The shoulder is a ball and socket joint made of the upper arm bone (the humerus) that sits in the socket in the shoulder blade (the scapula). The socket is smaller than the ball and shallow. The ball sits in its socket like a golf ball on a tee. To deepen the socket, nature created a cartilage rim called the labrum to stabilize the joint. The labrum is where the shoulder ligaments and the biceps tendons attach.
What is a SLAP Tear?
A SLAP (Superior Labrum Anterior and Posterior) tear is at tear of the shoulder labrum, at the top of the shoulder near where the long head of the biceps muscle attaches. A SLAP tear can not only damage the labrum but also injure the biceps muscle.
Common symptoms of a SLAP tear include shoulder pain in the front and back of the shoulder that may worsen with overhead motion and lifting objects, catching and locking or grinding in the joint, shoulder instability, arm weakness and decrease range of motion. Common in pitchers, it can cause a sensation of decreased throwing speed, weakness and numbness called ‘dead arm’ syndrome.
SLAP tears typically occur repetitive overhead motions such as throwing and lifting. Athletes who participate in activities such as baseball, tennis, swimming, and weight-lifting are more likely to suffer a SLAP tear due to their increased use of overhead motions. However, it can also be caused by trauma, a fall on an outstretched arm, a shoulder dislocation or a motor vehicle accident. Aging and wear and tear on the labrum can also fray the labrum which can result in a degenerative SLAP tear.
Dr. Petrigliano will review you medical history, ask about your symptoms and sports activities and work, and whether you suffered a specific shoulder injury. He will perform a physical examination testing your shoulder range of motion, strength and stability, and order imaging tests such as an x-rays, and an MRI arthrogram or ultrasound. An MRI arthrogram is an MRI with the injection of contrast dye into the shoulder joint to make it easier to see the tears on MRI. In the alternative, Dr. Petrigliano may order a high-resolution ultrasound of the labrum.
Treatment options vary depending on the severity of the injury but can range from physical therapy to surgery. The most common treatment for a SLAP tear is nonsurgical. NSIADs anti-inflammatory medications to reduce swelling ns pain, and physical therapy and rehabilitation exercises to improve strength and range of motion in the shoulder joint.
When nonsurgical treatment fails to improve pain, he may recommend shoulder arthroscopy or a biceps tenodesis. Both SLAP repair and biceps tenodesis provide excellent results.
- Shoulder arthroscopy is a minimally invasive surgical procedure to used to inspect the interior of the shoulder joint using an arthroscope, a small thin scope which contains a fiber optic camera that allows Dr. Petrigliano to not only view the tear on a video monitor but also treat the tear with miniature surgical instruments. Minimally invasive should arthroscopy is safe and effective with no complications. Potential risks include infection, bleeding, shoulder stiffness and damage to nerves and blood vessels. This will be discussed with the patient if he recommends shoulder arthroscopy.
- Biceps tenodesis is a procedure to treat biceps tendonitis in the setting of a SLAP tear with shoulder instability. It is an alternative to SLAP surgery.
It is important to seek medical advice as soon as possible in order to prevent further damage and optimize recovery. Contact Dr. Frank Petrigliano to schedule a consultation to learn about your shoulder pain and all your treatment options. He is an internationally prominent orthopedic surgeon and the Chief of the Epstein Family Center for Sports Medicine at Keck Medicine of USC in Los Angeles, CA. His specialty is shoulder conditions. His goal is to return his patients to the life they love and the sports that make life worth living with minimal interruption. Contact him at one of this three convenient locations to schedule a consultation and receive the correct diagnosis, all your treatment options, and expert personalized care.
At a Glance
Dr. Frank Petrigliano
- Associate Professor of Orthopaedic Surgery at USC
- Chief of the Epstein Family Center for Sports Medicine
- Team physician for the LA Kings and USC Athletics
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