Labral and SLAP Tears
The labrum is a rim of cartilage that acts as a stabilizing bumper around the rim of the glenoid (cup) of the shoulder joint. The labrum increases the depth of the cup and increases the concavity of the socket. The capsule attaches to the labrum and helps to stabilize the humeral head (ball) in the glenoid (cup). It can be injured with subluxation and dislocations of the humeral head in to glenoid. When the labrum is injured the attached capsule is also torn from the cup and stretched. This can occur in the front of the cup with anterior dislocations as well as in the back of the cup with posterior dislocations. Injuries of the labrum can also occur at the top of the cup. This is termed a superior labral anterior posterior tear or SLAP tear. This occurs commonly with repetitive overhead activities such as throwing, tennis and lifting. The biceps tendon inserts onto the labrum in this area and can also be involved in these injuries.
SLAP tears often cause pain in the shoulder. The pain from a SLAP tear typically presents with pain in the back of the shoulder. When the biceps tendon is involved, pain can also radiate along the front of the shoulder into the front of the arm and forearm. This pain is commonly worse with overhead activities and rotation of the shoulder. Additionally, in throwers, a sensation of a “dead arm” can often be described. Often, superior labral tears (SLAP) are associated with contacture and tightness of the posterior-inferior joint capsule. This leads to a decrease in the internal rotation of the shoulder, also known as GIRD (Glenohumeral Internal Rotation Deficit). This is very common in overhead throwers. Superior labral tears can also be associated with degenerative conditions like arthritis and rotator cuff tears. Occasionally, a cyst (paralabral) can also form adjacent to the glenoid (cup) when joint fluid goes out through the labral tear but cannot return into the joint. This can cause compression on nerves around the shoulder.
A description of the treatment of labral tear associated with instability/dislocations can be found in the shoulder instability section. Initial treatment of SLAP tears includes observation, avoidance of aggravating activities, anti-inflammatory medications and aggressive therapeutic physical therapy exercises focused on stretching of capsular contractures and if applicable, throwing mechanics.
Surgical treatment of SLAP tears depends of the needs of the patient as well as the symptoms that they are experiencing with their normal daily activities. Dr. Lenarz performs an arthroscopic repair of the labrum to it’s attachment site on the glenoid (cup); a SLAP repair. Often, there is also involvement of the biceps tendon at its attachment to the labrum. This may require a procedure called a biceps tenodesis as well.