Glenoid labrum and SLAP tears are soft tissue injuries that occur in the shoulder. To be more specific, a SLAP (Superior Labrum Anterior to Posterior) tear is a type of labral tear that occurs at the top of the labrum where part of the biceps originates.
In the ball and socket shoulder joint, the socket area is lined with a rim of cartilage, which is called the labrum. It is similar to the meniscus in the knee. The main function of the labrum is to help stabilize the ball within the socket, and tears of the labrum are commonly associated with dislocations.
Think of the socket like the face of a clock. At the 12 o’clock position, part of the biceps (the “long head”) originates. This is the region where a SLAP tear occurs. A tear can occur anywhere in the labrum, and some patients may experience multiple tears at one time or may experience a tear that extends around the clock face, for example, from the 12 o’clock to 8 o’clock position.
Glenoid labrum tears
Symptoms of glenoid labrum tears often include instability and may be positional where the position that causes instability helps identify the location of the tear. Symptoms may include pain with activity or mechanical symptoms, such as catching, locking, or popping.
Most glenoid labrum tears are initially treated non-operatively with rest and anti-inflammatory medications followed by physical therapy. In some cases, glenoid labrum tears may require surgery, especially if a patient has recurrent instability, which means the shoulder joint continues to dislocate despite non-operative treatments.
In some patients, a small tear in the back of the labrum can result in a one-way valve effect with joint fluid being trapped outside the labrum and forming a cyst. Most cysts don’t require treatment, as the body will simply reabsorb the fluid eventually. However, some cysts may push on the nerves that supply part of the rotator cuff and cause weakness that impairs function of these important muscles. In such a case, sometimes surgical treatment is needed to decompress the cyst, remove the pressure on the nerve, and allow fluid to go back into the joint.
A SLAP tear can also be associated with instability sometimes, but it often presents with pain that is positional. Because the tear occurs where the long head of the biceps originates, it means everything you do with your biceps is pulling on the tear, which can cause pain.
SLAP tears are classified by the location and severity of the tear and whether it extends around the clock face or into the biceps tendon itself. The most common type occurs when the superior labrum detaches from the glenoid, or the shoulder socket. This most often occurs in overhead athletes, such as baseball pitchers or volleyball players, but is also seen in military recruits and truck drivers who pull themselves up while supporting all of their body weight in an overhead position. It can also occur during a trauma to the shoulder.
SLAP tears are also treated initially with rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy, but those who fail to improve with non-operative treatment may require surgery. Surgical options may include debridement, repair, or a biceps tenotomy or tenodesis. What type of surgery is needed depends mostly on the type of tear.
A type I SLAP tear can generally be treated with debridement to shave off the torn part of the cartilage where the biceps is still attached, while a type II SLAP tear generally requires the use of anchors to reattach the top of the labrum along with the biceps origin. A biceps tenodesis is usually performed in a revision situation (repeat surgery) or when the tear extends into the biceps tendon itself. It involves anchoring the biceps to a new location, most commonly to the bone with a screw. Tenotomy involves releasing the torn part of the biceps while leaving the other part intact and does not require any hardware or a separate incision.
If you have been told you have a glenoid labrum tear or suspect you might, it’s a good idea to schedule an appointment and have your shoulder checked out if you’re experiencing regular pain, dislocations, or are unable to do your normal activities. Contact our office today to schedule an appointment.
By Oklahoma Shoulder Center PLLC
July 30, 2018