who I was seeing about my wrist) that acromioplasties are controversial procedures. I’m very confused and very conflicted!!

    What are your thoughts regarding an acromioplasty in my case? What about doing the acromioplasty + the SLAP repair? Separate… together… one and not the other…

    Is it possible I have a SLAP that doesn’t need to be repaired, but that my AC joint is really the problem? If I skip the acromioplasty now, and I doomed for another surgery? Note: the second doctor thinks the AC joint might heal on it’s own with some treatment. He gave me a steroid injection, and would continue that treatment for the AC joint.

    I’m scheduled for surgery in Feb. and need to make a deception ASAP. I am about to switch doctors… leaning toward not doing the acromioplasty.

    Any experience/thoughts you can share would be greatly appreciated!

    Thanks!

    • Grant .. Acromioplasties are no longer in vogue. It is very rare that an accomplished academic shoulder surgeon will perform one. An acromioplasty will also not deal with pain coming from your AC Joint. Very active people can develop painful arthritis of the AC Joint, or Osteolysis of the Distal Clavicle, which will also cause pain in the AC Joint. Options include a distal clavicle resection … and for many the results are great. An injection into the AC Joint will tell you if that is the source of your pain, and selective injections can help us determine which pathology is the cause of your symptoms.

      I hope this helps.

      Howard Luks

  • Thanks for the helpful article, those GJ I wish it had better news! I am wondering exactly how grim the success rates are for SLAP repairs for women over 40? I know your article says not good–but I’m looking for numbers. 50% unsuccessful? More? And how does that compare to succes rates for PT for managing pain and returning to activites at prior level without pain? I am a 44 yo woman in great shape, with activities like mountain biking, cyclocross, skiing and crossfit (likely how I injured). Pain is worst when sleeping, or if I do an overhead life which I haven’t in months. Sometimes days go by and I’m fine, then there are days with a level 5 or 6 nagging pain. I don’t want to have the surgery if Im likely to end up in the same spot as pre-surgery. Having said that in my thirties I had a meniscus tear in my left knee and a label tear in my right hip successfully scoped. And I was up and literally running within a month. Help?!

    • Hi Melissa… I think you need to look at this from a different perspective. In many cases where a SLAP lesion shows up in an MRI it is a red herring… it is NOT the cause of your pain. In 40, 50 and 60 somethings, the rotator cuff and bursa are the most common causes of pain.

      SLAP lesion produce a unique type of pain during overhead activities, such as volleyball, throwing, tennis, etc. They do not hurt people at night. The rotator cuff and bursa are responsible for severe pain at night in many people.

      In cases like yours, the MRI will usually find tendinosis of the rotator cuff or even a partial tear of the rotator cuff. Those are the more common causes of pain, they are usually successfully treated with physical therapy — and if the pain does not respond to PT then there are other options available.

      In the occasional person we actually think that the SLAP lesion might be the cause of pain, fixing the tear has not led to good results, and instead the orthopedics community typically recommends a procedure called a biceps tenodesis.

      Good Luck .. I hope this helped. Or at least gives you something to discuss with your surgeon or a second or even third opinion.
      Howard Luks

  • Hi doctor Luks, people with slap tears

    I’m a 26 & male.

    Let me first say that I am fine. I am more than fine. I am strong again. Also another thing I should mention beforehand is that my rotator cuffs are both 100%, without even the slightest tear.

    I was diagnosed with a slap type 2 on one shoulder 2.5 years ago. I got treated about 2 years ago and I am actually feeling fine about the surgery. I think choosing the proper doctor is a huge factor. You know that method where you put your arm up under the corner of the pillow and sleep with your head putting pressure on your shoulder? I can do that pleasantly. Sometimes I still feel a pain, but its very slight and far better than it used to be. On the pain scale I would say it’s about a 1 or a 2 that I feel, when I feel it, which is most of the time none at all.

    I have a history of 12 years lifting weights on and off and have always trained very carefuly even when handling heavy weights. I attributed the slap tear to factors completely unrelated to my physical training, such as a door I had to lift up at a weird angle. But the biggest factor was my work is computer related. I sat in the same chair for years and it was very comfortable. After it broke down while I was sitting in it, I got a new one without thinking about it much. But it was not so comfortable. In matter of fact I felt great discomfort from the armrests. I didnt think about it much and ignored it for months. I think this exhaustion in one of the shoulder muscles from this position it what made me experience a huge tear when doing an excercise I’ve done for many years, with a weight I’ve been handling for many years. Nothing special. Just goes to show though, the butterfly effect, injury can come indirectly from such a small thing as a chair and opening and closing a door by having to push it up as you spin the handle.

    After my first surgery I had to do alot of things with my weaker hand. Including lifting that door constantly. And leaning even more on the armrest which irritated my shoulder. I started getting trouble in my other shoulder, pain I didn’t feel before. It was getting worse. I decided to fix the door and get a new chair to work in, without armrests. The pain stopped getting worse but it was still there in the unoperated shoulder. At this point, considering I had no pain in this shoulder before, and it started, got worse, and stopped getting worse once I fixed the door and got a new chair, I had grown very convinced the problem of the source is not fitness related.

    I went to my surgeon to tell him of these observations I have made regarding non-traditional methods of doing harm to my shoulder and went on saying I think I may have done so again to my new shoulder. He didn’t believe me, but I mentioned how well I took the surgery, complained of no pain and how exceptional I did my physical therapy, and asked him, “do you really think a person with a strong personality like mine would have a psychological pain”? 2 weeks later MRI machine is ready to do a test in my name and it turns out I have a large cyst (exceptionally!) from a leak in a labral tear. He did not see the need for anchors in this operation and removed a tiny part of the labrum. This healed very quickly and my shoulder was back to strength within about a month. Physical therapy guy was like “nah, its fine mang, you can go home” and we ended up only doing half the sessions.

    I think, the best rehabilitation for such an operation is full range of motion excercises without any weight at all, and luckily, even more important, the weightlifting (after finishing physical therapy and discussing it with your doctor of course). I cannot imagine a better long term method of keeping and healing your repaired slap tendon than make it accustomed to handling weights again. Obviously we are talking very gradual here.I used to increase the weight every once in a while, but I won’t be lifting over 80% of my previous for a year or two. I call these “tendon strenghtening years”. I’m readying my tendons for many more years of being strong :D

    I know tendons are not velcro, but what happens when a strip of velcro is peeling away? Less force is needed to keep pulling the rest away. I’m 26. I considered it almost impossible not to have a full tear as time goes by. What when I’ll be 50, fat from no excercise with a worthless arm that has its tendon slowly ripped away and eventually require a weird solution like a tenodesis? Certain movements you make will just keep making it worse. I’m not so sure of this though, at the end of this text I have included a question specifically regarding this, could you please give your opinion?

    Please consider all the above text as a sort of travel into my shoulders thoughts and personal experiences with these obstacles. I’m not a doctor and I’m sure there may be some stupid mistakes I’ve made.

    Either way, I can do everything I’ve ever wanted again.

    Doctor, here are my questions

    – Would you say the skillset of the surgeon makes a substantianal statsitical difference on the positive outcome of the operation? I feel like my doctor was top level. He usually only operates on athletes. I cannot help but feel with another doctor these treatments may not have ended the same.

    – Could you please explain your view on doing slap repairs as a preventative measurement for the future, in which the tear will most likely get worse and worse and require something like tenodesis? You do not seem too hot on the idea of fixing tendons to prevent further damage to the tendons in the future. It may not “fix” the tendon in most cases but it would stop a decline in tendon strength right? From what I remember tendons fixed with anchors can handle more “power” before being ripped, while a weakened tendon like a piece of velcro peeling off should only get weaker every day right? I’m not arguing against you, you’re a doctor, you have your reasons and for great curiousity I would like you to know what you think regarding this matter? At first my doctor didnt want to operate (considering he only operates on athletes, I was an exception) but I asked him “if I don’t do the surgery will I be able to be a strong excercising man in middle age?” He said no. 30 seconds later we agreed on a date for surgery.

    – Related to above question also and possibly I will find my answer even more in the answer to this than the above, but what would you say the long term potential is for the slap repair? Should I take perfect care of my tendon, could I have realistic odds of being an 80 year old man without needing some new surgery for my tendon with anchors?

    – Regarding the second tendon, I am guessing large strains will stnad in the way of healing, but it is possible for the tiny fragment to grow back? From what I understand after 3-7 years often significant healing of tendons have been observed without repairs, but I cannot imagine this happening to a majority of people as most would have a pretty active lifestyle?

    It really is an interesting thing, the human body, being a doctor, helping people. Figuring out the formula of human health. Godspeed, doctor Luks. In a different turn of events I would have taken up being a doctor, truly the best of works things to do in this world.

  • hey dr Howard J. Luke mike here again have my slap tear back in may it does pop when i put my hand over where the slap tear is no pain feels a little werid 10 mins after poping it tho can you tell me y a slap tear pops like that

  • Hi Dr. Howard.
    Thanks for the article. I am scheduled for surgery in February to fix a SLAP tear in my right shoulder but I am still undecided whether I should go for it. The shoulder pain has been going on for over a year now. I have gone through a series of different diagnoses. First, I was diagnosed with shoulder impingement and had PT for 2 months, which didn’t help. Then I received an injection in the bursa and continued therapy for another 1.5 months. Then pain still did not go away. After that, I had an MRI (without contrast), which showed inflammation around the labrum, which leaks through a tear in the labrum (that’s how my orthopedic explained it to me). Following this diagnosis, I was treated with another injection in the inflamed region. This was suggested as a way to confirm the diagnosis rather than healing the tear. I found huge relief after the injection. However, I still experience shoulder instability and constant mild ache/stiffness. When doing certain movements, such as raising my arm in front of me and parallel to the floor or overhead, I would feel catching and locking of the joint and also my shoulder moving outwards. It doesn’t cause much pain but at the end of the day I feel sore. Overall, I would say that the condition is manageable but it does prevent me from doing physical exercise, etc. Even a few push ups make me feel uncomfortable. I opted for surgery with the hope that it will fix my tear and help me get back to “normal”. I am scheduled to have the surgery in a month but I am still confused. What would you suggest?

    • Haris … you seem to have been well cared for… you may be one of those patients who would benefit from a labral repair — the exact nature the procedure you need is best determined by your surgeon, your age, activities and exam.

      Good Luck
      Howard Luks

  • Hello Dr. Luks,

    My question to you is, Is it possible for a doctor to tighten your labrum and gleniod too tight during a repair? And is it likely for a doctor to go back inside of a shoulder with a slap if the patient never fully recovers?
    I ask that because i was diagnosed with a type 2 slap and partial Rotator cuff tear in my right shoulder in May and had surgery in June but the rotator cuff wasnt repaired, just cleaned up. This happened from my job, which was daily resistant pulling and over head work for about a yr and half. I been on workers comp but haven’t worked since last march. I complained about my left shoulder as well plenty of times but they just kept saying its from over using it because of my injured right shoulder. Now its January 2015 goin on 8 months since my surgery, and im still goin to a lot therapy but my right shoulder feels horrible. And to make things worst, i finally just had a mri on my left shoulder on the 30th of Dec and was diagnosed with the same exact thing on thing as the right (type 2 slap, and partial rotator cuff tear). The dr wants to repair it but im not so up for it because of the pain from my right shoulder which is supposed to be the repaired one. Both my right and left shoulder hurts but my right one the repaired one hurts much worst. It consistently feels tight in a specific spot in my right shoulder blade, it somewhat feels like i feel the actual anchor inside of my bone. Im able to do just about everything in my every day activity despite soarness and aching in both shoulders but i cant still cant do lots of things at high levels, like sports and workin out and certain wrk and activities without feeling alot of pain. Im only 24 nd im in good shape nd have great health. I feel like my right shoulder is never gonna be back to normal, and that my left shoulder has a better chance goin without the surgery. I just wanted to share my story and here another doctors input and thoughts or advice. Thanks for you time …

    • SLAP repairs are obviously a controversial area. It is an over-diagnosed, and an over-treated entity. Determining if a SLAP lesion is the source of your pain is difficult. Many times when we are operating on someone for something else will encounter a SLAP lesion and leave it alone. Fixing SLAP lesions can cause tightness or stiffness. And then resting or immobilizing the shoulder can lead to issues in and of itself.

      Some SLAP lesions do require a repair… many more do not. Perhaps you can see a second opinion who can help you straighten this out.
      Good Luck
      Howard Luks

  • My daughter is a competitive swimmer. She is 17 and in her junior year of high school. She has the desire to swim in college and has a great determination to keep swimming. After approx. 30 PT sessions , prescription anti-inflammatory, and 6 week out of water rest, she continued to complain and hurt. Her orthopedic here ordered MRI that indicated a tear in superior labrum. My question is, do you ever see these repair themselves after more rest and therapy? She is really bummed about not being able to perform her best without hurting. Activity level doesn’t seem to matter – she hurts sleeping etc. If surgery is done, I think she feels like she can work hard to be her best during her senior year thus reaching her goal to swim in the future. We want to provide best possible opportunity but feel as if we are on a time constraint and would like any advice you may offer. Is it a routine,simple procedure or should we travel hour an half south to one of the prominent sports clinics for athletes in Alabama? We are very pleased with our current orthopedic but are in limbo on what to do-more rest?, surgery, or rest with perhaps no improvement with delayed surgery. Thanks :)

    • It is not an easy decision … without examining your daughter I can not make firm recommendations. Although SLAP lesion are clearly over-diagnosed and over-treated there are times when the SLAP lesion actually is the source of pain. They will not heal themselves… but clearly many if not most with SLAP lesions will get by without surgery. Competitive athletes may not and may choose to pursue more aggressive treatments. It is not a challenging procedure… but if you have a top shelf shoulder surgeon near you — why not?

      Good Luck

      Howard Luks

  • Hi Dr Luks, I am 57yrs and have been swimming for 38yrs. I have been told I have a slap tear in my left shoulder. I only have pain when I stretch my arm out .I am a refrigeration mechanic and can lift a refrigerant bottle 12kg from the ground to chest height with no pain with my left arm. I don’t get pain when swimming,but my shoulder will be sore the next day. Will I cause more damage if I don’t have the operation
    Cheers Glenn Melbourne Australia

    • Sounds like you should avoid seeing the inside of an operating room unless their refrigerator is broken ! :-0

  • Last year on new years I dislocated my shoulder, a few months later after many more dislocations, I was diagnosed with a torn labrum. I underwent surgery last June and spent all summer recovering from the surgery, it was honestly the hardest thing I have ever had to go through. I was recently (about 3 months ago if you call that recently) Cleared for sports and working out. I began bench pressing good weight and felt amazing. Yesterday I was playing a sport(Lacrosse) and without contact, it dislocated. It just flew away from me and was out for about 10 minutes until I relaxed and it went back into place. I am now in more pain than I’ve been in months. I am planning on going to see the doctor who operated on me sometime this week, but I am extremely worried and was wondering if you had some advice for me. Could I have torn it again?
    Thanks,
    Graham

    • Hi Graham ..
      Redislocations do occur after an initially “successful” surgery. There are a lot of variables involved in the decision making process. Too many for me to know what to suggest without examining you. I’m sorry this has happened to you. Just be VERY sure that your doc is comfortable with revision dislocation surgery. It’s even more important then it was for the first procedure.

  • Hello dr Luks.i am surgeon I fall 9 month before and start complan r shoulder pain tooke fizioterapiya and medication improved about 3 month ago.internal movment become painful I started some strech movment pain become worse done mri shows biceps detachment from superior labrum ,inflamation labrum and biceps tendon
    .I have now develop.stifnes.after rest 2 month I.start exercise improving stifnes. While movment there is clik and pop sansation.and mild pain .seen several orthopedic surgeon some advise surgery some no
    Wat shoud I do now?what ia your opinion?mri finding there is long head biceps detachment superor labrum inflamation and.fluid around biceps .inflamation in a-c joint.at present I have abduction and external movment limited but improving
    Thanks

    • Hi ..
      The most important thing you are going to do is to improve your range of motion. Unless you have full motion you should not consider surgery. Depending on your age, a biceps tenodesis is likely a better procedure to consider instead of a direct superior labral repair. The results of direct SLAP repairs in adults is not very good. Whereas the results of a biceps tenodesis appear to be more reliably good.

      Good Luck
      Howard Luks

  • Thank you for reply.i am 40 years old.my shoulder range of motion increase,but I feel during abduction head of humerus not.glide in glenoid fossa , dont now is it due to stifnes?present pain not disturbing me to much if I will not do surgery is it dangerous continue conservative?thank you so much.

  • Hi Dr. Lukas. About one month ago I had a orthascopic labral repair in my dominate arm with 3 anchors. I recovered quickly and gained my range of motion back with in 3 weeks..however I am worried because I have had a few incidents where I put some pressure on it. In some cases it didnt hurt until the next morning in others it hurt shortly after applying the pressure and the next morning it was soar as well.. but every time the second day my arm would go back to feeling good and I could still do my pt exercises with little pain.. I am just worried that considering im so close out to my surgury and I was doing things I shouldn’t have which had caused pretty bad pain could be me ‘re tearing it.. would I know if I did and would it be normal to hurt for a day and get better if it retore or is this more of a sign that I agrivated it and it is just soar and swollen from the pressure to the area. I am 20 years old and active and had trouble not using my dominate arm after surgury and wasn’t wearing my sling as much as I should have. Just nervous and dont want to have to repeat this process. Thanks,
    Tom

    • Tom … having pain a month after surgery is not abnormal. You can disrupt the repair if you do not listen to your docs instructions. Your tear is NOT healed yet. It takes at least 3 months for the tear to heal. Don’t do anything your doc doesn’t say is OK to do.

      Good Luck

  • 72 year old female, non athlete. Mri showed severe tendonitis, severe bursitis, and some arthritis in shoulder, injured 4 monthscago in a fall. Did 8 sessions of pt and took advil frequently. Shoulder hardly bothers me now. Surgery scheduled in one week. No cortisone injection yet.

    I’m thinking of cancelling, and just living with it, maybe getting a second opinion and a cortisone shot instead.

    Can you comment? Thank you.

  • I had surgey on my labrum I’m 15 it was torn during football was fine very little pain till it started popping out of place I had surgey on March 2nd and jw how long you would believe the surgey recover would be start therapy April 2nd and hope to think I’ll be back for football 3 anchor 5 sutros

    • You are in the highest risk group to develop recurrent dislocations :-((( Therefore you need to go very slowly. Many shoulder docs would not let you back onto the football field for at least 6-8 months.. and many more might counsel you not to play contact sports. Sorry :-(

      Best of luck !!!

  • I know you aren’t able to diagnose my situation completely but I need some guidelines to make a decision for surgery or just physical therapy. I am not in lots of pain and usually only feel pain when I have my arm in certain positions….most painful is hooking my bra behind my back and sleeping. I am 67 years old and teach kindergarten. I had an mri with injection and these were my results:
    Rotator cuff: There is intrasubstance and undersurface tear of the supraspinatus. A small perforation is seen in the ventral leading edge of the spraspinatus tendon, Extraarticular gadolinium is appreciated. The rotator cuff is otherwise intact.
    Labrum: biceps tendon labral anchor is intact. There is a tear of the anterior labrum in its mid portion extending to the inferior aspect. There is no bony or bankart lesion. The labrum is otherwise intact.
    AC Joint: The acromial undersurface is flattened to slightly curved. There is mild osteoarthritic change in synovitis of the acromioclavicular joint with slight downsloping of the acromion. There is no os acromiale.

    Final statement on the document: tear of the anterior labrum from the mid portion to inferiorly.
    Focal perforation of the ventral leading edge of the supraspinatus tendon as well as intrasubstance/partial undersurface tear of the supraspinatus noted as well.
    Degenerative changes of glenohumeral articulation.
    Configuration of the acromion and acromioclavicular joint may result in impingement.
    Since I am a teacher I have a time frame of deciding whether or not to go through with the surgery during summer break. I have to tell the doctor in April so the surgery can be set up.
    Can you give some advice as to whether you think it looks like I should based on this evaluation. I know my doctor wants to do it but it is so hard for me to make the decision for sure. My pain is better than before so I just want to make the right decision.

    • The evidence based answer for a small degenerative tear is to treat with Physical Therapy. PT will help most patients live and function pain free. Only a small percentage will not respond and will go on to consider surgery.

      Good Luck

  • Hi, My name is Robert Medina…my sport is baseball and I’m a pitcher, I had labrum repair surgery about 6 months ago and started throwing again…I used to throw 93-95 Mph…and my first question would be…will I throw the same speed again?
    Secondly I’ve been having pain while throwing…But it doesn’t feel like its my labrum…its the not the same pain I felt before surgery it feels like its coming from something else in my arm…Its about 2-3 inches away from where my surgery scars are…so I don’t think its my labrum again, it only hurts when I lift my shoulder as if I’m about to throw the ball, it hurts when I throw too…its not extremely painful, it has days where it hurts and days when it doesn’t…so its confusing me…Any kind of opinion would help..Thank you.

    • Great #’s Robert. Sometimes the rotator cuff remains sore after the surgery for a while. That pain is usually below the shoulder on the outside of the arm. usually PT and cuff exercises can alleviate that pain. Good Luck with your continued recovery.

      Howard Luks

  • I am a 63 year old female and was diagnosed with frozen shoulder about 10 months ago. I went to physical therapy for 3 months and have continued with a home program. My range of motion increased with physical therapy, but not sufficiently. I went back to my orthopedist in December and he gave me a Cortisone shot. It worked quite well for about 5 weeks. Then my pain returned and so the Dr ordered an MRI. It indicated a probable tear from 11 to 2. He recommends surgery. I went for a second opinion this week. This Dr said that most women over 60 have labral tears and don’t require surgery except in extreme cases. He said I do have bursitis and some arthritis which may be the cause of my symptoms. He does think I have frozen shoulder which is thawing. He gave me a Cortisone shot into the bursa (not sure where the 1st one was) and recommended additional physical therapy exercises. This orthopedist was recommended by the top spine Dr in San Diego as being extraordinary. I really want to believe his diagnosis and certainly do not want to undergo surgery. What do you think? It looks like you give very good advice. Thanks for your time.

    • A 63 year old should not have labral surgery. Without examining you… it seems that your second opinion has a better thinking cap on :-)

  • 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?

  • 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 .

    • 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

  • 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.

    • 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

  • 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.

    • I agree with your second opinion … physio therapy and time are your best options right now.

  • 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…

  • 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.

    • 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

  • 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?

  • 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?

    • 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.

  • 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

  • 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.

    • 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.

  • I am concerned about my 50 year old relative. He complained of pain in his shoulder two monthsago; it went away then returned days later when he wasdriving. He has been going to work in manufacturing job where he has limited his own lifting and has not missed any work. He went to his doctor, got an MRI (I am not a doctor, but the language sounded like minor concerns) He was then sent to a surgeon and was told because he is a young man he needs surgery right away to repair the tear instead to removing the muscle. Below is what the MRI and surgeon notes state. I want him to get another opinion before surgery because I am worried the surgery will make his disabled and unable to work again.I kinda think this is something that heals itself and takes time, but does go away. What do you think?
    Findings:
    • Only mild changes of osteoarthritis at the acromioclavicular joint, but the joint capsule is markedly thickening and fibrotic. There is no subluxation or erosion. The acromion is mildly laterally downsloping.
    • There is trace fluid in the subacromial/subdeltoid bursa
    • The supraspinatus, infraspinatus and subscupularis tendons are moderately thickened and contain heterogeneous increased PD and T2 signal, but no descrete tear is apparent. Only the teres minor tendon is normal.
    • The rotator cuff muscles are unremarkable, with no edema or atrophy
    • The glenoid labrum is within normal limits on this study without intra-articular contrast.
    • The long head biceps tendon is markedly thickened and is of increased PD and T2 signal intra-articularly, but no discrete tear is apparent.
    • Glenohumeral articular cartilage appears well-preserved.
    • Contours of humeral head and glenoid rim are normal.
    • There is no glenohumeral subluxation,
    • There is a trace glenohumeral joint effusion
    • No loose body is apparent.
    • There is no periarticular fluid collection.
    • There is no evidence of fracture, avascular necrosis, or destructive osseous lesion.
    MRI Conclusion:
    1. Moderate tendinopathy of supraspinatus, infraspinatus and subscupularis and long head biceps tendons
    2. Trace glenohumeral joint effusion and trace fluid in the subacromial/subdeltoid bursa
    3. Only mild changes of osteoarthritis at the acromioclavicular joint, but the joint capsule is markedly thickening and fibrotic.
    4. Full range of motion. Tenderness with palpation subcaosular bursa posteriorly. Point tenderness over biceps tendon. Increased pain with resisted flexion and supraspinatus isolation. Pain with range of motion, no instability.
    His doctor sent him to an orthopedic surgeon:
    Exam note: Full range of motion. Tenderness with palpation subcaosular bursa posteriorly. Point tenderness over biceps tendon. Increased pain with resisted flexion and supraspinatus isolation. Pain with range of motion, no instability.
    Diagnosis: SLAP tear, degenerative in nature vs primary buceps tendons partial tear or tendosynovitis. Left shoulder subcapsular byrsitis
    Surgery: Left shoulder arthoscopy with SLAP repair and bicep debridement or tenotomy.Will inject subcapsular bursa at same time

    • There is noting on the MRI that requires surgery. We do not fix SLAP lesions in 50 year olds. If he is working and comfortable he should continue working :-)

      Besides… even if he has some residual pain, it would not be treated with a SLAP repair at his age. And it is NOT an urgent matter.

  • Hi Dr. Luks,
    I’m a 25 year old male. 3 years ago I had a hard fall on an outstretched arm, that had me in a lot of pain at the time. It subsequently got better – and currently I only feel a very moderate amount of (dull) pain, which feels slightly worse after using the arm for a bit. I have full ROM. This pain and the fear of doing further damage makes me avoid using my arm for anything too strenuous.

    I recently got diagnosed with detachment of the superior labrum/biceps anchor inferiorly – consistent with a SLAP type 5 injury and possible small bony Bankart lesion, and thickening/oedema and inhomogeneity of the distal infraspinatus (IS) tendon mainly at its anteromedial/articular surface extending from 10mm proximal to and directly onto its postero-superior greater tuberosity attachment consistent with partial thickness articular surface tear/chronic tendinosis / tendinitis.”

    My doctor is recommending surgery.
    I would just like to find out if physical therapy may be worth a try first?
    I am worried that the risk and length of recovery from surgery may not be worthwhile as the pain is manageable. Although I also don’t want the tear to get any worse, or to restrict the use of my arm too much in the future.

    Thank you so much!
    Donald

    • So… SLAP lesions only need to be treated surgically if the pain is interfering with your quality of life. If your shoulder is not dislocating then it’s not typical to consider surgery for a Bankart lesion.
      This is your call … and your choice… and the choice should be made depending on how much pain you have… not because you have something torn. Many people are walking around with a SLAP lesions and lead very active happy lives.

      Good luck !

  • Hi Dr. Luks,

    I had a biceps tenodesis and subacromial decompression in 2012 after a fall in an exercise class the previous year led to SLAP and biceps tears. Pain returned in five weeks ago after being low or non-existent for many months. The pain started a day after pumping bicycle tires, although I had no pain while pumping the tires. I have started in recent days to take naproxen 500 mg/day, but this has not helped yet. Most of the pain is in the posterior shoulder and is often constant, even at rest and often worsens as the day goes on. I have had a few flare-ups over the past couple of years, but they have lasted only around 7 to 10 days. This flare-up has lasted more than a month with no end in sight. Suggestions? Thank you!

  • 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

    • 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.

  • 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?

    • 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.

  • 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?

    • I’m sorry Karina… I can’t make that decision for you. It is not an easy decision. Good Luck !

  • 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.

    • 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 !

  • 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.

    • 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

  • Dear Dr. Luks,
    I am a 53 year old man. My original injury was about 18 years ago when playing basketball and landed on my outstretched shoulder. Dr. said if I was a professional athlete, he’d do surgery, but otherwise, it should function and heal acceptably. For many years I haven’t been able to throw a ball overhand without feeling like my shoulder was slipping out. For the last couple of years I had to make sure my wife was on my left side to put my arm around her when at church or a movie (whenever raising my arm, it would sometimes “slip” when I tried to bring it back down. About a year ago, I had to stop lifting weights – not heavy, just trying to get a little exercise. Recently, I had to stop sleeping on that side as it causes pain.

    I went to an orthopedist which recommended physical therapy. I tried for weeks with no improvement, then tried a cortisone shot in the shoulder. Within a couple weeks it was feeling very good, but while reaching up to get a bowl from the shelf, nothing heavy, felt a sharp pain. Since then therapy didn’t help, and many simple moves feel like the shoulder is slipping out causing pain – maybe a 6-7. It subsides fairly quickly, but happens often, greatly reducing quality of life. I almost constantly feel some discomfort – not necessarily pain.

    MRI results showed mild thickening and irregularity of the supraspinatus tendon (otherwise intact). Minimal fraying of the ifraspinatus insertion (otherwise intact), mild thickening of the subscapularis tendon – no evidence of rotator cuff tear.
    It says the glenoid labrum is intact with no evidence of labral tear, but an extensive SLAP lesion with the tear from 9-2. Also a small paralabral cyst anteriorly, 2mm.
    It also said the signal in the marrow spaces is unremarkable, no evidence of fracture or dislocation, and mild hypertrophy and degenration of the acromioclavicular joint.

    The doctor gave options of a shot guided by a scope or the surgery. He says it is not disclocating, but the tendon (or ligament? I forget) is moving around, causing that feeling of instability I have. Since that movement is when I feel the pain, my thinking is that it is time for the surgery, and that another shot would at best be a temporary fix. Does that make sense to you? I scheduled surgery for next month, but will be getting a second opinion in a week.

    Thank you so much in advance!

    • Fixing SLAP lesions in a 50 something is not advisable. Cleaning out a torn piece might help ???? repeat might, if it is loose and floating in the joint. The irregularity of the rotator cuff is the most common cause of pain in our age group — that’s early tendinosis. I can’t say whether or not surgery is the right answer for you without examining you. Good Luck !!!

  • Hi Dr. Luks,

    I am a 34 year old female who is active in sports, and I am also a firefighter and rescue technician. About 3 months ago I injured my shoulder when I landed on it wrong doing a roll in Hapkido. My pain was evident immediately but then seemed to subside enough for me to complete practice. However, immediately after practice I had a horrible aching pain along the outside of my shoulder. This pain didn’t subside and I saw an Orthopaedic surgeon 3 weeks out from injury. I had lost quite a bit of range of motion and he said I likely had rotator cuff tendonitis and possibly a SLAP tear. I did 4 weeks of PT and was prescribed Naproxen. The Naproxen did help a bit with the pain and PT helped my range of motion, but I was still having sharp pains at times and aching pain from time to time. I went for a follow up at which time he sent me to more PT and for an MRI without contrast. 4 weeks later I was back in the office, still with pain but again improved range of motion. He said the MRI showed tendonitis but no obvious rotator cuff tear but that he could not rule out SLAP tear from what he saw. He gave me a cortisone injection which didn’t do anything (in fact, it made it worse and took me a week to get back to my new normal level of pain) and again another round of 6 weeks of PT. During PT, I can do pretty much everything but it is painful, and it really hurts when he pushes on and manipulates my joint. I am due to go back to the surgeon again in 3 weeks and am frustrated. Based on my reading it seems like a lot of shoulder issues manifest with the same symptoms. I have also seen a lot of information on the use of MR arthograms instead of normal MRIs for diagnosing SLAP lesions. I’m lost as to what to do. Whenever I try to resume normal activities I end up in significant pain. I don’t want to have surgery if it isn’t necessary. I want to be able to definitively say what the issue is without having to do anything exploratory. Should I ask to have a MR arthrogram done? How else can I know whether my pain is just tendonitis or is a SLAP tear?

    • A good exam should be able to tell you :-) It is not a lost art :-)

      Perhaps a second opinion? PErhaps an ultrasound guided injection to know if the correct space was injected?

      Good Luck

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