Slap Tears: What are they and what to do?

So I realized that I have missed mentioning a key injury in the shoulder, particularly in overhead athletes. Interestingly, we’ve only known about what this injury actually is since the early 80’s.

SLAP stands for Superior Labrum Anterior-Posterior. You may recall (if you’ve read my other posts) that the shoulder is like a golf ball on a tee, and the tee has a washer on it, which is the labrum. Well, if we imagine that we’re looking at the top of the golf tee and imagine it being a clock, the bicep tendon actually goes into the shoulder joint and attaches to the labrum at the 12 o’clock position. The reason why this is a problem, especially with overhead athletes, is that every time an athlete goes through their sport motion, the bicep tendon “tugs” on the labrum and over time, pulls the labrum away from the glenoid (the golf tee). Perhaps the best analogy I can provide is from the American Sports Medicine Institute in Alabama – they said it’s like pulling a pesky weed out of the ground. To do so, you typically pull back and forth repeatedly until it eventually pulls away from the ground.

There are many types of SLAP tears and it’s beyond the scope of what I’m trying to do here on this site. I suggest that it’s important for you to know that the severity of tears vary from simple degenerative fraying to full tears either labrum and bicep together or pulled separately from each other.

What are the symptoms then? Well, first and foremost, if you are an overhead athlete you are at risk. Typically, they are in younger (<40 years) athletes, but certainly if you are an active older athlete, it is possible. If you are older, chances are it was a traumatic injury that caused it. Second, people typically complain of pain that is “deep” in the shoulder, making it difficult to localize. People aren’t typically point tender with these either. Pain is most often felt in the “late cocking” phase of throwing, but certainly can be felt during acceleration or follow through. You may experience a “clunk” or “click” in the shoulder as you move it through rotary motions. There are a litany of special tests that either your orthopedic physician or physical therapist can take you through to determine if you have a SLAP tear, but many are unreliable. It’s usually a combination of those tests and the subjective complaints that you have.

Interesting story about these…back in the 1970’s, pitchers would complain of pain in the shoulder with progressive decreases in velocity and eventually a “dead arm” feeling in the throwing shoulder. It was really known as the “kiss of death” in baseball pitchers. Physicians had no idea what the injury was because “it saw them but they didn’t see it”, so they just assumed that the athlete was either faking it or they just weren’t tough!! As more and more athletes came forward with these complaints, it led to the discovery of this condition.

What to do about these? If it’s your throwing shoulder, you definitely need to have surgery on this. It will not heal on its own. If you just have some degenerative fraying and you’re not a thrower or intend on stopping, you might be able to get by. However, if you have any intention of doing overhead activity, even rec league softball, you should get this fixed. If its in your nondominant arm, you also may be able to get by.