That is the dilemma that thousands of people ponder. Have you been recently diagnosed with a SLAP tear or a Shoulder Labral tear? Have you been recommended to undergo arthroscopic surgery to repair a SLAP tear? Many people see an orthopedic surgeon and are given the diagnosis of SLAP or labral tear. They receive the orthopedist’s recommendations on treatment and they come home unsure about what to do. I would like to help.
First, what is a SLAP tear? A SLAP tear is a tear in the labrum (a cushion of cartilage attached to the socket bone of the shoulder) inside the main shoulder joint. The labrum attaches to the bone together with the biceps tendon on top of the socket bone. Sometimes a particular type of SLAP tear will cause the biceps tendon to be unstable and painful. Moreover, the joint, itself, may become unstable as a result of the labral tear.
Next, how does one tear their labrum? Repetitive overhead activities is one cause. Throwing athletes, such as pitchers, tennis players and quarterbacks have a high incidence of SLAP tears. A fall on an outstretched arm can also be a cause. Lastly, weight training, such as in the gym, can often lead to a labral tear.
The symptoms are, obviously, pain in the shoulder. Sometimes, the symptoms can be deep and, often, there is a lag time between the injury and the onset of symptoms. Catching, popping or clicking is very common. Lastly, patients often feel as though their arm is “dead” or weak. Athletes find that their level of performance has diminished.
So, should you fix it? Well, that depends upon the type of SLAP tear.
A Type I SLAP tear is just some fraying of the cartilage tissue with a stable biceps attachment. This type of tear, typically, responds well to conservative treatment such as physical therapy and anti-inflammatory medications.
A Type II SLAP tear is the most common. It is tearing of the labrum that causes an unstable biceps attachment. An attempt of conservative treatment can be made with this type of tear. Unfortunately, younger, athletic and active patients often do not improve with conservative treatment and arthroscopic surgery to repair the SLAP tear is warranted.
A Type III SLAP tear is a fairly large tear with a displaced piece in to the joint. The biceps attachment, though, is still intact. An attempt of conservative treatment can be made for this tear and, because the biceps attachment is stable, some patients do improve. Unfortunately, because of the size and displacement of the tear, many patients require arthroscopic repair.
A Type IV SLAP tear is the same as the type III but with an unstable biceps attachment. This very often will require repair.
Lastly, a Type V SLAP tear is a tear of the labrum that begins in the front and top of the socket bone and reaches all the way down to the bottom. This can cause some very considerable shoulder instability and arthroscopic SLAP repair most often is indicated.
I recommend that a patient listen to their own body. Consider the level of pain that you are experiencing. Moreover, consider your age and level of activity. Most older patients that are not very active can avoid a repair and benefit from conservative treatment. Unfortunately, younger and active people frequently require a repair to be able to return, pain free, to their desired level of activity.