Introduction
The shoulder is a complex ball and socket joint and is a freely moveable part of the human body. It is made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The humerus bone is situated in the shoulder blade round socket (glenoid). A fibrous tissue covers the glenoid, which is called the labrum. The labrum stabilizes the shoulder joint and attaches many ligaments to the shoulder. Around 25 percent of adults have shoulder pain due to stress or injury, and around four to eight percent of shoulder injury that occurs is superior labrum anterior and posterior (SLAP) tear.
What Is Superior Labrum Anterior and Posterior Tear?
A superior labrum anterior and posterior (SLAP) tear, also known as a labrum tear, is an injury of the top part of the labrum. The S in SLAP refers to the top part of the labrum, and when it gets a tear, the upper arm bone loses its socket or cushion, and the bicep tendon loses its attachment to the shoulder blade socket. The L in SLAP refers to the glenoid labrum that supports the functioning of the shoulder. If the SLAP tear is neglected or untreated, it can cause severe shoulder pain, and the shoulder is not able to move.
What Are the Types of Superior Labrum Anterior and Posterior Tear?
The superior labrum anterior and posterior (SLAP) tear is divided into different types and was described by Synder.
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Type 1: In type 1, the labrum starts shredding, but the shoulder can still function. It is mostly seen in middle-aged people.
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Type 2: It is the most common type of SLAP tear. The labrum and bicep tendon is torn from the shoulder socket.
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Type 3: The tissue of torn labrum is caught in the shoulder joint in type 3.
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Type 4: The bicep tendon is also torn along with the labrum.
What Causes Superior Labrum Anterior and Posterior Tear?
The superior labrum anterior and posterior (SLAP) tear can occur due to vehicle accidents, forcefully stretching of the arm, forceful shoulder movement while moving or catching a heavy object, or fall on the shoulder side from a certain height.
The SLAP tear can be caused due to certain causes that include:
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Age - When the labrum wears out over time with age, then it can easily cause a SLAP tear. In people around 30 to 40 years of age, tearing and fraying of the superior labrum are common.
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Chronic Injury - In people playing sports like baseball, basketball, swimming, or weight lifting, SLAP tear can happen easily and is the most common cause of this condition.
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Acute Injury - The SLAP tear can occur while catching a heavy object, and the shoulder is outstretched or when there are abrupt jerking movements while lifting weights.
What Are the Clinical Features of Superior Labrum Anterior and Posterior Tears?
Common symptoms of a SLAP tear include:
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Difficulty in lifting weights and pain in the shoulder.
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Popping or grinding sensation and noises while moving the shoulder.
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Feeling that the shoulder is going to pop out of the shoulder blade.
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Pain while raising or stretching the arm.
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Decreased range of motion.
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Sharp pain deep in the shoulder.
How Is Superior Labrum Anterior and Posterior Tear Diagnosed?
Superior labrum anterior and posterior tears can be diagnosed by certain methods that include:
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Physical Examination: During the physical examination, the shoulder’s stability, motion, and strength are checked. The doctor will ask the patient to lift the arm upwards and examine the head and neck.
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Medical History: The doctor will ask the patient if any injury or trauma has occurred in the past. Along with this, the doctor will note the patient’s history of calcium deficiency as, in older age, the bones get weakened.
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X-Ray: This imaging test helps get a clear dense image of the bone. Though the labrum tissue will not be visible on an X-ray it helps in detecting any other abnormalities like arthritis.
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Magnetic Resonance Imaging (MRI) Scan: An MRI scan helps detect the labrum clearly. A dye will be injected intravenously to get a clear view of the labrum tissues (IV). A healthcare professional will ask the patient to lie down on the bed of the machine. Once the patient is settled, the expert will operate the machine in a different chamber. The machine will take several scans, which take around half an hour to complete.
How Is Superior Labrum Anterior and Posterior Tear Managed?
Treatment options include:
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Nonsurgical Treatment: In most cases, SLAP tear is treated non-surgically. Nonsteroidal anti-inflammatory medications like Naproxen and Ibuprofen reduce swelling and pain. Physical therapy helps in strengthening the shoulder. The range of motion exercises such as stretching the shoulder capsule helps regain strength and relieve pain.
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Surgical Treatment: Surgery is recommended if the pain is not going. A surgical technique, arthroscopy, is performed. A surgeon will insert a camera (arthroscope) in the shoulder joint, and the surgeon is able to access the joint to manage the instruments used to fix the tear. A very small incision is made as the instruments are very thin. The torn labrum part is removed or reattached depending on the situation. It is a very simple procedure and, in most cases, does not cause any complications, and the shoulder is healed faster. A sling is given after surgery for 4 to 6 weeks to keep the arm from moving. Any sports activity can be started again only after three or four months, as per the doctor’s advice.
Conclusion
Superior labrum anterior and posterior tear or SLAP tear is the injury of the inner part or top part of the labrum. It can occur due to sports activities like basketball or due to age. It can cause severe pain or limited shoulder movements if neglected for a long time. It can easily be diagnosed through imaging tests and treated through surgical and nonsurgical methods. Proper care and not lifting heavy objects for a certain time will help faster recovery.
