Biceps tendon disorders - SLAP (Superior Labrum Anterior Posterior) tears

To allow you to move your arm again, pain-free

If you are unable to perform everyday movements such as taking the milk out of the fridge or lifting a water bottle without pain, you may have a SLAP lesion. If you can’t throw a stone or you can’t serve playing tennis you might have a SLAP lesion. This is a rupture or tear of the glenoid labrum in the glenoid cavity.

Our experts at Schoen Clinic specialise in treating SLAP lesions. They will find the cause and the right therapy for you.

What do we understand by a SLAP tear?

The glenoid cavity is surrounded by a fibrocartilaginous tissue (glenoid labrum). SLAP is an abbreviation and stands for a Superior (topmost) Labral tear from Anterior (front) to Posterior (back). In simple terms, this is a tear or rupture at the upper edge of the joint socket. The long tendon of the biceps muscle is attached to the upper edge of the glenoid labrum. The area of the upper glenoid labrum and the attachment of the long head of the biceps tendon is called the labrum-biceps tendon complex. Damage and tears in this complex are called a SLAP lesion (labral tear).

A SLAP lesion occurs when the upper labrum (superior labrum) is torn at or near its attachment with the biceps.

Symptoms indicating a SLAP lesion

Patients with a labral tear typically have little pain at rest and during simple everyday activities however, movements of the shoulder over the head are very painful. Rotating the arm behind the back e.g. when reaching for a car seatbelt, can also lead to pain. Some patients complain about a loss of strength in the shoulder, athletes lose speed when throwing and some patients feel movements accompanied by a “cracking” sound.

Causes of a SLAP lesion

  • A SLAP lesion can occur due to a chronic overload
  • A SLAP lesion can occur due to accidental injury, traction or fall on an outstretched arm

How we diagnose a SLAP tear

The diagnosis is made from the history and findings at an initial consultation. The patient can present with pain or mechanical symptoms in the joint. If associated with an anterior labral tear, they may present with a history of shoulder instability or dislocations. In addition, special imaging such as an MR-Arthrogram help in confirming the diagnosis however, in the absence of findings on examination or MR, a diagnostic arthroscopy may sometimes be performed.

Freedom of movement for your shoulder

The treatment for a SLAP lesion is as individual as the causes. If symptomatic, the tear can be treated surgically using 'keyhole' surgery as a day procedure. Our experts at Schoen Clinic specialise in the treatment of SLAP tears and will work together to ensure the best outcome for you.

Arthroscopic (keyhole) surgery

Using special bone anchors (screws) and sutures, the torn labrum is attached back to its normal position. Sometimes, the tear may be irreparable in such cases, it is smoothed down (debrided) to a stable surface and the long head of biceps is fixed into the humeral head (biceps tenodesis).

As with all surgery there is a risk of some complications. These are rare, and our specialists will discuss them with you prior to any procedure. They can include:

  • Complications relating to the anaesthetic
  • Infection
  • Failure to achieve a successful result
  • A need to redo the surgery Injury to the nerves or blood vessels around the shoulder
  • Fracture Implant failure
  • Complete tear of biceps
  • Prolonged stiffness and/or pain

SLAP tears: Aftercare and rehab

Typically, you will usually be in hospital either for a day or overnight. Prior to discharge you will be seen by your consultant or physiotherapist and they will provide you with advice and an exercise programme to guide you through your recovery. You will be given a sling, which you will be required to wear for 3-4 weeks. You should avoid forced straightening of the elbow or heavy lifting for at least six weeks. You can expect to be back at work between 6-10 weeks depending on your occupation. Your symptoms should be approximately 80% better after three months but may take 6-12 months for a full recovery.

Pain:

A supplementary local anaesthetic or nerve block is often used during the operation, which can result in the shoulder and arm feeling numb immediately afterwards – this may last for a few hours. Following this the shoulder may be sore and you will be given painkillers to relieve the pain whilst in hospital. When you are discharged you can continue to use painkillers plus ice packs which may also help to reduce pain e.g. wrap frozen peas or crushed ice in a damp, cold cloth and place on the shoulder for up to 20 minutes.

Wearing a sling:

You will return from theatre wearing a sling. This is required for up to four weeks, to allow the repair to heal.

Exercises:

After leaving hospital you should exercise the arm frequently throughout the day. The arm may feel sore whilst you are doing the exercises but there should be no intense or lasting pain. Aim for two exercise sessions per day. Your physiotherapist will advise you regarding the exercises prior to discharge.

The wound:

There will be no stitches (or absorbable ones) only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5-7 days.

Driving:

You may begin driving 4-5 weeks after your operation.

Returning to work:

Returning to work will depend on your occupation. If you are in a sedentary job you may return as soon as you feel able, usually after one week. If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence (eight weeks).

Leisure activities:

You should avoid sustained, repetitive overhead activities or those involving forced elbow extension for three months.For guidance on any physical activities such as golf (typically can begin after 12 weeks), DIY and racquet sports you should speak with your physiotherapist for advice.

Follow-up appointment:

A follow-up appointment will be made for you at the hospital for approximately three weeks after your surgery. At this stage you will be reviewed by your consultant who will check your progress, make sure you are moving your arm properly, and give you further exercises, as appropriate.

SLAP tears: Our specialists

SLAP tears: Our specialised hospital