SLAP Tear

Recent attention has turned toward the labrum as a source of pain. Labral tears occur as a result of a fall or wrenching to an outstretched arm or from repetitive microtrauma (i.e. throwing). These labral tears are in distinction to bankart lesions associated with shoulder dislocations. Labral tears are categorized depending on their location, anterior, posterior, or superior tears.

Anterior labral tears often are a continuum of bankart lesions. These often occur with major traumatic events. Superior labral tears commonly are referred to as SLAP tears (Superior Labral Anterior Posterior). SLAP tears involve the biceps anchoring into the labrum. Major trauma or repetitive overhead throwing leads to slap tears. Posterior labral tears often are seen in conjunction with a posterior subluxation/dislocation episode.
Nonoperative treatment of isolated labral tears is less well defined than tears associated with a dislocation. Large detachments seem to require operative intervention. It is not unreasonable to proceed with a trial of physical therapy if there is no associated instability.

SLAP tears typically fall into one of two categories. Tears where the labrum is securely anchored but peripherally torn require isolated removal of the involved portion. Complete disruption of the labrum anchor necessitates surgical repair. The rehabilitation differs dramatically for these two scenarios. Patients undergoing isolated shaving are in a sling for comfort and typically can expect to return to full activity within two months. On the other hand, surgical repair requires four weeks in a sling, and approximately four month before return to full activity. Pitchers/quarterbacks can expect a six to eight month recovery.

Surgical repair of a SLAP tear proceeds as does a bankart repair. A diagnostic arthroscopy confirms the presence of a detached SLAP tear. (Type II SLAP) Scar tissue is removed from the edge of the glenoid to provide optimal healing conditions for the SLAP tear. A suture anchor is placed at the desired location in the glenoid. (SLAP Anchor Drill) Sutures are passed around the torn labrum. (SLAP Anchor Placement) Knots are tied to secure the labrum. Subsequent anchors are placed as needed. The final repair is evaluated to confirm secure fixation. (SLAP Suture Passage)