A SLAP tear is a tear of tissue that is located on top of the shoulder. SLAP stands for “Superior Labrum Anterior Posterior.”
The shoulder is a ball and socket joint, similar to a golf ball on a tee. A rim of tissue called the labrum surrounds the socket like a bumper on a pool table.
The shoulder is a ball and socket joint
The labrum surrounds the socket
Several muscles in the shoulder and arm insert on the ball and socket. For example, the biceps muscle in the arm is anchored on top of the labrum.
A SLAP tear is a detachment of the biceps muscle where it is anchored to the top of the labrum. It is similar to a tree being uprooted from its soil.
To evaluate for a SLAP tear, a doctor will perform an examination after a history is taken. X-rays are performed to image the shoulder. To further evaluate the shoulder, an MRI may be ordered. The MRI will show muscles, tendons, and ligaments around the shoulder that are not visible on the x-ray.
Sometimes a SLAP tear can be present with other shoulder injuries, such as an instability injury (add hyperlink to bankart) that can occur after a dislocation.
SLAP tears are often painful and can cause clicking in the shoulder. They often occur as a result of a jarring motion of the arm. Unfortunately, SLAP tears do not heal on their own and usually require surgery to allow them to heal properly.
The biceps muscle inserts on the top of the labrum
Normal labrum surrounding the shoulder socket
A SLAP tear is torn tissue on top of the labrum
An isolated SLAP tear occurs from 9:00 to 3:00 on a clock face
A SLAP tear combined with an instability tear occurs from 9:00 to 6:00 on a clock face
If surgery is recommended it is performed arthroscopically. Arthroscopic surgery uses small incisions and small tools, about the size of a pencil, to perform the procedure. All the work is visualized with a small camera, the arthroscope. The surgeon sees inside the shoulder with the arthroscope and its images are projected on a video screen.
The torn tissue is stitched back to the bone. By stitching the torn tissue back to the bone, the SLAP tear can heal in its proper location. The stitches are held in the bone with anchors that are drilled into the bone.
As mentioned earlier, SLAP tears can occur at the same time as instability tears. If the two are present, then they are both repaired during the same procedure.
Arthroscopic camera and tools in the shoulder
SLAP tear before repair
SLAP tear repaired back to its normal location with stitches
Examples of absorbable anchors with attached sutures (stitches) used to reattach torn tissue to bone
Shoulder X-Ray showing anchors in bone for SLAP repair
A combined SLAP tear and instability tear
Repair of a combined SLAP tear and instability tear
What to Expect after SLAP Repair Surgery
Your doctor may prescribe a sling after surgery. If so, you will probably wake up from surgery with the sling on.
Recovery after SLAP repair surgery is gradual. Patients usually take one to two weeks off from work. Physical therapy will be required for a proper recovery, usually for several months. Activity restrictions will apply after surgery until appropriate rehabilitation goals have been achieved.
A typical post-operative sling