<h3How does a Superior Labral injury happen?

A common superior labral injury is termed a SLAP tear which stands for “superior labrum from anterior (front) to posterior (back) tear”. The labrum is cartilage that helps to deepen the socket part of the scapula (shoulder blade). It is connected to one of the two tendons which form the biceps muscle of the arm.

The most common causes of a SLAP tear are:

• Overuse. The overuse of the shoulder especially in overhead athletes can result in an injury.  Anyone who uses their shoulder to make repeated motions can tear their labrum.
• Injury. It can occur during a fall when the impact is on the extended arm. These injuries may also occur when someone pulls on an extended arm.

What does a Superior Labral injury mean to the Patient?

Patients with SLAP tears will complain of pain, especially with overhead activities such as heavy lifting or rock-climbing. Patients with SLAP tears sometimes also experience clicks in the shoulder with the arm in an overhead position.

• Most patients will experience a decline in athletic performance after such injuries. This serves to hamper the lifestyle of patients and can be a source of frustration.

What is the Assessment and Work-up?

Based on your clinical history, the doctor will perform a focused clinical examination targeted at determining if you have a labral tear. This includes checking the range of shoulder motion and whether you have any pain when the biceps tendon is pressed. He/She may also perform specific tests to stress the superior labrum.

If he/she suspects that you have a SLAP tear, he will frequently refer you for an MRI scan. The purpose of the scan is to assess the state of the superior labrum and biceps tendon. The scan will also allow the doctor to check the shoulder joint for other injuries that may have been sustained together with the superior labral tear.

What are the Treatment Options?

The treatment provided depends on your age, activity level, the severity of your injury as well as the associated instability. There are nonoperative and operative treatment options. Surgery is often not the first treatment option.

Non-surgical Treatment

• Avoiding overhead and throwing activities. By eliminating these actions, the shoulder is allowed to heal. This is often the first recommendation.
• Anti-inflammatory medications are often prescribed to alleviate symptoms. Medications such as Non-Steroidal Anti-Inflammatory medications may be prescribed to decrease swelling and pain which are common symptoms.
• Physical therapy exercises will help you relieve pain, increase joint range of motion, and eventually help you regain the strength in your shoulders.

Surgical Treatment

If these nonsurgical treatments do not seem to be effective, surgery may be recommended. SLAP tears are often repaired with arthroscopy which is a minimally invasive surgery. During this surgery, the doctor makes small incisions in your shoulder and a tiny camera is placed in the shoulder joint. This allows the surgeon to see the insides of the shoulder joint through a monitor. Using small tools, your surgeon will then trim the torn part of your labrum, and then reattach it with sutures.

Generally, patients undergoing SLAP surgery will be able to start gentle physical therapy exercises immediately after surgery. Skin sutures are usually removed after 2 weeks.

Rehabilitation and Recovery

Initially, limitations on shoulder movement may be placed on you as a precaution to prevent recurrence while the labral injury heals. All patients will be required to undergo a course of monitored physical therapy as part of their recovery. In general, most patients will be able to return to sporting activity  2 months after their surgery. For assessment of your condition, please book an appointment with Dr Yong Ren.

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