There are various causes of orthopedic shoulder injuries and pain in the overhead athlete or just the typical person among us that frequents their local gym.
Many disorders involving the proximal (at the shoulder attachment) biceps tendon have been identified as a source of pain. This is common in throwing athletes as well as in people that use weights in the gym.
One basic type of disorder is biceps tendinitis in the shoulder. This typically presents with pain in the front of the shoulder which is exaggerated with overhead activities. This is commonly associated with early stages of rotator cuff (tendons in the shoulder) diseases.
Biceps subluxation or dislocation (slipping out of its groove) is another disorder of the proximal biceps which can occur in conjunction with tearing of the subscapularis (one of the rotator cuff tendons).
These disorders or shoulder injuries of the proximal biceps tendon are often treated conservatively but if that fails then there are multiple surgical treatment options that include an arthroscopic shoulder surgery procedure called debridement of the biceps, moving the attachment of the biceps tendon, or even detachment of the biceps.
SLAP tears are very common in people that use weights in the gym or participate in overhead athletics. This refers to a critical place in the shoulder where the proximal biceps attaches, together with the labrum, at the top of the glenoid (socket bone in the shoulder). The labrum is a cushion of cartilage that wraps around the periphery of the glenoid. It is has an important role in the stability of the shoulder.
The symptoms of SLAP tears include a vague deep shoulder pain. There may be a delay in developing pain after the time of injury. There is often a popping and clicking in the shoulder. Moreover, people may feel a weakness or fatigue. Finally, many athletes feel a decrease in their performance with these type of shoulder injuries..
There are, essentially, four major types of SLAP tear shoulder injuries. Type 1 is some fraying of the top of the labrum. This usually responds very well to physical therapy and anti-inflammatory medications.
Type 2 SLAP tears cause a disruption of the biceps attachment at its anchor to the bone. These types of tear are often treated with an arthroscopic shoulder repair of the labrum. Alternatively, there has been some recent potential evidence that a biceps tenodesis may be also an effective method of treatment. This is a procedure that moves the attachment of the biceps to another part of the bone. This may, potentially, diminish the pressure on the labrum attachment. In fact, there has been some recent debate over which procedure is the best option for the treatment of a Type 2 SLAP tear. In my experience, I find the best option is to repair the labrum (instead of the tenodesis) and restore the natural kinematics and anatomy as best as possible.
Type 3 SLAP tear involves a displaced fragment in the joint. Type 4 SLAP tear has a displaced fragment in the joint as well as a detached biceps tendon attachment. These tears may be treated with a repair of the labrum or a tenodesis of the biceps tendon (depending upon the extent of the biceps tendon detachment). In some cases the displaced fragment may be excised.
These days people are much more aware of the benefits of physical activity for our overall health and well-being. Injuries may often occur but the advent of advanced and minimally invasive methods of treatment allows for a safe and easier return to full activities.